Christopher Agrusa

Christopher Agrusa, MD, FACS, RPVI

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About Christopher Agrusa, MD, FACS, RPVI

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Relationships and collaborations with for-profit and not-for profit organizations are of vital importance to our faculty because these exchanges of scientific information foster innovation. As experts in their fields, WCM physicians and scientists are sought after by many organizations to consult and educate. WCM and its faculty make this information available to the public, thus creating a transparent environment.

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What are the different types of living donor relationships?

Living Related — Living related kidney donors are blood relatives of the person needing the transplant. Examples of living related donors include a parent, an adult child, a sibling, or an aunt, uncle, or cousin.

Living Unrelated — Living unrelated kidney donors are people the transplant candidate has a relationship with, outside of blood relatives. This can be a spouse or partner, in-law, friend, neighbor, co-worker, or other acquaintance.

Altruistic — An altruistic donor is a person that wishes to donate a kidney but who has no intended recipients; they simply want to donate to someone who can benefit from a transplant. Other terms used to describe altruistic donors include "non-directed" or "Good Samaritan" donors. Altruistic donors are a huge part of the success of Kidney Paired Donation transplants because they add a donor but not a recipient into a registry, thereby increasing the donor pool.

Who is eligible to be a living kidney donor?

Donors often have misconceptions that only family members can donate. However, there are many different types of donors, and many are not blood relatives of the person who needs a kidney.  

Most people over the age of 21 (and in some cases, over the age of 18) can become kidney donors if they are in good general health and have normal kidney function and anatomy.

According to the Consensus Statement on the Live Organ Donor...

"The person who gives consent to be a live organ donor should be competent, willing to donate, free from coercion, medically and psychosocially suitable, fully informed of the risks and benefits as a donor, and fully informed of the risks, benefits, and alternative treatment available to the recipient."
JAMA 2000;284:2919-2926 

Donors must be free of major diseases such as diabetes, high blood pressure (some mild forms of high blood pressure are no longer considered an exclusion to donating), or severe heart disease.

Donors should not have recent cancer, history of certain forms of cancer, liver disease or a history of multiple kidney stones. 

Testing of the potential donor will ensure that there is adequate kidney function so that the donor can survive on one kidney alone. The donor needs to be living in a stable environment with social supports and must have medical insurance before donation. The potential donor must be able to demonstrate understanding of the donation process, the risks involved in the surgery, and the need for follow-up visits after donation.

Potential donors do not need to be a relative of the person needing a kidney, although relatives often offer a better genetic match for the recipient. 

Thanks to advances in surgical techniques that enable minimally invasive surgery for donors as well as improvements in anti-rejection medications, we can now allow both related and unrelated people to donate. 

Generally, unrelated donors have some emotional relationship with the recipient, such as a spouse, friend, neighbor, or co-worker. However, altruistic donors (people who wish to donate a kidney but do not have a specific recipient in mind) now represent an increasing proportion of living donors.  

In addition, blood type and crossmatch compatibility used to be required for living donor transplantation. However, due to the availability of Kidney Paired Donation programs, donor and recipient pairs that are blood type or crossmatch incompatible can "swap" with other pairs. These programs are also offered to compatible pairs seeking a better age or genetic matched kidney.

Learn more about Kidney Paired Donation.

What are important factors in finding a match?

There are several factors that influence the length of time it will take to find a match within a Kidney Paired Donation registry.

For some transplant candidates, a match is found within a week or two of entering the registry, while for others, it may take a couple of years to find a good match.

It is important to remember that transplant candidates will also be on the deceased donor waiting list during this time, and a kidney could also become available via the deceased donor list. The factors that influence the length of time to find a suitable match are listed below.

Antibody Levels of the Transplant Candidate. Transplant candidates develop antibodies through prior exposure to human cells through blood transfusions, pregnancies or from previous transplanted organs. It often takes longer for sensitized recipients to find a compatible donor if the donor has genetic makeup (antigens) that the recipient has antibodies against.

Although these transplant candidates may find a match within a KPD program, it is possible that the candidate might have some antibody reactivity against the matched donor. In cases such as this, transplant candidates may need additional medications and treatments (called desensitization) designed to reduce antibody levels to a point where transplantation is possible. 

Blood Type. Similar to getting a blood transfusion, kidney transplantation requires that the donor and recipient have compatible blood types. The chart below shows which blood types are compatible.

Chart that details which blood types are compatible

Because 'O' donors are the universal donor and can donate to any blood type, there tend to be fewer 'O' donors available for 'O' recipients, who can only receive organs from type 'O' donors. This is an area where entry of compatible donor/recipient pairs into Kidney Paired Donation registries may be beneficial since this could free up some 'O' donors for 'O' recipients. To illustrate this, consider the scenario below.

A 40-year-old man is blood type 'AB', which means he can get a kidney from anyone. His wife is going to be his donor, and she has type 'O' blood. If this compatible pair enters a KPD registry, his wife's kidney could be donated to someone in desperate need of a transplant from someone with type 'O' blood, while the man can receive a kidney from a donor of any blood type, since a person with blood type 'AB' can receive an organ from a donor of any blood type.

Number of People in the Registry. The larger the pool of donors and recipients in the database, the greater the chance of identifying a match pair. In addition, the chance of finding matched pairs also has the potential to increase significantly when blood type and crossmatch compatible pairs are entered into KPD programs.

For these reasons, national exchange programs have the potential to generate the most transplant opportunities.

How does Kidney Paired Donation work?

People interested in participating in Kidney Paired Donation (whether donors or recipients, incompatible or compatible) are entered into a Kidney Paired Donation database. The information entered into the database includes their blood type, HLA antigen typing, and other basic medical information.

Sophisticated computer software designed to match up donors and recipients within a Kidney Paired Donation registry is run on a regular basis, usually anywhere from daily, to once per week to once per month, depending on the number of donors and recipients entered into the registry since the prior run. The software then identifies donor and recipient pairs that may be good matches for each other.

Based on the matches generated by the software, a living donor transplant chain is formed, consisting of numerous donors and recipients that are compatible, as determined by the registry. These donors and recipients are usually involved at different transplant centers, often across the country. Therefore, the matched donor and recipient may be on opposite sides of the country. In most cases, the matched donors and recipients are not asked to travel to another transplant center. Rather, the respective surgeries are performed at a transplant center close to the homes of the matched donor and recipient, and the donor's kidney is shipped to the recipient's transplant center. Kidneys are shipped via commercial airlines, similar to the process in which deceased donor kidneys are shipped.

KPD Programs in the U.S.

The largest KPD program is the National Kidney Registry (NKR), which was founded by the father of one of our young transplant candidates at NewYork-Presbyterian/Weill Cornell. Since 2008, we have performed over 200 kidney paired donation transplants by working with the National Kidney Registry. Visit www.kidneyregistry.org to view the current number of transplants that have been facilitated by the NKR.

An additional program is the Kidney Paired Donation Pilot Program of the United Network for Organ Sharing (UNOS), whose goal is to develop a national matching program. 

Why is a pancreas transplant recommended?

A pancreas transplant is recommended for people who have serious complications from type 1 diabetes mellitus. These complications may include kidney disease (nephropathy), nerve problems (neuropathy), decline or loss of vision (retinopathy) and/or are not able to sense when their blood sugar is dangerously low (hypoglycemic unawareness). 

Pancreas transplantation is not a cure for diabetes, since patients need to take immunosuppressant medications to protect the pancreas from rejection. However, benefits of pancreas transplant may include ability to live without taking insulin injections, improved quality of life, and prevention or improvement in complications of diabetes. 

What is a pancreas transplant?

A pancreas transplant is a surgical procedure performed to give a patient with type 1 diabetes mellitus a healthy pancreas from a deceased organ donor. 

The diseased pancreas is left in place during the transplant procedure because even though it no longer produces insulin, it does still produce enzymes needed to digest the food you eat. The transplanted pancreas is placed in the lower abdomen on the front side of the body. When the transplanted pancreas functions well, patients are able to stop insulin injections immediately after transplant. 

There are several types of pancreas transplant that can occur: 

• Simultaneous pancreas and kidney transplant is performed in patients who also need a kidney transplant due to kidney failure from diabetes. The transplant is performed using organs from a single donor. 

• Pancreas after kidney transplant is performed in patients who have already had a kidney transplant (usually from a living donor). The pancreas transplant usually occurs at least 6 months after the kidney transplant was performed, and the patient then has organs from 2 separate donors. 

• Pancreas transplant alone is performed in patients who do not have kidney disease from their diabetes, but they do have other diabetes complications such as eye or nerve damage and hypoglycemic unawareness. 

Podcast: What You Need to Know About Spinal Injections for Spinal Pain

Physician examines patient with back pain.
In this episode of Back to Health, Dr. Jaspal Ricky Singh — a co-director of Weill Cornell Medicine's Center for Comprehensive Spine Care — shares his expertise in interventional spine pain management and offers answers that may help you decide if you should have a spinal injection.

What happens if my kidney fails?

If a kidney transplant fails, the patient will need to return to dialysis. It may be possible to receive another transplant. However, this depends on many factors such as the number of previous transplants, levels of antibodies in the body, and whether the patient was adherent to their medication and follow-up schedule.

In some cases, the new transplant can be performed before the previous transplant fails completely (particularly if a living donor is available) in order to avoid dialysis.

What is my long-term outlook after kidney transplantation?

Living with a transplant is a life-long process. Medications must be given to suppress the immune system so it will not attack the transplanted organ. Other medications must be given to prevent side effects of the anti-rejection medications, such as infection.

Frequent visits to and contact with the transplant team are essential. Knowing the signs of organ rejection and watching for them on a daily basis are critical. You know your body and will be the best person to inform us if you are not feeling well or if something important (such as your daily urine output) has changed dramatically. 

Unfortunately, kidney transplants do not last forever. This is particularly important for young patients, who may require several transplants over the course of their lifetime. Taking the best possible care of your transplanted organ is important to reduce the number of future transplants that may be needed.