The Wee, the Wound and the Worries: My Experience of Being a Kidney Donor
By Pearl Howie
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“Thank you so so much for your kind words and advice, it has really given me so much to think about and to be grateful for. Thank you once again for taking the time to respond to my email, even though I don't know you, you have given more invaluable advice than anyone I know :-)” Kerri
“Just wanted to say a HUGE thankyou… found it very informative (they don't tell you all that in the hospital!) and funny too- couldn’t help sniggering at some bits!” - P
“…you have given me so much hope and the reason to keep going now… You are an inspiration to me already.”
“…It is an utterly candid account of a difficult subject, written with love for her brother and her family but confronting squarely the challenges... Wise, practical and respectful of the reader's concerns it will be of real value to others in a similar situation… …she is to be admired for having the courage to write it.” Joyce
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The Wee, the Wound and the Worries - Pearl Howie
A Little Bit Of Personal History
In 2001, several years after his doctors advised him that he would eventually need dialysis, my brother Joel’s renal consultant decided that that time was imminent. Although we knew that Joel had terminal kidney failure, i.e. one day they would pack up, he was now in end stage kidney failure i.e. they’re about to pack up soon. I think it was July that Joel and my mum went to look around a dialysis unit. Up until then I had assumed that dialysis was a wonderful, non!invasive solution to the problem of kidney failure… not.
I remember when she called me to tell me about it. She was very upset. Joel had a choice between two types of dialysis. The first one, is called haemodialysis and is the one you normally think of, when a person goes into a unit every three or four days, and their blood is pumped around a cleaning unit. In order to do this you have to have an operation to make what’s called a fistular, which is a reinforced vein in your arm. This has to be done some months before dialysis begins, to allow it to be healed. The major problem with this for Joel was that he has partial (but substantial) paralysis of his right arm, so if the operation was done on his left arm and went wrong, he would basically be stuffed. (He eventually had it on his right arm.)
The other type of dialysis is peritoneal dialysis, where a bag is inserted (a different operation that needs to take place months before), in the abdomen near (or it might be in) the peritoneum, and the blood is cleaned by means of diffusion with the contents of that bag. This is continual, so it requires the kidney patient or their carer to do some actual nursing. With Joel’s physical disability this again was a pretty poor solution.
When Joel had a stroke at the age of fourteen he lost a lot. He had to learn to walk again, to talk again, and has permanent disabilities as a result of the damage to the areas of his brain that deal with speech and movement on his right side. He was on constant blood pressure medication. Then he developed epilepsy and had to take drugs for that too. He has had electrotherapy on his right leg and arm, and botox injections to prevent muscle spasms and help him with his movement. He has speech therapy and had to learn to use his left arm to do everything, even though he was previously right handed. He never took G.C.S.E.s, but through sheer bloody mindedness he went back to college, and did a BTEC (which took three years because after the first year they changed the rules and he had to start from scratch), a Foundation in Art, and finally a BA in Fine Art. He’s shit hot too. The point is that Joel has had to go through a lot, it would be horrible to see him go through any more.
I told my mum that I wanted to find out about giving a kidney.
I remember coming home that night feeling really depressed, partly for Joel, partly for myself. When Joel was 14 and I was 15 he had a stroke. Writing about the kidney transplant, and even Joel’s eventual dialysis (the kidney failed after 7 and a half years) is very emotional, but I can’t even begin to tell you about the stroke. I could sit here and tell you about the details, but I am not sure if I will ever be able to describe the sheer tornado of a serious stroke, especially on a young family, and having to watch one of the people you most love in the world become as helpless as a baby. For months we visited, watched, prayed, cried, hoped, put on brave faces and did that thing that is less than living, called surviving. When I spoke to mum about dialysis I felt like it was all starting again. As I was sitting, feeling sorry for myself at home, an acquaintance of mine rang out of the blue. She wanted to know why I felt so down, I told her and, as she tried to be sympathetic, I felt like saying that she couldn’t possibly understand what was happening. Then she told me that her sister had died in a car accident before she was twenty. She understood it all, the guilt that you feel as a sibling that it didn’t happen to you, and all the confusion. But she made me realise how lucky I was. To still have my brother, and maybe to be able to help him.
First Things First
Before I get too in-depth there are a couple of points it’s worth mentioning.
First of all you have to find out if your loved one is able to receive a transplant. I know it’s a sensitive and sometimes difficult question. If he/she is already on the transplant waiting list then the answer would usually be yes, unless their condition has recently deteriorated. A transplant is still a major operation for the recipient, so, before you jump ahead to worrying about the transplant, please slow down and check what the situation is.
If your loved one is not yet on the transplant list, just saying that you are interested in donating should speed up the process of getting them approved for a transplant.
If you have said that you wish to donate, your loved one should still stay on the list in the meantime. If a kidney becomes available they should receive it – so remember that this is also a possibility.
If you’re a woman and you are thinking of getting pregnant in the future, don’t worry, pregnancy is still entirely possible after donating a kidney. I was told that I had to wait at least a year before thinking about it, but if you were to donate through keyhole surgery that time might even go down. It’s best to talk directly to your transplant co-ordinator to check what the current medical advice is, as this does tend to be constantly amended!
In order to be able to donate you need to be in good health. Not too overweight, with good general organ function - heart, lungs, and of course kidneys!
If a transplant is an option, you should be put in touch with a transplant co-ordinator. First of all you should have a meeting with them where they can talk you through all the details, and you should have blood tests to see if you are a match and check basic things such as blood pressure, weight etc.
At none of these stages should you feel committed, as there is still a long way to go. Even if you are a match you will still need to have a lot of other tests.
The general age guidelines are 18-60 for donors, with donation for people up to the age of 55 being seen as routine
.
Need To Know
Before the blood tests, although often on the same day, comes a chat
.
Because we had all offered to be donors we had a meeting which consisted of; the transplant co-ordinator Alison Hansford, my mum, Joel, my two sisters and myself. My older brother couldn’t be there because he had to work, but personally I think he just wanted to get the gory details from one of us (blokes are a bit squeamish sometimes.) Anyway the chat is supposed to tell you all the major aspects of being a donor. Most of it was no surprise to me because I had done a little bit of research on the internet, but there were a few little new bits of information.
The chat is a bit daunting, and so are the blood tests, but in retrospect they really aren’t much to write home about. The transplant co-ordinator will tell you that it is a major operation (this is for open, not keyhole surgery), requiring eight to twelve weeks off work, that it will take you a year before you’re 100% again and that 4% of all live donors will feel some pain a year after the operation.
Initially you won’t be able to do much picking up - so you’ll have to have help around the house or stay with someone.
You may also be told, as we were, (and you can imagine the effect on three women of child-bearing age) that Portsmouth Health Authority did not recommend that any women give a kidney if they plan to have children. This was something that I had not read anywhere else, and I must admit, it really threw me. This was the moment that I really wavered. Before you get upset (as I did) every other scrap of information we came up with said that it was not a problem. If you do have children after you have given a kidney you will be monitored very closely, because they will worry that you have a higher risk of high blood pressure and pre-eclampsia, but according to the research that we did in 2002 - nobody who had given a kidney has ever had a problem. I would go along with waiting a year till you get pregnant after you give a kidney though.
It was at the chat that I realised the full extent of my older sister’s problem with needles. Alison started to explain to us the process of testing a live kidney donor. First there are the blood tests, then a series of non-invasive tests; a chest X-ray, ultrasounds, an ECG, more blood tests (to test for HIV and Hepatitis, which are not tested in the first round), some really fun urine tests, and if all of those are hunky dory, then comes the fun one. The last stage (although don’t be fooled because they repeat all the other tests right before surgery,) is the angiogram (also sometimes referred to as an arteriogram). Now I have always thought that an angiogram was for your heart, so was a bit confused, but this one is for your kidneys. A local anaesthetic is applied to your leg, and a needle inserted into the main artery running down your leg (the femoral