Caitlin Whyte (Host): This is Community Connect presented by TGH. I'm your host, Caitlin Whyte. Joining me today is Dr. Pranjal Jain, a nephrologist, the Chief of the Division of Nephrology, and the Medical Director of Living Donor Kidney Transplant at Tampa General Hospital.

Well, Doctor, so great to have you on the show today. My first question for you is how does a living donor kidney transplant compare to dialysis in terms of long-term patient outcomes and quality of life?

Dr. Pranjal Jain: Oh, a living donor kidney transplant has significant advantage as compared to dialysis. Transplant in general has a significant advantage, both a survival advantage and a quality of life year advantage. And if there was a choice on table, a living donor transplant affords better survival. The transplant works right away. It's an elective surgery. You schedule it. You almost know everything about your donor. You know when it's going to be done. You get off dialysis immediately or avoid dialysis. And, you know, as per the recent data, you know, average survival for a living donor transplant is somewhere 16 to 18 years as opposed to 11 to 12 years for a deceased donor kidney transplant.

Host: Wow, that is fascinating. Well, what are some of the benefits of a preemptive kidney transplant over starting dialysis before transplantation?

Dr. Pranjal Jain: Yeah, that's an interesting question. And, you know, I think a lot of patients are under the impression that I can only get a transplant when I'm on dialysis, but that's not true. In fact, you know, if you're seeing a nephrologist, I'm sure they're discussing your GFR with them. And once your GFR, your glomerular filtration rate, which is calculated from the creatinine, drops below 20, the chances are that you will probably deteriorate your kidney function fast. And hence, this is the time when you can be evaluated and actually transplanted.

And what this does is avoids the end-stage complications of kidney disease. You know, when your phosphorus goes high, you get very anemic. You start developing hyperparathyroidism, which affects your bone health. Your vessels start getting calcified. So, a preemptive transplant does better than when you were to receive a transplant on dialysis. So, that's why the need for early referral to a nephrologist and early referral from a nephrologist to the transplant center, and that imperative need to find a living donor, because as you know, you can get on the list when your GFR is less than 20, but then there is a wait time. So, why not use that time to find a living donor and get transplanted?

Host: All right. And do kidneys from living donors last longer than those from deceased donors? And what factors contribute to their longevity?

Dr. Pranjal Jain: Absolutely. I mean, this is a question which has been answered for the last 60 years. So, there's not even an iota of doubt which kidneys last longer. In fact, the first transplants that were done in Boston were in identical twins. That's how the field of transplant moved forward from there.

So, living kidney transplant outpaces a deceased donor transplant any given day from any donor of any age, any ethnicity. Yeah, it's not even a question. It's a no-brainer. And the factors that actually lead to it is because, you know, a deceased donor transplant, you are clamping the organs. The organ suffers a lot of injury in the body when it is being recovered, then it stays on ice, and then comes out from the ice and goes back into the recipient. And, you know, this is just a lot for the kidney to take in. While a living donor transplant is probably in the next operating room, the heart is beating, everything, they procure the kidney fast, they transplant it in an hour. There is no circulatory death or brain death in the donor. So, all these factors contribute to the longevity of the kidney and it working right away.

Host: So, who qualifies as a living kidney donor then? And how is donor compatibility determined?

Dr. Pranjal Jain: Yeah, that's a good question. So, you know, a living donor has to meet certain requirements. So, first and foremost is the age requirement. So, everybody has to be above the age of 18 to make that informed decision about their risks and benefits of donation, and then follows a full medical and psychosocial evaluation. Why you are doing this? Are you medically suitable? Are you socially acceptable? So, all the workup, by the way, is on recipient's insurance. So, I've had a few questions regarding that. All the donor workup is covered by the recipient's insurance. At least at Tampa General, we try to do the evaluations in one day, which may involve CAT scans, seeing a dietician, a living donor advocate, psychologist, a financial coordinator, nephrologist, surgeon, psychiatrist maybe. So, you know, there are steps for you to get to be an approved living donor, but it's very simple. There's an online form at Tampa General's website. You can fill it out. It's in English and Spanish, very easy. While you're sitting on your iPad, you can do that. If you're any blood type, you are more than welcome to fill it out.

And there are certain conditions which rule you out as a living donor. You know, if you're too obese, if you have active cancers, active heart disease. But I still encourage you to not make those decisions yourself. You know, that online questioner that I was alluding to takes you through a set of questions and has some hard stops. So, it'll stop you, you know, if you don't qualify. But at least you'll feel you've done your part and, you know, you've been appropriately evaluated. If you do pass that questionnaire, then our team will call you and take it from there.

Host: And to wrap up our conversation today, Doctor, what is kidney paired exchange and how does that help patients who have willing but incompatible donors?

Dr. Pranjal Jain: Yeah. So, up until 15, 20 years ago, you know, we classically know that a blood type B donor can only give to blood type B, O can give to O. I mean, O being a universal donor can actually give to anybody, but you know, you have to be blood type compatible. But many years ago, they interestingly innovated and said, you know, well, you have an incompatible donor and another pair has an incompatible donor. But guess what? They are compatible with the other recipients. So, they exchange the kidneys.

So, this exchange is done either at the center, like Tampa General, we'll find a pair which is in the same predicament as you and exchange the kidneys. Or it can be done nationally on a National Kidney Registry list or Alliance Paired Donation List. So, there are national lists for living donors, that's why, you know, if you are pursuing a living donor, the only thing we say is anybody above the age of 18 is welcome to apply and should fill out that questionnaire. So even if you're incompatible, but you want to do it, we will take care of it at the back end. 

Host: That has been Dr. Pranjal Jain. For more information, you can check us out online at tgh.org/livingkidneydonor. If you enjoyed this episode, please be sure to like, subscribe, and follow Community Connect, presented by TGH on your favorite podcast platform. I'm Caitlin Whyte. And this is Community Connect, presented by TGH. Thanks for listening.