David Nicklin with kidney transplant recipient Sherri Martz
Becoming a living organ donor is an incredible act of generosity, but it takes on a special meaning when a person donates just because, and to no one in particular. David Nicklin, MD, an associate professor of Family Medicine & Community Health at Penn Medicine, is one of those people.
It all started this past spring when a woman in his Quaker community – whom Nicklin has known for years – was in renal failure and heading for dialysis. Members of the community were asked to keep her in their prayers, but Nicklin decided to take this one step further; he wanted to give her one of his kidneys. After first getting an okay from both his family and members of his practice – and then undergoing an intense screening process – he was ready to move ahead with the donation. It was then that he realized he wasn’t alone. Another member of his community had made the same offer and, as it turned out, was a better match for the recipient than Nicklin.
Rather than just back out, though, Nicklin decided to make the donation, even though his kidney would not directly help anyone he knew. “I’d already been cleared to give mine,” he said, adding, “it was like being all dressed up with nowhere to go!”
For a healthy individual, donating a kidney has little risk. According to the National Kidney Foundation, people can live normal lives with only one kidney. In fact, when one kidney is removed, the remaining one will increase in size to compensate. But being healthy is key, said Joe Sinacore of the National Kidney Registry, which facilitates living donor transplants. “Living donors can have no existing comorbidity, such as high blood pressure or pre-diabetes — anything that might impact future health.” But, in the event that the donor’s remaining kidney starts to fail, “that person will be given priority on the deceased donor list,” Sinacore said. “It’s the right thing to do.”
Some kidney transplants result from “directed donations,” in which the donated kidney goes directly to a loved one. If the recipient is incompatible – meaning the person has the wrong blood type or antibodies – a single paired exchange can take place. In this case, the donor’s kidney will go to another recipient in exchange for a compatible kidney going to the donor’s loved one.
Nicklin’s “Good Samaritan” donation – better known as the non-directed donor – had no connection to anyone on the waiting list. And, unlike a directed donation, a non-directed donation can kick-start a chain of kidney transplants. “We find a recipient in our pool that’s a match for the non-directed donor. Then, that person’s donor pays it forward,” Sinacore said. “We push the chain as far as possible, exhaustively looking at our pool to find matches.”
While some chains comprise only a few transplants, others grow to include 20-plus pairs or more. In fact, in 2015, Penn Medicine was part of what still is the longest kidney transplant chain, involving 25 transplant centers and 68 patients – 34 donors and 34 recipients! But, “even if it helps just one person, it’s significant,” said Donna Collins, MSN, transplant coordinator for Penn’s Transplant Program.
Indeed, “spreading the wealth” through kidney chains is a lifeline for the over 100,000 people on the kidney transplant waiting list. Kidneys remain the most sought after of all transplanted organs; nationally they comprise more than half of all transplants performed each year. The wait for a deceased kidney could be five years… or longer.
Living donations allow scheduling surgery on a date that’s convenient to the donor, but, more important, “the procedure can be performed when the recipient is still in good health,” said Abraham Shaked, MD, director of the Penn Transplant Center, as opposed to a patient getting sicker waiting for a new organ. And a living kidney donation leads to better outcomes. According to the National Kidney Registry, kidneys transplanted from living donors last nearly twice as long as kidneys transplanted from deceased donors.
Also, “a living kidney donation starts working right away, whereas up to 40 percent of deceased kidney donations may take a few days to get started,” added transplant surgeon Peter Abt, MD. In Penn’s Kidney Transplant Program, the largest in the region, about one-third of kidney transplants come from living donors. Last year, 80 patients received living donor kidney transplants.
Nicklin’s surgery took place on May 15 at the Hospital of the University of Pennsylvania. It paved the way for eight transplants. His kidney went to a recipient in Ohio. The paired donor’s kidney went to Colorado, and so on. It also resulted, indirectly, in providing a kidney for HUP transplant patient Sherri Martz. When her kidney started failing, “It happened so slowly I didn’t realize how bad I was feeling, until after the transplant,” she said. “I just adapted – if I was tired, I took a nap.” But now, five months post transplant, she’s “feeling great” and about to start a degree in Health Information Management.
Nicklin returned to work less than three weeks after his surgery. He originally planned to take two weeks off to recover but his transplant team deemed that “unacceptable,” he said, laughing. Most recoveries from this type of surgery take four to six weeks. “I agreed to take three.”
But on post-op day three he started working in his garden. Five weeks after surgery, he started riding his bike back and forth to work and is now back to workouts at the gym. While the surgery site remains a little sore, it’s clearly not limiting his day-to-day life. Nor is he regretting his decision. “This is the type of person I’ve always tried to be. I went into Family Medicine to create a more equitable world and one that was just,” he said. “As a Quaker, we believe in community and this was an opportunity to be connected.
“I made the donation because I wanted to make a difference in the world.”