Dr. Amit Tevar, Surgical Director of the UPMC Kidney and Pancreas Transplant Program discusses the benefits of living donor kidney transplants and a program underway to help patients find a living donor.
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– [Announcer] This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgments when advising their patients. Patients in need of medical care should consult their personal care provider.
– Saving lives with the help of living donors. Welcome to the UPMC HealthBeat podcast. I’m Tonia Caruso, and joining us right now is Dr. Amit Tevar. He is the surgical director of the UPMC Kidney and Pancreas Transplant Program. Dr. Tevar, thanks so much for joining us.
– Oh, thank you for having me here today.
– We begin — UPMC, really the home of transplantation, and all these years later, UPMC continues to be on the forefront, especially when it comes to living donors.
– Yeah, so that’s actually one of our forefronts, and one of the things that we’ve really found as a program and as an institution is that in our goal to save as many lives as possible, focusing and implementing programs that promote and help people find living donors and actually utilize living donors truly saves lives even more so than other forms of transplantation. So, whereas other programs keep it as a small part of their program, it’s by far a major part of both our programs in liver transplantation and kidney transplantation.
– Right, and so you focus on kidney transplantation. Let’s talk a little bit about kidney disease and how quickly it can progress.
– Yeah, so, you know, it’s interesting to note that there’s actually a large portion of the population that suffers from end-stage renal disease, or failure of your kidneys. And for most people, this is something that doesn’t affect them greatly. But for a large portion of those folks, they do go onto what we call dialysis or end-stage renal disease, and it requires them to be in a dialysis unit for six hours a day for three times a week. And that can be somewhat traumatizing and exhausting, not only on an emotional level, but also we see that those folks who are on dialysis have a very blunted or actually smaller, much less of a lifespan than anyone who does not have end-stage renal disease. So the treatments for that are actually lifelong dialysis, which has a very, very poor outcome and a very shortened lifespan, or transplantation.
– Do you find that patients are surprised when they come to you and realize that a transplant is a viable option and perhaps more viable than staying on dialysis?
– So, yes and no. I think that when people come to us for transplantation, they already are, most, the ones that are on dialysis, know how hard it is, and they really want anything to not have to do more dialysis. Because keep in mind, not only is it six hours a day, three times a week, but the days after dialysis, you’re exhausted physically. You really can’t function. And most of those folks can’t do the things in life that they enjoy, which may be hanging out with their children, may be going to work, pursuing hobbies. Those are all things that are not a possibility for them. So they would like any option that would actually allow them to not do dialysis. And then number two, what they, I think, a lot of times don’t realize is that dialysis is not a long-term really good option. They have a lot of complications from dialysis and their life span isn’t very long on dialysis.
– You already alluded to you help folks find donors.
– Correct.
– So, first, who makes a good donor?
– So I think the first and most important thing for someone who wants to be a donor is that they truly want to be a donor to help their loved one, or friend, or family member, or church person, or even someone from a bridge club. The first step is they truly have to want to donate. And then from there, as I always tell everyone, we’ll take it from there, which means once they call and say, “I’d like to be a donor,” our goal is very simple. It’s to make sure that they have a safe process, to make sure that no part of the donation is going to affect them long-term and throughout life or put them in undue jeopardy. So we do a lot of screening. So we want to make sure that it’s a safe operation for them, they don’t have underlying chronic diseases that may get worse over time, and to make sure that they truly psychologically want to do this and are expecting an appropriate outcome.
– And so you also, though, do kidney chains and kidney swaps. What’s that all about?
– So, you know what, I think sometimes when people want to be a live donor, they start going through, well, “Am I the same blood type? Am I the same match? Do I have to be from the same family?” And the answers to all those are no. So you do not have to be related. In fact, a majority of our live donors are unrelated, meaning a husband, wife, or a friend or someone from work. And also they are, a lot of them are not the same blood type. So if you have a different blood type, what we do is we find a matching pair that has also a similar mismatch in blood type and are age-matched, and we actually would do a kidney exchange, where one kidney goes to a different recipient and that person’s kidney goes to another recipient. So what that allows us to do is both recipients get transplanted, both donors get to donate at the same time.
– Let’s talk about COVID-19 in relation to patients coming and seeking care. When cases first emerged in our region, did you change the way you did anything? Did anything change in how you treated patients?
– Yes, I will tell you here at UPMC, we did actually implement a very early plan of screening. The temperature screens that we do every day coming into work for not only our patients, but every single employee, including all the physicians and surgeons, I think has been great for keeping our incidents of COVID within our institution at a very low rate. We actually had very early testing for our COVID patients. So currently, if you’re a live donor, and even in the months of April where COVID was just emerging, we actually were doing live donors and were testing both the donor and the recipient prior to coming into the hospital. And so that allowed us to actually pursue a life-saving transplant for someone in a very safe way within the hospital system.
– And so what do you want to say to people who maybe have been putting off care for fear of COVID?
– No, so, and I will say, listen, your fears are very, very appropriate and very well-justified looking at what’s happened throughout the country. Within our system and within Pittsburgh, our incidence has actually been very low. Within UPMC specifically, we have a very, very regimented system to make sure people are screened coming in. For live donors and recipients, we actually test for COVID prior to them even coming into the hospital, and within the hospital system itself, if there is a patient who has COVID, they’re moved to a separate part of the hospital. I would say in our estimation and what we’ve experienced, it’s actually very, very safe to actually pursue transplantation during this time within UPMC with our current measures in place.
– Right. I guess my final question, what’s the most rewarding part of your job?
– So I’ve been doing this for a long time now, and it still warms your heart every time. And, you know, I’ve said this before, but I think one of the most touching things that I get to experience as a surgeon is when we have a live donor pair and you have, let’s say, a wife donating to a husband, and each one has undergone surgery, and the first thing that the donor says when I say, “How are you doing?” is, “How’s my husband, or my recipient, doing?” And the first thing when I ask the recipient, “Hey, how are you feeling?” the first question they have is “How’s my donor doing?” And to see that bond between two people is truly something that you really can’t get tired of seeing.
– Well, Dr. Tevar, thank you so much for coming in and spending some time with us today. We certainly do appreciate it.
– Oh, pleasure’s mine. Thank you for having me.
– I’m Tonia Caruso. Thank you for joining us. This is UPMC HealthBeat.