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[MUSIC]
My name is Robert Montgomery and I'm a transplant surgeon at
Johns Hopkins Hospital and I'm the
Director of the Comprehensive Transplant Center.
[MUSIC]
The two most common causes of renal failure in
the United States are diabetes and high blood pressure.
There are a lot of other diseases that
are much less common that can cause renal failure.
When somebody develops renal failure, their kidneys aren't
doing the job that they need to do.
They're not cleansing the blood and without that cleansing a person will die.
Thankfully, we have dialysis and dialysis can take the place of
kidney but it doesn't do as good a job.
So what happens is, when someone's on dialysis for a very long period of time,
they tend to get a lot of wear and tear on their body and
they can develop heart problems, strokes, high blood pressure.
A lot of other medical problems that
are greatly increased by dialysis and that's where transplantation comes
in because transplantation, when you actually give them a
kidney, that kidney can do what their old kidneys used to do.
It's a better replacement than dialysis and they're much more likely
to live longer and to have a better quality of life.
I mean, let's face it, dialysis is, it is really difficult.
You have to be hooked up to a machine
usually for three or four hours, three times a week.
Many people are unable to work when they're on dialysis.
A lot of my patients are on disability.
There's a recovery phase for a lot of patients after dialysis that can extend
anywhere from a few hours to a day and it's not, they can't travel.
They're, they're a lot of limitations on their lives.
When they receive a transplant, yeah, they have to take
some additional medications but they have a normal life again.
And I think most of transplant patients will tell you that they feel normal and
that they're able to do all the things that they were able to do before.
[MUSIC]
Right now, in the United States the average time to wait on the,
on the list for a kidney transplant is between three and five years and in
fact, there's some areas where it's considerably more than that.
During that waiting time, almost a third of the patients will die waiting.
And transplanting patients earlier is very
important because dialysis, while it
is life preserving, it produces a lot of wear and tear on the
body and it increases the likelihood of
patients having other serious medical problems.
So as a result of that, the longer they
wait the more likely they are to, to die waiting.
So earlier transplantation becomes very important and that's really where
live donation has a significant impact because if you have a
live donor, you can essentially receive your transplant as soon as you're
cleared to have a transplant and avoid that waiting period.
[MUSIC]
When a patient sees me in clinic and has just been told
that they're going to need a kidney transplant, my job
I think is to first of all reassure them that they're
gonna be okay and to be confident, to be confident in
my ability to help them and in what I'm telling
them that you know, they will be okay.
We, we have you know, things that we can offer them.
there, where they are at that moment is not how life is going to be.
it's, it's gonna be a lot better and
I think, you know, that reassurance and that confidence
helps someone tremendously who is you know,
has been given news that seems very frightening.
And it's, it's very important to, to you
know, make sure that they understand what kidney disease
is and what their options are and what
they should expect or can't expect in the future.
There are a lot of patients who
either because of, of blood typing compatibility or tissue incompatibility,
are unable to receive a kidney from a willing donor, a loved one usually.
And we've come up with a number of different approaches,
a number of different options for patients to be able
to to have their donor donate either directly to them
or to someone else so that they can receive the kidney.
One of them is one, one of these options is called abdominal kidney
paired donation and what that involves is we have over a
hundred people every year in the United States who come forward and
say, I want to give my kidney to anyone who needs it.
So they, they don't have anyone in mind and they
come to a transplant seminar and say, look, you know, I,
I want to donate one of my kidneys and what
that has allowed us to do is to start these dominoes.
So that person, we, we call them altruistic donors
or non-directed donors, can give to someone who has
an incompatible donor and that incompatible donor can give
to someone else and you create these chains of transplants.
This is a concept that we came up with, in the, well, about five or six years ago.
And we have done these very long chains.
You can either do all the transplants in one day and we did
a, a eight way domino or transplanted eight people with
eight donors, had multiple different
institutions shuttling kidneys around on airplanes.
That's the biggest one that has been done.
Or you can do you, you can create the chain
one link at a time and we have chains now that have extended over 20
transplants.
So the, so abdominal pair donation is, is a way to
match up people who have an incompatible donor with,
with other pairs that are incompatible in order to
produce a chain of compatible transplants.
And there are a lot of these being done now
throughout the country, so it's we've set off a chain reaction.
There are certain patients who are hard to match because
they have been exposed to foreign tissue either through pregnancy,
previous transplant or a blood transfusion and they developed these
harmful antibodies that can cause a new kidney to be rejected.
The other type of incompatibility is a blood type incompatibility.
So we all make harmful antibody against blood types that are
not our own for reasons that people don't completely understand but if
we put an organ into someone that's, that's a wrong blood type
without preconditioning their body to receive it, it'll be rejected right away.
So, there are essentially two types of incompatibilities.
Someone can be incompatible by tissue or by blood.
And we've developed multiple different procedures to
either get around those incompatibilities, or remove the
harmful antibody, so that the person can
receive an incompatible organ from their loved one.
[MUSIC]
Plasmapheresis is a way of removing a
harmful antibody that can attack a, transplanted kidney.
People develop, these harmful antibody.
We usually think about antibody as something
good but in this case it's, it's not.
They developed those antibody as a result of exposure to foreign tissue.
So that can be through a pregnancy, so women are a
lot more likely to, develop a sensitization to other people's tissue.
Previous transplant or a blood transfusion.
And essentially, what plasmapheresis does is we pass
the patients blood through a machine and the machine
filters out these harmful antibodies and we have
to do a number of treatments before the transplant.
And by doing that, we're able to use a live donor kidney that that patient would
have rejected immediately and get excellent outcomes.
In fact, the patients are, are twice as likely to, live
to eight years after this treatment than if they didn't receive the treatment.
We're a transplant center in a hospital that has
a tremendous depth of expertise, that is a leader in the
field in terms of research and innovation and new developments
but we don't forget the human part of what we do.
And you know, we're doing a lot of really interesting things here.
A lot of interesting protocols allowing people to receive
a transplant who wouldn't otherwise or wouldn't at other institutions.
But we you know, we do it one transplant at
a time and we do it with a sense of humanity.