Kidney Quest: Matching

Within a week, as promised, we had the initial results of the typing. The first measure--blood type.

Prior to the "Results Show," the DeFord audience had elected Bob by a vote of 5-1 (guess who had been the lone dissenter?). Only those with A+ blood needed to apply, as that matched Alan. Only Art and I qualified.

I was in the bottom half of the match. On a six point scale, art was a four. I scored a two. Thinking two was too low, Susan Siriwatana, our case manager, assured me successful transplants happened with a zero score. (Which, I proudly announce, I am not, never ever have been a zero).  The first determinant is the blood type. However, it does not mean you are a match, but you can be considered.


Our tissue typing would be repeated later in the matching process, within a week of the surgery, because compatibility levels an change.

HLA-A1 (Photo credit: Wikipedia)

The Matching Process:

1. Donor and recipient need the same Human Leukocyte Antigens (HLA). These are proteins on the surface of the white blood cells and tissues in the body. Siblings have a 1 in 4 chance of being identical matches. Just because you share blood type doesn't mean you share the HLA.
2. Matched for specific immune reactivity. This checks to insure the recipient, in this case my brother, had the antibody toward my tissues. (How could he?) Antibodies are use to fight off foreign bodies such as bacteria, viruses and stray kidneys. The antibody will only injure the donor if he has the specific antibody to the donor's particular HLA. You are looking for a negative cross-match.
3. HLA antibodies can come and go. The Percent Reactive Antibodies (PRA) needs to be retested within a week of the surgery. The PRA is determined by testing the recipient's serum to sixy types of HLA.

Thankfully, Susan knew this was more information than we needed. For us, I knew I only ranked a 2/6 and had five years to make a decision.

Or so I thought.

More later.

Related articles

• Kidney Quest: Initial Screening for Donors
• HLA Complex in Predictive Medicine
• Kidney Quest: 24 Hour Urine Collection
• Kidney Quest: The Story of Organ Donation

Kidney Quest: 24 Hour Urine Collection

Alan and family today

After the phlebotomist took vial after vial after vial of blood, I returned to my siblings in the waiting room, Here I discovered the problems of leaving my brothers and sisters unattended while the vampire (aka phlebotomist) emptied my blood. They read the information about organ donation that Mt. Sinai thought its donors should know.

"Hey," brother Bob called out. "Did you know that they could transplant portions of a pancreas?"

Fig. 2 The pancreas. 1. pancreatic head. 4. pancreatic body. 11. pancreatic tail. (Photo credit: Wikipedia)

He demonstrated the fact that he could read by pointing out the details. In 2003 the procedure was still experimental (only two to five living transplants a year according to UNOS data and only 160 to date). The best results came from whole pancreas which would come from a "deceased donor" (obviously).

We discovered during this time that most living donations came from:

1. liver
2. lung
3. kidney

Which of course resulted in sick DeFord humor as we considered ransacking our body parts for a brother we adored.

"Bob," Art said, "you can afford to live the wild life and not worry about getting the organs you need."

Bob gave him a blank stare.

"You've got five donors ripening at home." He referred to his five sons.

"Then Janine got me beat," Bob said. Janine couldn't come to the screening because she was expecting her sixth baby in February.

"Yeah," Alan said. "But none of them are ripe yet. You've, though, Bob has three ready to harvest."

We assumed the donors had to be over eighteen-years-old in order to donate. Bob's three oldest boys met that criteria.

We laughed at our sick jokes, and I'm sure we offended others sitting in the office. But the only way we knew to relieve our tension was to laugh.

Then the mood turned somber.

After reading another pamphlet, my sister Marianne discovered another test we'd have to endure: The Twenty-Four Hour Urine Collection.

"What?" We gasped in unison.

"Where does it say that?" I asked.

She pointed it out.

This fact horrified us.

• ask us embarrassing questions
• test every part of our bodies
• take out a kidney

But collect pee for twenty-four hours and then lug it to the hospital?
That nearly transcended our love for Alan.

Related articles

• Kidney Quest: Initial Screening for Donors
• Kidney Quest: The Story of Organ Donation

Kidney Quest: Initial Screening for Donors

Mount Sinai School of Medicine, New York, NY (Photo credit: Wikipedia)

On a hot, humid Tuesday morning, five of us piled into my sister's Suburban and headed to Mount Sinai for our initial screening. Without a long wait in the outer office, Susan Siriwatana, our case manager, ushered us into her office. Every transplant has a nurse who oversees and coordinates the entire process. Here we learned two things that made us gasp. She said:

1. "We will find a donor because you are siblings." Since four of us were available to donate (my youngest sister was pregnant with her last child, so she was off the hook), Alan was virtually guaranteed a match. As stated in the last post, siblings offer the best chances for a match.
2. " Blood type is the first eliminator." Alan was A positive. Anyone not A positive or the universal donor would be eliminated.
3. "After a donor is chosen, the surgery can be performed within three weeks." Three weeks! We gasped collectively. We agreed to matching with the probability of donating within five years. Little did we know, how soon the surgery could be completed.

After our collective interview, we were called in one by one and interrogated. And the questions for our initial organ donation screening?

1. Have you ever done drugs?
2. Do you smoke?
3. Do you drink?
4. Have you had cancer?
5. Do you have safe sex?
6. Ever have hepatitis? HIV? TB?

If you are wiping your forehead and breathing a sigh of relief because your youthful drug habits or smoking have eliminated you--you're not off the hook. Much depends on when it occurred, how frequently and your current health. I failed some of the above, passed others (not revealing which). I still became the donor.


Once the initial screening was over, the phlebotomist drew five vials of blood for testing. It turned out she needed more than five--but that's another day's blog.


Are you considering donating a kidney? Do you have questions or comments? Feel free to add them in the comment box.

Kidney Quest: The Story of Organ Donation

My family: Alan far left-back--I'm three to the right of him.

A dear friend currently faces failed kidneys--something that happened to my brother, Alan, about ten years ago. In honor of my friend and her quest to find new kidneys, I'd like to take some time to chronicle my own path as an organ donor.

My brother Alan's kidneys were failing. His nephrologist said he had about five years before he would need a transplant and it was best to begin the search early. The chance of success increases with a live donor as opposed to a "deceased donor."

Kidneys are one of the few organs that can be safely transplanted from a living donor. It's the only one where the entire organ can be used (seeing as we have two). The others being parts of:

1. liver
2. intestines
3. pancreas
4. lung
5. skin

In all, but the kidney, only parts of the organ can be used. And the kidney is the most successfully transplanted organ.

If the kidney comes from a sibling, the transplant has a greater success rate because of the genetic ties. The success rate is higher than an organ coming from a parent as the brother or sister genetic make-up from both parents whereas the parent only has her/his own genetic material.

For Alan, as all transplant candidates, performing the surgery as an elective is best. It ensures:

1. both the candidate and the donor are in the best health.
2. it avoids dialysis which hampers the success of a transplant because it taxes every organ of the body.
3. a convenient time when surgeon and patients are not stressed.

With all of this in mind, on August 19, 2003 (two days after meeting my future husband, no less), five of us DeFords head to Mount Sinai's kidney transplant unit at 5 East 98th Street in Manhattan to discover who would be the lucky donor.

The Wife of Lappidoth

Gustave Dore's interpretation of the prophetess Deborah. (Photo credit: Wikipedia)

Judg 4:4-5: Deborah, a prophetess, the wife of Lappidoth, was leading Israel at that time.  She held court under the Palm of Deborah between Ramah and Bethel in the hill country of Ephraim, and the Israelites came to her to have their disputes decided.

Of all women who prove the God-given ability and right to lead and teach, Deborah must head the list. Her husband only has one mention in the Bible. The whole of Judges 4 and 5 are devoted to this woman of God, Deborah.

Deborah was a prophetess and a judge of Israel. This means she not only led the Israelites politically, she was also a religious leader, since a prophet or prophetess speaks for God.

First, the name Deborah means bee. And this Deborah lives up to her name. According to Lockyer, "Science confirms the ancient belief that, of all the animal kingdom, the bee ranks among the highest in intelligence...so Deborah stands out as among the wisest of all the Old Testament women"(40).

Simply looking at the opening verses of Chapter 4 we see that:

1. Deborah's office as a prophetess would give her a ministry in the Word. If the Old Testament would allow a woman this ministry, women today can hold that office.
2. Deborah's office as a judge shows that women can lead men, contrary to the belief of many sects of Christianity.

Immediately after her introduction, we see her call Barak to her side and instructs him in God's commands--orders he fears to follow.

How does Deborah solve this issue? Tune in next Wednesday.

Asparagus

This time of year shows us what Eden must have been like. Fiddlehead ferns poke through the forest floor, and wild leeks crop up and morel mushrooms nestle in wooded alcoves.

I'd love to understand the world of foraged food--to be able to go out, scoop up a handful of roadside vegetation and scramble up a delicious dinner.

However, I'd probably poison everyone. So I'll stick to the domesticated things in my backyard. Last week we looked at the first sign of spring--rhubarb. This week it's asparagus.

Did you know:

1. asparagus are members of the lily family?
2. it can grow ten inches in a twenty-four hour period?
3. the larger the diameter of the spear, the better the quality?
4. it is high in Folic Acid, potassium, fiber, vitamins A, B6, C and thiamine and the "mother of all antioxidants"--glutathione?
5. it helps our brains fight mental decline?

Weird facts:

1. Asparagus day was May 1.
2. Only 2/3 of the population get "asparagus pee."
3. It helps cure hangovers.
4. Is considered an aphrodisiac.

Tonight's Recipe:

Sprinkle asparagus spears with olive oil, Parmesan cheese and garlic. If you like feta cheese, sprinkle with that. It gives it a great pop of tangy and sweet. Roast at 350 degrees for 10-15 minutes.

How do you like your asparagus? (My favorite (besides any way) is in cream of asparagus soup).

Related articles

• May is Asparagus month!
• asparagus and red quinoa salad
• Olive Oil, Lemon & Parmesan Asparagus

Writing Prayers: How to Fail

Written Prayers (Photo credit: TinManVII)

I read Christian fiction, and I admit, I've been a Christian for longer than I've been alive. I know the jargon, the formulas and the patterns of prayer. So I usually skip all prayers in the novels I read.

Why?

They generally:

1. don't add to the plot or the conflict
2. don't characterize the prayee
3. don't interest anyone

They're generally written like we pray them--state the obvious, begin with the usual introduction and try to sound all so pious.

How should we write prayers?

1.  Like good dialogue. We don't write vocal pauses or "hi, how ya doing?" or "nice day today. 
2. With knowledge of our audience.  Christian authors do hope their novels will reach the unsaved, but our audience is primarily Christian. If we're writing to doctors, we don't define EKG; to lawyers, we assume they understand voir dire; a CSI would know whatever I don't know. So skip Christianeze, and if the prayer doesn't advance your story, skip that to.
3. With characterization in mind. Is your character goofy? Her prayer will have that element. Weak in his faith? Then it may be apologetic. Forget the "Christian Correctness" believing this is how we must pray. We're not praying. We're entertaining our readers.
4. With conflict in mind. Is your character angry with God? Doubtful? Heretical? A prayer that reflects these elements will not damn you as author--it doesn't scream, "This is what this author believes." Instead, it immerses the reader into the world you've created.

Do you want readers to devour every word you write? Take a look at your prayers. Do they do something besides sounding pious?