AFTER ERICA BEGER DONATED A KIDNEY TO HER FATHER, PERRY BEGER, THE TWO ARE AGAIN ABLE TO ENJOY FISHING TRIPS TOGETHER.

Photo courtesy of Erica Beger

BY TIM FOX

In November 2024, Erica Beger became part of a small but growing community; she is a living organ donor. Thanks to WashU Medicine transplant surgeons Jason Wellen, MD, MBA, and Adeel Khan, MD, MPH, Erica was able to donate one of her kidneys to her father, Perry Beger, who was on the wait list for kidney transplantation.

Dr. Khan, director of robotics surgery, and Dr. Wellen, surgical director of kidney transplantation, are part of the Washington University and Barnes-Jewish Transplant Center. The Center is a national leader in the use of robotics during living-donor and transplantation surgery. This technology allows for greater precision during surgery and the use of small incisions, both of which can result in less pain for the patient and faster healing.

In talking about her experience, Erica notes that her father had been living with kidney disease “for more than 10 years, and it was slowly progressing.” Her father’s physician suggested he be placed on the wait list at the Transplant Center, given its reputation for excellence. Eager to donate a kidney to her father, Erica submitted her paperwork to the Center in April 2024 and subsequently completed preliminary testing. In August, she learned that she was a good match, and she and her father scheduled their surgeries.

Erica’s efficiency turned out to be a very good thing. In the weeks leading up to his scheduled transplant surgery, Perry’s creatinine levels suddenly increased, indicating that his kidney disease was now progressing rapidly. Initially, Erica and her father and been told he had about six months before he would need to start kidney dialysis, “but having the surgery already scheduled helped us avoid a crisis,” she says.

In this Q & A, Erica, Dr. Khan, and Dr. Wellen discuss the experience of living donation—and the ways in which WashU Medicine’s pioneering robotics program is making more kidneys available for transplantation.

I’D NEVER HAD SURGERY BEFORE—I STILL HAVE MY WISDOM TEETH—AND WASN’T EXPECTING TO HEAL SO QUICKLY.

What is the biggest challenge facing transplant programs in the U.S., especially for people like Erica’s dad?

Dr. Wellen: Today, tens of thousands of people around the world are waiting for a lifesaving kidney transplant. Many of them are alive thanks to some form of dialysis, which can extend life. But the wait list is not something that people want to stay on indefinitely. For such people, a kidney transplant is the only option. Our ongoing challenge is to find suitable donor kidneys for the more than 850 people currently on our wait list at the Transplant Center.

Dr. Khan: Thanks to our robotics program and other advances, over the past seven years we have significantly increased the number of kidney transplants we perform. Such improvements mean the Center can offer kidney transplantation to people who wouldn’t have qualified for the procedure in the past, especially those with very complex health needs. We also have made donation an option for more living donors. More people now qualify to donate and those who do experience a speedier and less difficult recovery after surgery compared to those undergoing a traditional donation procedure. The Transplant Center is now performing about 400 kidney transplantations annually.

Dr. Wellen: Unfortunately, these successes coincide with a significant increase in the two major causes of kidney failure in the U.S.: high blood pressure and diabetes. Even though we are treating more people, our transplant wait list grows every year.

How are you addressing the growing need?

Dr. Wellen: We’ve developed expertise that allows us to safely use deceased-donor kidneys that other transplant centers might not be able to use. For example, we work with an initiative that is focused on preserving deceased-donor kidneys, keeping them viable longer. Another effort involves the use of perfusion pumps that can help keep organs healthy before and during transplant surgery.

Our robotics program also has allowed us to increase the number of people who qualify to donate a kidney. And it has allowed us to treat patients in need of transplantation that might not be able to receive treatment elsewhere given their age, health, and other complicating factors. Even though we are treating more people with complex complications, our outcomes remain consistently high.

ERICA BEGER AND HER FATHER, PERRY BEGER, AFTER HER DONATION SURGERY AND HIS KIDNEY TRANSPLANT

Photo courtesy of Erica Beger

Dr. Khan: Another way we’re addressing that gap is telling patients and their families about the options we offer for living donors. We hope people reading this story will help inform others. We want to reach as many people as possible with information about our kidney transplant program and the benefits of living donation through robotics technology. The more people know, the more comfortable they become with the idea of donating a kidney.

Erica: I don’t live in St. Louis, so I learned about the Transplant Center because of its reputation—and my dad’s doctor had heard of the program and its outcomes. I didn’t know I’d be having a robotic procedure until I met with Dr. Wellen, but the Center’s reputation is what brought me here.

How does robotics technology contribute to better outcomes?

Dr. Wellen: The technology has, for example, allowed us to perform transplantation surgery for people who traditionally would not qualify. Like the general population in the U.S., people with kidney disease now have generally higher body mass indices (BMIs), an indication of obesity, than in the past. Many transplant centers aren’t able to perform transplant surgery for these patients due to a number of potential complications. But with robotics, we can use incisions that are smaller than traditional (open) or laparoscopic transplant surgery. When the wound is smaller, there is a lower risk of infection and other complications.

Dr. Khan: Exactly. We originally thought that the patient experience and outcomes for robotics procedures would be similar to those we see with laparoscopic surgery, which also uses smaller incisions than traditional surgery but doesn’t use robotics technology, which is very precise. But we quickly found out that robotics transplant procedures offer advantages over laparoscopic procedures. In many studies, for example, we have shown that using robotics shortens the length of hospital stay after surgery compared with laparoscopic surgery. It also often means patients require less or even no opioid medications afterward, they often don’t require drainage tubes at the surgery site, and hospital readmission rates typically are lower. Many people also are able to return to work and their normal activities much sooner after robotic surgery, whether they donated or received an organ.

Erica: That matches my experience. I had surgery on a Tuesday and was back home in Columbia, Missouri, on Friday. I probably could have gone home sooner, but I wanted to spend a little extra time with my dad because I knew I wouldn’t see him for a while after his transplant. I’d never had surgery before—I still have my wisdom teeth—and wasn’t expecting to heal so quickly.

I’m surprised that your first surgery was a robotic procedure to donate a kidney.

Erica: Yes, but the team at the Transplant Center put me at ease through the entire process. I trusted Dr. Wellen and his decision to perform a robotic procedure. I also had a great donor coordinator who was there for me any time I had questions.

Dr. Wellen: At the Transplant Center, all living donors work closely with a dedicated donor coordinator who guides them through the process, from beginning to end. Every potential living donor also works with a donor advocate, someone who is focused on the donor’s best interests and ensures the donor feels comfortable with the decisions they make, whether they decide to become a donor or not.

What is the process like leading up to the surgery?

Erica: After I submitted my paperwork to the Transplant Center, I received a call and answered questions about my medical history. Once I’d completed that step, I had blood work and urine testing in Columbia, and then I went into Barnes-Jewish Hospital for a chest X-ray, an abdominal CT scan, and more blood work. After those results came in, it was pretty certain that I was going to be a good match, but we did one final round of blood work for cross-match compatibility.

Dr. Khan: The goal of all that testing is to gather the donor’s history and ensure that both of their kidneys are healthy. We want the living-donor procedure to have zero impact on the donor for the rest of their life, which means we don’t want to increase their risk of needing a kidney transplant later. However, studies have shown that if you select the right people for donation and plan carefully, then using a kidney from a healthy donor should not increase the risk of the donor experiencing renal failure or requiring dialysis later.

OUR ROBOTICS PROGRAM ALSO HAS ALLOWED US TO INCREASE THE NUMBER OF PEOPLE WHO QUALIFY TO DONATE A KIDNEY.

Cross-match testing is important, as it helps us identify the possibility of organ rejection after transplant. But even when we don’t have a perfect match, as we did for Erica and her dad, we may be able to offer some additional treatment before the transplant procedure to decrease the risk of rejection.

What options are available if you can’t find a living donor?

Dr. Wellen: The other option is to transplant a kidney that comes from a deceased donor. The majority of the kidney transplantations we perform use an organ from a deceased donor. We encourage living donation when it’s an option because it offers the benefits we have discussed here. But traditional transplantation certainly saves lives. Whether the procedure uses an organ from a living donor or a deceased donor, our goal always is to transplant a healthy organ.

Dr. Khan: We do encourage everyone on our wait list to try to find a living donor. However, we don’t want that burden to fall solely on the patient. We have a program called Live Donor Champion that helps each patient identify a person in their life who can advocate for the need for a living donor. That person, called a Donor Champion, can approach potential donors on the recipient’s behalf. We also have additional programs that can help a patient find a donor.

Erica, have you and your dad talked about your gift to him?

Erica: Yes, we talked about it beforehand and afterward. He’s very grateful that I was willing and able to donate. But in my mind, I thought, “This is my dad. If there’s anything that I can do to help better his life, I’m going to do it.” So while I know it was a generous thing, it was also a very small thing to do for him.