From the time she was a nursing student in Houston, Heather Wertin, RN, BSN, MPH, now the manager of abdominal transplantation at Barnes-Jewish Hospital, was fascinated with the field of organ transplantation. Her first nursing job, at Texas Children’s Hospital, involved caring for patients before and after kidney and liver transplants. Eventually, she became the kidney transplant coordinator at that hospital.
Wertin felt so strongly about organ donation that she included it on her top-100 bucket list of life wishes. But she assumed she would achieve that goal at her death. In this interview, Wertin explains how she fulfilled her wish during her lifetime, what her generosity meant to her family and why she continues to advocate for this compassionate, life-saving gift.
In 2002, you became a living kidney donor. How did that come about?
In 2001, my sister’s husband began having kidney problems. His family has a history of polycystic kidney disease, an inherited disorder that develops in adulthood. His mom and several other relatives already had the disease. By 2002, his physicians began talking to him about kidney dialysis. He and my sister had two little children, and dialysis would have greatly complicated their lives.
Because I was then and continue to be so vested in the transplant process, I jumped at the chance to be tested as a possible living kidney donor for him. I was living in Saudi Arabia then, with my own three small children, but even so I convinced my sister I was the best candidate. Because her children had a 50 percent chance of developing the disease, I told her to save her kidney in case one of them needed it in the future.
Since you weren’t a blood relative of your brother-in-law, what was the likelihood of being a perfect match for him?
The concept of “perfect” match is one of the misunderstandings about transplants and living donors. In reality, there are just two conditions that must be met. First, the blood types between donor and recipient must be compatible, though a new process now makes it possible for a donation between incompatible blood types as long as certain criteria are met.
The second condition is called negative cross-match. This means that when blood from the donor and recipient are mixed, the recipient’s cells do not attack and kill the donor cells. A negative cross-match increases the likelihood that the recipient’s body will not reject the transplanted organ.
It’s been said the donation process is harder on the donor than it is on the recipient. Is this true?
In a way it is true. A transplanted kidney is placed at the front of the recipient’s abdomen, in the pelvic area, so the incision isn’t as deep as the one required to retrieve an organ from a living donor.
But advances in surgical techniques have made donor surgery much easier than it was for me 16 years ago. Now, in a procedure called laparoscopic nephrectomy, the surgeon removes the donated kidney using several very small incisions. Even when laparoscopy isn’t possible, today’s mini nephrectomy involves a fairly small, hockey-stick-shaped incision under the ribs. Donors usually go home a couple of days after surgery. By comparison, my surgery involved a radical midline incision, a large incision that is no longer used, and a six-day hospital stay.
How did donating a kidney affect you?
To be a living kidney donor, you need to be in good health. Once I recovered from surgery, my life continued as it had before. I follow just two restrictions: I don’t take ibuprofen for pain, and I drink water instead of diet soda. I do have my blood pressure and creatinine level checked annually because elevations in these can indicate kidney problems.
In general, it’s recommended that living kidney donors do not participate in contact sports like tackle football, but most of us can return to our everyday activities.
Has the living-donor screening process changed since you went through it in 2002?
Emphasis on the physical well-being of living donors remains a constant. Potential donors go through rigorous testing and screening to determine if they are healthy enough to undergo the procedure.
What has changed is the way we counsel living donors throughout the process. At Barnes-Jewish Hospital, a social worker and a living-donor advocate talk with potential donors about their motivations. We want to ensure donors are making well-informed decisions and are not being pressured in any way. Once a donor is approved and makes the decision to move forward, he or she receives ongoing support from the transplantation team before and after the surgery. If at any point someone decides not to donate, we support that decision by providing the potential recipient a medical explanation for that choice. All potential donors’ medical information is confidential. The decisions they make about donation are theirs alone and not swayed by outside influences. We also work with our donors on a long-term basis through a follow-up clinic.
Why do people become living kidney donors?
As in my case, the most common reason is the desire to help a relative or close friend. But we’ve seen a sharp increase in the number of altruistic donors, those who want to donate a kidney to make life better for someone they don’t know.
But the need for organs continues to be overwhelming. There are more than 100,000 people on the national United Network for Organ Sharing’s kidney wait list, while only about 15,000 kidney transplants are performed in the United States annually.
At Barnes-Jewish Hospital, there are 840 people waiting for a kidney transplant. We have about 80 people waiting on the liver-transplant wait list and about 25 each on the lung and heart lists. We perform approximately 240 kidney transplants annually, 25 to 30 percent of which are made possible by living donors.
Now that it’s been more than a decade since your decision to be a living donor, what are your thoughts?
I chose to be a donor so that my sister, her husband and their kids — they now have four — could have the life they had planned. That has happened, and it is extremely satisfying.
Those of us who work in the transplant field operate in a world of hope. We see very sick people, like my brother-in-law, get well and go on to lead great lives. Every day we are privileged to celebrate the gift of life made possible by organ donors.