A Friend, Indeed
In an act of kindness and respect, an LVN donates her kidney to a nursing colleague in need of a transplant

By Rebecca Ray
May 28, 2003

Every Monday, Wednesday and Friday for the past year, Arkansas RN Regina Allen would undergo 3½ hours of dialysis to treat her kidney failure. But thanks to an invaluable gift from a co-worker, Allen is on her way to resuming a normal life. She even plans to take a trip to Florida for her birthday this fall and spend time at the beach.

Allen's co-worker, Gina Benson, an LVN at the Medical Center of South Arkansas, donated one of her kidneys to Allen.

Now that Allen has a working kidney, she probably won't have to worry about dialysis-or the weak spells that follow dialysis sessions-for another 15 to 20 years.

Chances are good that Allen will live longer, said pre-transplant coordinator Susan Turton-Weeks, RN, of the University of Arkansas for Medical Sciences in Little Rock, where Allen and Benson underwent their surgery in April.

Allen, 43, and Benson, 34, have worked together on the acute medical floor at the Medical Center of South Arkansas in El Dorado, for five years. Although Allen was diagnosed with kidney failure in April 2002, Benson never thought of donating her kidney until one day this winter, when she heard Allen joking with some of their co-workers about having their blood drawn to see if it matched hers.

No joke

"People were laughing back and forth with her about it, and I took it a lot differently, I guess, than other people did," Benson said. "To me, it was a plea for her life."

So, at the end of January, Benson told Allen she would undergo a blood test to see if they possessed the same blood type.

A few days later, when Benson told Allen that the blood test had returned-and their blood matched-Allen "was just silent," Benson said. She didn't seem to take the LVN's offer to donate her kidney seriously, Benson said.

But according to Allen, "I got really nervous, and that feeling like you won a million dollars, like you won the jackpot," she said.

Although donors' and recipients' blood types don't have to be the same, they must be compatible. Benson has type O blood and can donate an organ to a person of any blood type-as long as Benson and the recipient are a negative crossmatch.

"She's one of the people at work whom I really admire," Benson said of Allen before the surgery. "I respect the job that she does and the type of nurse that she is. Even through this illness, she comes in and works on Tuesdays and Thursdays when she can, when she's not having dialysis. Her attitude is just unreal to me.

"Most people want to feel sorry for themselves, and they're down and depressed, and with every right. But she is happy and upbeat and [has] a positive attitude and is just as cheery as someone who's perfectly healthy. And I guess that part of her has really struck me, because she's so strong."

Benson's biggest fear wasn't that having only one kidney would diminish her quality of life-which it wouldn't-but that the transplanted kidney would not benefit, and would somehow even harm, Allen.

"I've worried about Regina, because I feel like if anything happens to this girl after she gets my kidney, if my kidney does anything to her, it would kill me," Benson said before the transplant.

However, further series of presurgical tests reassured Benson that she probably had nothing to worry about.

She had an intravenous pyelogram, or IVP, to make sure her kidneys were normal, and a renal arteriogram to make sure the arteries in her kidneys were open. Health workers also gave her a complete physical that involved the heart, lungs and back, asked if she had ever experienced lower back pain, tested her for hepatitis and AIDS, and took urine cultures to make sure she had no infection.

They even made her take a pregnancy test-just to make sure.

"They drew so much blood, I didn't think I had any more left," Benson said jokingly.

However, she added, the testing process was "easier than I thought it would be." The only difficulty she had, Benson said, was that some of the tests required that she not eat beforehand, and she likes to snack throughout the day.

Recognizing the risks

As health care professionals, Allen said she and Benson could probably imagine more things going wrong before and after the transplant than most people. Like any other surgery, kidney transplants involve risks.

Risks for donors include the normal risks involved with any kind of surgery, such as bleeding and infection, as well as urinary leak and renal thrombosis.

Benson said that if her remaining kidney were ever damaged, she'd be in trouble. However, she said, she knows from her line of work that significant damage usually does not occur to the renal area even during a severe accident.

Benson also said she could develop kidney cancer; however, this is rare.

Allen's risks included incessant bleeding and her blood not clotting. Her body also could reject the transplanted kidney. However, Turton-Weeks said, the newer immunosuppressive medications make it far less likely. If the kidney comes from a living donor, there's a 90 percent to 95 percent chance that the transplanted kidney still will function within the first year. If the kidney comes from a cadaver, the chances of rejection are higher.

Odds were even further in favor of a successful transplant because Benson always has been in perfect health, and her family has a perfect health history.

Being able to receive a kidney from a nonrelated individual is a fairly recent phenomenon. About 15 years ago, doctors considered only immediate family members as donors. If the kidney patient's family members didn't match, or the family members didn't want to donate their kidneys, doctors would look at more distantly related family members, Turton-Weeks said.

But because modern immunosuppressive medications are more effective, doctors now can consider spouses and friends.

This is fortunate for Allen, whose older daughter, LaShay, 21, was not a blood match, and whose younger daughter, Raquidia, now 19, was 18-younger than the recommended age for donating-at the time of Allen's diagnosis. Half of Allen's immediate family members also were ruled out because of high blood pressure.

Statistically speaking, patients live longer with transplanted organs than they do on dialysis, Turton-Weeks said. The half-life of a living donor kidney is about 15 to 20 years, while the half-life of a kidney from a cadaver is 10 to 12 years, Turton-Weeks said. "Half-life" refers to the time until half the patients' transplanted kidneys stop working.

Allen's doctor told her she might outlive her donated kidney because she's so young. If this happens, Allen would go back on dialysis and be included on a new donor list.

The kidneys don't always last longer, Turton-Weeks said, because the patients still have the condition that caused their kidney problems in the first place. Most dialysis and transplant patients die of something other than kidney failure, Turton-Weeks said.

High blood pressure caused Allen's renal failure and is one of the most common causes of kidney failure in the United States. Hypertension can damage the small blood vessels in the kidneys, so that the vessels no longer can clean poisons from the blood.

Once Allen's kidneys stopped working, she experienced uremia-her body filled with extra water and waste products. Once a patient's renal function drops below 10 percent to 15 percent, he or she cannot live long without dialysis or a transplant.

However, people can live a normal life on one kidney and with less than 50 percent of their original renal function-as long as their renal function remains stable.

So far, so good

Although Benson was looking at four weeks of missed work-and at starting with light duty once she returned-she should be able to resume normal activities within six weeks. She said she planned to stay at the hospital only three days-the recommended stay is three to five days-and then "recover at the river, fishing."

Sure enough, she was discharged the evening after the surgery in April, and has visited her co-workers several times.

Allen was discharged from the University of Arkansas for Medical Sciences 15 days after the surgery. Although she said the first couple days after the surgery were "a little touchy" because her new kidney retained a little too much fluid, she felt good afterward and was happy with her progress. So far, her body has not rejected the kidney.

Allen also said she had more energy. She added that although she has a low tolerance for pain, she wasn't in much pain after the surgery and hardly ever needed to take pain medication.

For the first two weeks, Allen said she was scheduled to have her blood checked about three times a week because the doctors wanted to make sure her body didn't reject the donated kidney. She and her husband even stayed at an apartment near the hospital, because their El Dorado home is a two-hour drive from Little Rock. She said the blood tests would gradually taper off to about once every three months.

Allen's doctor said she should wait at least six months before returning to work, because her immune system would be diminished. She also was told to avoid driving for three weeks, doing housework and other normal home activities for six weeks, swimming for eight weeks and lifting more than 10 pounds for three months. She also was told to avoid crowds for three months-which is why she usually saw visitors one-on-one after the surgery.

However, her doctors wanted her to start exercising immediately and walk every day, rather than be stationary, to reduce the chance of blood clots.

Allen said she plans to walk a lot and continue to eat a healthy diet to further increase her chances of living longer.

One thing that helped Allen throughout her illness is strong family support, she said, which can keep a patient from slipping into a deep depression. As a nurse, she said, the hospital patients she's seen do the best are the ones who receive the most support from their families.

Allen's family seems to extend beyond her biological family; she said that her co-workers at the Medical Center of South Arkansas, who are like family members, organized a potluck for her and Benson the week before their surgery.

Surgical celebrities

The transplant has received statewide media attention. Allen and Benson did interviews with the Arkansas Regional Organ Recovery Agency about the importance of donating to commemorate the agency's Tissue and Organ Donation Month-which, coincidentally, is April.

U.S. Department of Health and Human Services Secretary Tommy Thompson also declared April as National Donate Life Month, during which he encouraged health care professionals, volunteers, educators, government agencies and private organizations to promote the nationwide need for organ and tissue donations, according to the United Network for Organ Sharing.

As of May 14, 81,496 Americans were on the national waiting list for organ transplants, according to UNOS, but only 4,140 received transplants in January and February. Nearly 3,080 of the transplant patients received organs from cadavers, according to the Organ Procurement and Transplantation Network.

"I've been amazed at all the attention," Benson said. "I had no idea that we'd get as much attention as we have. If it'll encourage someone else or ease their mind that there's life after giving up a body part, then I think it's great."

Benson added that she hoped it would encourage other people to donate their organs, because "you can add a lot of life with just a simple thing."

Allen's husband, George, also is hoping for nationwide attention. He contacted "The Oprah Winfrey Show" about the transplant even before his wife and Benson began their series of tests, and is waiting to hear from the show's producers.

Allen and Benson have grown closer since the transplant, as well-Allen said she and Benson, who used to see each other only when their shifts overlapped, have been calling each other long-distance once a week to see how the other is doing.

"[Allen's] got grandchildren to look forward to, and things that I feel like she wouldn't have been able to do without this," Benson said. "And it touches me that I can give her that. It's an overwhelming feeling."

Contact Rebecca Ray at rebeccar@nurseweek.com