Today, Explained - How to save a life

Episode Date: May 24, 2019

Dylan Matthews, host of Vox's Future Perfect podcast, gave away his kidney because it felt like the right thing to do. Learn more about your ad choices. Visit podcastchoices.com/adchoices

KiwiCo is back. They're offering today, Explained listeners, the chance to try out their educational projects for free. To redeem the offer and learn more about KiwiCo projects for kids of all ages, visit KiwiCo.com slash Explained. They're on a mission to empower kids! We're going to the transplant center at Hopkins Hospital in Baltimore, and I'm here to get checked up and meet my surgeon before I give my kidney to a stranger. I'm Dylan Matthews. I'm a writer at Fox, and I host the Future Perfect podcast. I first started thinking about donating my kidney when I was 19.

I was a sophomore in college, I think, and I read an article in The New Yorker called The Kindest Cut. It was by Larissa McFarquhar, and it was about people who gave their kidneys to strangers. And it just seemed obvious I should do this. If you need a kidney, that probably means you're on dialysis. And if you're on dialysis, that means your kidney's failed. If you're on dialysis, you're hooked up to a machine for four hours a day, three days a week, typically. That's typically in a dialysis center or a hospital. It's a physically exhausting process.

You typically can't hold down a job. The death rate with dialysis is 25% in the first year and about two-thirds within five years. That's about the same as brain cancer. So you have a deadly disease. And if you're in that situation, you're on dialysis and you get a kidney from someone, typically your lifespan increases by 10 years. So just like looking at the math, I'm able to extend the life of someone by 10 years. The risk of death in surgery for someone like me who doesn't have high blood pressure is about one in 10,000. It increases my odds of kidney problems, which you would expect, but not that much. And I still have a 99% chance of being okay kidney-wise. Like the way I thought about it was just, what do I have that's going on that I shouldn't take this small risk to myself to give someone 10 years? It's a long process. And I

documented a lot of it using my phone, taking video diaries. Joss Fong on our video team wanted to make a video about it. And I thought that would be a good idea to show people what the process is like. And so she and I were filming stuff sort of as we went. The big thing is that they have to make sure that your kidney is working reasonably well. At this point, I've done two 24-hour urine collections, which are as gross as they sound, and the results were inconclusive. So now I'm going to go get some radioactive particles shot through my kidneys. They just put me in a room at the Hopkins Hospital, and a variety of specialists came in. So there was a social worker who was going to be my advocate. There was a psychologist to make sure I was of sound mind and no one was pressuring me.

There was a kidney specialist who came in to make sure I wasn't taking any medications that would be bad to take on one kidney. I met the surgeon. Eight hours of meetings with various people on various aspects of this. I had to wait a few weeks and I finally got approval. They mailed me a letter saying that I was approved to donate. I took a little video of myself reading the letter with my cat. So this is a letter I got today from Hopkins. Dear Dylan, you have been approved as a kidney donor by our multidisciplinary transplant team at the Johns Hopkins Hospital. On behalf of the Johns Hopkins Comprehensive Transplant Center,

thank you for coming forward as a living kidney donor, and we look forward to assisting you through your donation. And even then, it took a few months at least to schedule when I was going to do it because I wanted to do it so that I could set up what's called a chain. If you need a kidney and you have a loved one who's willing to donate to you, but you're not a match biologically,

there's probably someone out there that they are a match to. The idea with the chain is that you can get that person to donate if you can promise their loved one would get a kidney. You set up a chain where their loved one gets a kidney, and they get it from someone who also has a loved one who needs a kidney, and on and on and on. That has to sort of end somewhere. There are infinite kidneys in the world.

It has to end with someone who's willing to give a kidney and doesn't need a kidney back. And so that's where people like me who can donate to a stranger and not expect a kidney in return can come in and be helpful. These can go really, really long. There was a guy in California named Rick Ruzzamenti who did a chain that got 30 people kidneys. One good Samaritan steps forward to help the sick, setting off a chain reaction of selflessness,

linking 30 people who were willing to give up an organ with 30 who needed a donation to survive. I wanted to help somebody who needed a kidney, and I had an extra one, and it was really simple. It just made sense. No big deal. I knew I wanted to do a chain like that because it was a unique thing that someone in my position could do. It's all happening.

There's someone I've meshed with, and there's a time set where I'm doing the surgery, and it's part of a chain with four transplant centers. And yeah, it's exciting. I'm pumped and yeah, yeah. The surgery was on a Monday. My girlfriend Hannah and I and my dad went up on Sunday on the train, got a hotel. We had to be up at, I think it was 3 a.m., took an Uber over, got mocked up, got in scrubs.

Dylan, we already marked your belly, your left side. We have to mark your left side before we go back. My left or your left? Your left. My left. Your left. I'll clear that up. Met my anesthesiologist,

got some needles put in me for general anesthesia. So it looks like I'm getting an IV in next, and then my dad and Hannah can come back in and visit. And I'm supposed to give my glasses to my dad. That's very important and then i don't remember anything else my dad and my my girlfriend were in the waiting room sort of patiently waiting to see what would happen. The surgeon got out and said to them, Dylan has a beautiful kidney. It's gorgeous.

It's on its way. They're like, is he okay? He's like, oh yeah, also he's okay. Next thing I know, it's a couple hours later. I've woken up in a recovery room. Everything hurts. This is sort of the worst moment of recovery is right when you're out of it. It's mostly the carbon dioxide that they pump into your stomach.

The way that abdominal surgery often works now is three small incisions. One of them is for a camera. One of them is for tools. And then they had what's called a hand port that the surgeon put his hand through so that he could get the kidney and pull it out. The way that they can do this is that they pump your stomach full of CO2 so that your abdominal wall lifts up so that they can survey the landscape and see where they're going. And so the hard thing was the gas pain, just like having CO2 gradually reabsorbed, hitting nerve endings. So I would get these sharp shoulder pains.

The first day was rough, as that probably indicates. But it's one of those things where each day is exponentially easier than the last. Initially, I was not allowed to drink anything. And so the most that they would let me do is dab my lips with ice so that I would not feel totally dehydrated. But by the next day, I was drinking water, Jell-O, gradually building up to solid foods. They make you do a lot of walks to help reabsorb the carbon dioxide. I remember getting lapped a lot by a guy in his 80s who seemed really psyched to be lapping a 26-year-old.

They made you do all these coughs as an exercise to make sure you're breathing right, and there was a teddy bear that you have to hold to your stomach and do coughs to make sure your lungs were going well. I have to do coughs with my cough buddy three times an hour. They also had another thing that was like a lung capacity exerciser where you had to inhale and get this little ticker within a certain region on this little contraption to make sure that you were breathing right.

And so on. Apparently that keeps me from getting pneumonia. Science is a magical thing. One of the things that I had to do before they let me out was they had to make sure that I was peeing right, because the kidney is part of the urinary system. So I would go and pee and be like, hey, I peed. And they're like, we have to double check. And then they would ultrasound my bladder. They were like, there's still some pee left.

You can't fool us. We know there's still pee in there. We're nurses. We have our ways. After I recovered a little bit, Janet Hiller, who is our administrator who did kidney chain operations, showed me that my kidney was healthy, it looked good, and that they had shipped it to Cincinnati for someone to receive. So here's Dylan. His kidney went to the Christ Hospital in Ohio, and then the Christ Hospital donor went to Georgetown, DC.

Then the Georgetown donor went to a recipient at UCLA in California, and then the UCLA donor went to University of California San Francisco Francisco for the last person would have been someone on the waiting list. I remember Janet telling me before I did it, the people she had talked to who had donated said there's some point, and it might be three weeks in, it might be four weeks in, it might be five weeks in, where you just wake up and you realize you feel normal again, that you don't feel like you're recovering from something. And about four weeks in, it might be five weeks in, where you just wake up and you realize you feel normal again, that you don't feel like you're recovering from something. And about four weeks in that happened. I woke up and I was like, yeah, that was a good feeling. And by that point, I was back to work. I was eating normally. And one of the things they ask you when you donate is, do you want to

meet your recipient? I was sort of of two minds on this. I thought it would be very meaningful to meet him. I was also very wary of setting up a weird sense of obligation. Like, he doesn't owe me anything. I didn't do this to help a specific person. I just thought it would be a good thing to do. And so I was tempted to do it totally anonymously, but I eventually decided if they want to get in touch, I'm open to that. And so in March, about six months after I donated, Janet sent me an email with a copy of a letter that the recipient had sent her. I got a letter from my recipient. He was on dialysis for 15 months.

I'm in relatively good shape physically and have high hopes to now live perhaps 20 or 25 years with the kidney which you so graciously gave, which was an excellent match for me. Let me say again, thank you from the bottom of my heart and assure you I will take most excellent care of your kidney. That's all I can really ask. Hey, it's Amit. Amit, it's Sean from Today Explained. How you doing? Hey, great.

How are you? Great. You're my colleague, but we've never met. I know. I don't even know. Are you based in New York? I'm based in D.C. Oh, okay. All right. But you're based in New York. Yeah, I am.

And you have children. I do. We have a 12 and 15-year-old girl. And these two girls I found out last week, big fans of the KiwiCo projects. Yeah, yeah, exactly. Like some things resonate, some things don't. You know, like there's like sort of different personalities. like the Doodle Crate is a little bit more artsy. And so one of our girls was like, oh, really into arts and crafts. And the other one is like a little more tinkery in terms of like science experiments and stuff like that. So, you know, she wanted sort of the more engineering style ones. But you did this all, you got your

KiwiCo subscription in an era before Today Explained existed, is that? Oh, yeah, yeah, no, for sure. We got it like a few years ago. But the thing is now that I know about it, I sort of like recommend it to friends. Yeah, and you can tell your friends when you tell them that they can go to KiwiCo.com slash Explained to try KiwiCo out for free. Yeah, that's true. How about you? Do you have kids or anything?

No. Sorry, I just got kids. Dylan, as a person who has had some bad experiences with surgeries, I am not afraid to admit that surgeries kind of scare me. I don't think I'm alone in this world that surgeries scare me. It's not like donating blood. You weren't scared of surgery? Yeah, I'm a weird person in certain ways.

And so I was probably less scared of it than the average person. Like when I got my wisdom teeth out, I had them knock me out because I wanted to watch them do it and see how they did it. And if you don't have that kind of relationship to surgery, it seems scarier. But it's really not that bad. And you do have to go under. You're under general anesthetic and everything that that entails. But you're out of the hospital in a few days.

I came out and stuff hurt for a while, but things were still basically all right. Okay, so as a weird person who's okay with being in a somewhat painful situation, are you comfortable assessing the risks of a kidney surgery? I know the numbers. I don't feel like I am emotionally on the same wavelength as most people reading the numbers. I read the numbers and I'm like, obviously I should do this. What are the numbers? The benefit is you add nine or ten years to the average lifespan of the person you're giving it to. Yeah. The biggest risk that you worry about is dying, obviously.

In the surgery itself. In the surgery itself. But it happens super, super rarely. The number is 3 in 10,000 and 1 in 10,000 if you don't have hypertension. This is in the United States? This is in the United States. The way that one doctor put it to me is, like, if someone dies in surgery, it's going to be on the news. It's like a major event. But if you are a person who can get pregnant, your risk of preeclampsia and certain complications in pregnancy does go up. The really

significant in your life risks are concentrated among people with uteruses, which is not fair, but is something that I try to say to women, trans men who might be interested in doing this. What about like giving away a kidney, making you at higher risk for kidney failure at some point? Is there a risk there? It does do that, which it would be sort of surprising if it didn't. Yeah. But here's the thing. If you're donating a kidney, you've passed this battery of tests for kidney health and you're a lot healthier than the average person. So the average American, the rate of kidney failure eventually at some point in your life is 3%. And for people who've donated a kidney, it's 1%. What's more, if you do get

that situation, you get bumped up to the top of the transplant list. You know, after tragedies, after major traumatic events where people are injured, people die, you always see this uptick in blood donations and people coming out to do whatever they can. Has there ever been an event where you saw an uptick in kidney donations, or could there ever be some such event like that? I'm not a nephrologist, and so I don't want to rule things out entirely. It's just really hard for me to imagine. Most kidney failure is due to things like type 2 diabetes and obesity in the United States. It's this sort of lurking chronic condition that never emerges all at once

in one big tragedy. It's sort of a slow grinding tragedy that's happening in the background. Does that mean that there will always be this sort of struggle to find kidney donors? I think it means that to some degree. And also, like a blood donation doesn't even like change your day appreciably. Unless you're a wuss like me when you pass out, you know? Yeah. Well, the other thing about blood is that it's legal to buy and sell blood in the United States. When things get really bad, they can just go and buy a bunch more blood. And so it's both more necessary, but also a much more dramatic thing. And if kidneys went that way in America, could we end up creating a system where certain people have an easier time getting organs than

others? Totally. And I think this is a huge fight within the kidney world. There are very vocal people who oppose monetary compensation for kidneys. There are people who are very ardently in favor. And how much would a kidney go for? A kidney would go for like 60 or 70 grand. Wow. So that's like a game-changing amount of money for some people. Well, here's the thing.

We have Medicare for all in America for one disease. Richard Nixon said, no matter what your situation is, Medicare pays for everything kidney failure related. It was this weird lie he did in the 70s. So Medicare has to pay for dialysis for everyone, which is like ungodly expensive. And transplants save so much money compared to that, that they're willing to shell out 60, 70, 80 grand. And that would still save them a lot of money. It's not a question of do we commodify it or not. It's already commodified.

If you're a rich American, you can get a kidney. You just go to India or South Africa or someplace in Brazil. But it becomes this debate almost like the drug debate in the United States. We know this is happening. As long as rich people get kidney problems, they're going to be going and creating these markets. Is there a way that we could use that mechanism in a way that protects the people selling kidneys or donating kidneys in exchange for compensation

and that prevents abuses and prevents it from being a free-for-all? Is there a way? So my ideal world solution, which is many, many eons from being a reality, would be to have Medicare be single buyer. So they would pay out 60 or 70 grand to people who donated a kidney, and then they would assign those kidneys on the basis of need. The rich people couldn't cut the line. And there would be a really hard minimum of,

I would even be willing to go like way above 60 or 70 and do like a hundred grand or something. I wouldn't have felt exploited if someone gave me a ton of money in exchange for doing that. I didn't feel exploited doing it for free. And I think we have to be thinking about a way to increase donations that protects people

and make sure that people are not being pressured into doing it and doing it out of desperation. But something like 40,000 people are dying every year in the United States because we don't have enough kidneys. It's a problem roughly on the scale of suicide or car crashes or gun deaths in the United States. We're arguing against a status quo that is like unbelievably horrible. And it's hard for me to think that we couldn't figure out a system that's better than that.

Do you think money would be enough to get people over the psychological hump of going under the knife to make a donation? I think it would. People do wild stuff for money, man. Right. And like much, much more dangerous. We allow people to be like loggers and big catch fishermen in Alaska. There was a good paper that some folks at Duke did comparing the legality of the National Football League and the illegality of kidney compensation.

Huh. legality of the National Football League and the illegality of kidney compensation. Based on all we know, being an NFL player is so much worse for your health than donating a kidney. Like, it's not even comparable. And we've agreed that because you've got a ton of money for doing it, not only are we going to allow this, but we're going to allow a whole secondary industry where you get paid nothing in college to do this in hopes that you might one day make some money doing this professionally. That's a decision we've made as a society. That's a physical risk we're willing to let people take in exchange for enough money. Now that you belong to like a community of people who have donated their kidneys, do you feel like, I mean, obviously there's like the privilege of health,

but also was there another element of like your privilege that allowed you to do this? Sure. There are a bunch of things that I was lucky to have that helped a lot. Vox has unlimited medical leave. I didn't have any lost wages. That was a big privilege. I also was privileged to be in a job where I don't have to lift heavy objects. You can't lift anything over 10 pounds for several weeks after the surgery.

If you're in a manual profession, if you're doing construction work, and also if you're a parent of small children who you have to pick up, that might not be something you're able to do. So I had the privilege of that not being a problem for me in my life. And like to just the person on the street who might find out that you did this in conversation or like see a scar and ask you what that is and they go like, whoa, you gave your kidney away. Like why would you do that? Do you have like a stock answer? My elevator pitch?

Yeah. It seemed like an easy way to help another person a lot. And then they ask you about how easy it is and I give my whole spiel about how it's not as bad as you think. But that's really the core answer, that it didn't cost me that much, and it helped this guy a lot, and it helped his family a lot. And, I don't know, that was enough for me. Dylan Matthews is the host of the Future Perfect podcast at Vox.

It's all about finding radical ways to make the world a better place. The second season has just commenced. Its theme is philanthropy versus democracy. How all those billionaire donors who want to save the world might not actually be helping at all. If you're subscribed, episode one is waiting for you. It's about Andrew Carnegie, who gave America a whole lot of libraries so they'd forget all about his brutal steel mills. If you're not subscribed, well, we certainly can't be friends anymore.

I kid. I kid. Me. I'm Sean Ramos from This Is Today Explained. Irene Noguchi, Bridget McCarthy, Afim Shapiro, Noam Hassenfeld, Amina Alsadi, and Halima Shah make the show with a little extra help from Brit Hansen this week. Siona Petros is the intern, is the intern, is the intern, and the mysterious breakmaster cylinder makes music for us today explained is produced in association with stitcher and we're part of the vox media podcast network monday's memorial day so the show is back on tuesday thanks to kiwi co for swinging by to support this podcast once more. The KiwiCo people are offering today,

Explain People, the chance to try them out for free. To redeem the offer, all you got to do is go to kiwico.com slash explained, conveniently, the place where you can also learn more about KiwiCo's projects for kids of all ages. Ciao for now.