Living kidney donation: a gift for life

The number of organ donations is far too low, patients wait decades for a transplant - and often in vain. Michael W. was lucky. He got his best friend's kidney

Günter W. lifts his light green surgical shirt and pats himself on the flank. "The right one, that's it," he says and laughs. In a few hours, doctors at Halle University Hospital will cut a kidney from his body and plant it in Michael W.'s. If everything goes well, she will immediately take over the tasks that his organs are no longer capable of. Michael has been on dialysis for seven years. "I wouldn't be without the machine," says the young man. Until the call comes that a donor kidney is available, he would have to wait years. If it weren't for Günter.

Around 8,000 people in Germany are waiting for a new kidney. Last year 1364 received an organ from a dead donor, 557 from a living one. Close relatives in particular are eligible as donors. However, people who are "particularly close to the recipient", as stated in the Transplantation Act, can also donate.

A cross on every stomach

While Günter is talking, a doctor enters the room and draws a cross on his side. This is where the kidney is taken out. Michael gets a cross on his stomach. That's where the kidney goes in. "Then you have a lump on your stomach from me," jokes Günter. Laughing, joking, that's their way of dealing with difficult things.

However, Günter didn't feel like laughing when he found out about his friend's illness. When Michael was in his late 20s, a doctor accidentally discovered that the kidneys were not working properly. "Maybe because of a dragged-out flu," he suspects. The young, sporty man doesn't worry at first.

When the kidney values ​​are tested again, it is too late. Michael is dependent on blood washing. He has to go to the hospital three times a week for four and a half hours. "After that you are totally exhausted," he reports. Kidney failure also means being thirsty all the time. Michael is not allowed to drink more than half a liter a day. His kidneys are no longer excreting fluids. There is also a strict diet. Too much potassium - and your heart could fail.

His wife, whom he met while on dialysis, would donate a kidney. But she has two children. "The kidney specialist immediately said the risk was too great for him," says Michael.

When Günter found out that he too could donate, he quickly realized: I'll do that. Michael doubts. "You can talk a lot. At first I didn't believe it." He only slowly realizes that his friend really wants to give him a new life.

Long list of investigations

Especially since the way was not easy. Blood tests, heart echo, abdominal CT, kidney scintigram: Günter can hardly remember the long list of examinations. After all, his kidney doesn't have to be just for Michael. It must also be established that his body is able to do without the organ.

In order for a healthy person to be able to donate an organ, an ethics committee must also approve. It consists of a doctor, a psychologist, and a lawyer. Everyone asks questions: first donor and patient together, then each separately. It has to be established that Günter's decision is voluntary and that he does not receive any money for it. In addition, it must be clear that both of them cope psychologically.

Interview with the Commission

The experts want to know how long they have known each other. Whether they are having serious discussions about what they are up to. What if the surgery is unsuccessful? What if Michael doesn't take his medication regularly and loses the organ? "I said: That's his kidney - and his responsibility," said Günter. But was that what the experts wanted to hear?

When Günter leaves the room, he has tears in his eyes. Michael also comes out of the questioning dejected. "I thought they said no." But it turns out differently. The Commission wishes them both good luck. The door to the hospital room opens, a nurse pushes in a machine: a dialysis machine. It could be the last blood wash for Michael - for many years, maybe even forever. Are they excited?

Michael waves it away. "They know what they're doing." Only one thing, that would be tough: "If you take out Günter's kidney and my body rejects it." His friend would have sacrificed an organ for him - in vain. Better not think about it.

The next day, just before 9 a.m. While the arms of the surgical robot are being brought into position in the next room, the surgeons are freely dissecting Günter's kidney. You are looking at a monitor to which a camera transmits images from inside the body. The interventions are carried out in a minimally invasive manner. "We are very proud of that," says Professor Paolo Fornara, transplant expert and head of the urological clinic at Halle University Hospital. This saves the donor an almost 20 centimeter incision. The recipient's risk of wound infections is reduced. Since his immune system is inhibited, this is particularly important.

The kidney comes

The hot phase begins at 10:32 a.m. The kidney's blood vessels are pinched off. Now every move has to be right. It can take a minute, at most a minute and a half, until the doctors have put a cold infusion into the organ that preserves it. "The kidney is coming," calls out surgeon Dr. Nasreldin Mohammed. He carefully pulls the organ out of his body through a small incision, holding it in his hands like an injured bird that needs help quickly. The medical team is already bending over it, rinsing it, carefully sewing it into a cooling coat made of a belly cloth and ice. It will only warm the blood in Michael's body again.

It only takes a few minutes to get to that point - one reason that the chances of success of a living donation are excellent. However, not only has the number of dead donors decreased dramatically in recent years. Living donations are also carried out less often. "The whole of transplant medicine is in crisis," laments Fornara. One consequence: the waiting times for an organ continue to increase. "And it's not like waiting for a train. It means complications, suffering, dying."

Dialysis enables survival. In the long run, however, the body suffers. When patients receive an organ, the damage is often irreversible.

High-tech assistants in action

"The system needs a package of corrections," demands Fornara. In his opinion, the first big step would be the so-called contradiction solution: Those who do not want an organ removal after their death should have to speak out clearly against it. That Federal Health Minister Jens Spahn has now initiated a reform - long overdue for Fornara.

In the operating room next door, everything is already prepared for the insertion of the organ. Surgeon Dr. André Schumann is sitting at a console a few meters away from Michael. Using a joystick, he controls the operating room equipment, in which the robot's arms end, without trembling and accurate to a fraction of a millimeter. The high-tech assistant makes it possible to insert the organ in a minimally invasive manner. According to the clinic's first studies, the new method actually has advantages for the patient.

At 12:05 p.m. the vessels and ureters are connected. The clamps are opened, the organ fills with Michael's blood. Now it's his kidney. In the corridor in front of the operating room, a nurse wipes the number 2050 off a white board and replaces it with 2051. This is how many kidneys have now been transplanted in the hospital. "We always change that immediately," she says. If it is forgotten, it is considered a bad omen among the employees, she admits with a smile.

Life like before the illness

The next day, Günter in particular is exhausted, while his friend would like to get up. "Everything is fine," both assure.

Two months later, the friends are in rehab together, just as they imagined. Fitness in the morning, then swimming, later a walk by the lake. "I didn't even know that I could get that far down," says Günter. He used the time here to quit smoking. After all, he wants to take good care of his remaining kidney. He doesn't feel that he only has one left. What is annoying, however, is the amount of bureaucracy with the health insurance companies.

Since the transplant, Michael has had to take drugs that inhibit his immune system so that his body does not reject the new organ. Otherwise he can live almost as he did before the illness. When he came out of the clinic, it was first time to celebrate. "My body has a completely different strength again," he says. Professionally, he now wants to make a fresh start.
The organ donation has not changed the friendship of the two young men. "We squabble as we did before," says Günter with a laugh. They just stay what they were: pretty best buddies.