Hi all,
I am a male in my late 20s who has been undergoing testing for kidney donation for the past few months and was recently approved by the transplant center. The testing went very well; however, there was concern about my ten year history of hypertension (dad had it in his early 20s as well). I feel conflicted due to the long-term health risks of donating in my situation. On the other hand, I am not sure if there are any other options.
From information I found perusing posts on the site, I chose to see an independent nephrologist as well, who recommended that due to my young age and hypertension, I should not be donating (he recommended that donors with hypertension only donate if > 50 years old since the long-term risk of living with one kidney is greater in younger donors). In addition, the procedure would cause my blood pressure to increase further (the transplant center noted this as well). It is well controlled on a small dose of an ace inhibitor currently; however, I am worried that it would rise after donation, which could put me at a greater risk of kidney disease in the future, especially considering my family history (mom has end stage renal disease in her 60s) and reduced kidney function post donation.
Even needing to control my blood pressure with multiple medications could be problematic as I am fairly active and enjoy running long distances (up to 50 miles so far, but working on getting to 100 for the Leadville ultra), so taking certain classes of blood pressure medication could make this impossible (diuretics affect electrolyte levels and beta blockers slow heart rate).
When I spoke with my mom (I mentioned everything except for the approval part), she seemed understanding but also wanted to spoke with the nephrologist who was against it and gain access to my medical records. Ever since she asked me to donate, she has been a bit pushy about the whole thing, including trying to expedite the process (I was doing contract work at the time and obviously had to wait until I had a full time job with good health insurance and PTO to begin testing) and inquiring with my transplant team about my status (which is against HIPAA regulations). I know that she is just scared about her own health, and I am doing everything in my power to help her, but I don't want to end up resentful if I have significant long term health issues from this. Her pushiness just makes me have more reservations about the process.
Other family members seemed upset, acting as if it would be a burden just to take a few days off from work for testing. I'm the only member of my family that has volunteered to be tested, taken time off for testing and to take care of my mother (I haven't used any vacation days on myself), and spent thousands of dollars on medical tests (had the independent nephrologist appt and a renal artery scan before my deductible kicked in). I realize that these are small sacrifices (especially compared to donating a kidney), but I do feel a bit unappreciated. Everyone seems to think they have the right to come up with any excuse not to consider donation, but when I have a legitimate medical reason to be concerned (which I can do nothing about), they get upset and defensive.
Do you guys think it would be beneficial to get a third opinion from another nephrologist? This seems like the best way to make an objective decision on the matter. If I try to go with emotions only, I'll feel obligated to help my mother (and guilty if I don't) but also resentful towards her pushiness and the rest of my family's lack of empathy towards my situation. I think that getting as unbiased of a medical opinion as possible might be the only way to make a decision that I can live with.
If my mom's partner is a good candidate, then I think that might be the best option. If the third nephrologist says it's safe for me to donate and my mom's partner is not eligible to donate, then I think I should donate. If my mom's partner is not a good candidate, and the third nephrologist says that I should not donate, then we're in a bad situation, but I'll at least know it's too risky of a procedure for me to go through with.
What do you guys think? I feel cowardly for having these conflicted feelings, especially when the transplant center approved me as a candidate (they have been fantastic throughout this whole process by the way: honest, resourceful, compassionate, and patient). However, as the independent nephrologist noted, there is not a whole lot of data about younger hypertensive donors (donors > 50 with well controlled hypertension do as well as other donors in follow up).
Thanks for all of your help guys.