How many times can the same organ be transplanted?

[kaylasdad99]

My dad went into the hospital yesterday. He had been diagnosed with CHF a couple of weeks ago, and had been being treated with diuretics and a restricted sodium diet. Yesterday morning, my sister saw him, noted that he was looking like he felt like crap, and persuaded him to go to the hospital. The doctors decided to perform some kidney function tests, and learned that he’s in kidney failure (approximately 70% of his kidney function is now gone).

Of course, I immediately offered him one of my kidneys (depending on the results of tissue matching, of course). He turned me down, based on the fact that the doctors haven’t even indicated yet that they want to start dialysis, much less to try giving him a new kidney. And also the fact that he’s just about eighty years old; he doesn’t think a donated kidney would be best utilized in a man his age.

Well, I’m not entirely certain about that; but that’s not what I want to discuss here. What I want to discuss is: if he did accept my kidney, and then died within a few months of non-renal-related causes, what would be the technological impediments to removing the transplanted kidney, and putting it back in me?

Let’s take it as read that he is free of any bloodborne and bodily fluid-borne pathogens.

[Shmendrik]

@kaylasdad99

My dad went into the hospital yesterday. He had been diagnosed with CHF a couple of weeks ago, and had been being treated with diuretics and a restricted sodium diet. Yesterday morning, my sister saw him, noted that he was looking like he felt like crap, and persuaded him to go to the hospital. The doctors decided to perform some kidney function tests, and learned that he’s in kidney failure (approximately 70% of his kidney function is now gone).

Of course, I immediately offered him one of my kidneys (depending on the results of tissue matching, of course). He turned me down, based on the fact that the doctors haven’t even indicated yet that they want to start dialysis, much less to try giving him a new kidney. And also the fact that he’s just about eighty years old; he doesn’t think a donated kidney would be best utilized in a man his age.

Well, I’m not entirely certain about that; but that’s not what I want to discuss here. What I want to discuss is: if he did accept my kidney, and then died within a few months of non-renal-related causes, what would be the technological impediments to removing the transplanted kidney, and putting it back in me?

Let’s take it as read that he is free of any bloodborne and bodily fluid-borne pathogens.

IANAD. The short answer is that they wouldn’t do it, IMHO. I wouldn’t be surprised if the risks of the surgery to return the transplanted kidney outweigh the risks of you continuing to live with one kidney. Also, the kidney would have spent several months in a seriously immunocompromised host, and it could have picked up all sorts of nasty things during that time, so I don’t think you can assume he is free of pathogens.

[Broomstick]

I’ve never heard of it being done.

Keep in mind, between the initial surgery and living in your dad’s body for awhile (‘cause even under the best of circumstances the hosts’ immune system still tries to attack the new kidney) the kidney will have suffered some level of damage. Depending on how your dad hypothetically passes away, the manner of that death might render the kidney useless - for example, liver failure causes all sorts of damage in the body. If he dies of infection the giving you back the kidney could make you sick. If he suffers from low oxygen saturation for a die before expiring that can also damage his organs.

So no, you won’t be getting your kidney back.

That said - if you, as a live donor, wish to donate your kidney to your 80 year old father then, assuming he is healthy enough for the surgery, they’d probably do it. It would certainly be unusual, though.

[rekkah]

I understand your impulse to help your father and I really admire it - I certainly hope I would do the same thing for my dad if he needed it. However, I think you may be jumping the gun somewhat. Depending on a number of factors people can survive for a long time with good quality of life on only 30% kidney function. For comparison, dialysis only gives a person about 5-8% kidney function, so 30% is much much better than a patient on dialysis. If your father’s problems are progressing slowly (or can be improved), he may very well never need dialysis or a transplant.

The risks of having a transplant are far from negligable - it’s major surgery, and the immunosuppression puts the patient at increased risk of infections and cancer (plus requires regular hospital visits and blood testing etc). It may be that for him that even if his kidney failure progresses enough for a transplant to be considered, the risks will outweigh the benefits and it won’t be the best option for him.

I too have never heard of an organ being returned to the donor and think it’s highly unlikely for the reasons Broomstick outlined. In addition, immunosuppressive drugs can themselves damage the kidney. Also, for you the get the kidney back, he would have to die in such a way that they could keep the it functional - if he were in hospital on life support that would be one thing, but if he died outside hospital then I doubt it would survive long enough to be recoverable (or would at least sustain substantial damage, in addition to the damage caused by the original surgery , immune reaction, drugs and any other problems).

[Da_ICON]

@kaylasdad99

My dad went into the hospital yesterday. He had been diagnosed with CHF a couple of weeks ago, and had been being treated with diuretics and a restricted sodium diet. Yesterday morning, my sister saw him, noted that he was looking like he felt like crap, and persuaded him to go to the hospital. The doctors decided to perform some kidney function tests, and learned that he’s in kidney failure (approximately 70% of his kidney function is now gone).

Of course, I immediately offered him one of my kidneys (depending on the results of tissue matching, of course). He turned me down, based on the fact that the doctors haven’t even indicated yet that they want to start dialysis, much less to try giving him a new kidney. And also the fact that he’s just about eighty years old; he doesn’t think a donated kidney would be best utilized in a man his age.

Well, I’m not entirely certain about that; but that’s not what I want to discuss here. What I want to discuss is: if he did accept my kidney, and then died within a few months of non-renal-related causes, what would be the technological impediments to removing the transplanted kidney, and putting it back in me?

Let’s take it as read that he is free of any bloodborne and bodily fluid-borne pathogens.

I am in THE EXACT SAME SITUATION, and also wondered about getting mine back one day (FYI, my father is 63).

Sorry, slight hijack but if I do give him my kidney, what can I expect in my later years if I don’t get it back (as that appears from the responses here unfeasible)?

[Shmendrik]

@Da_ICON

I am in THE EXACT SAME SITUATION, and also wondered about getting mine back one day (FYI, my father is 63).

Sorry, slight hijack but if I do give him my kidney, what can I expect in my later years if I don’t get it back (as that appears from the responses here unfeasible)?

The risk of living kidney donation

Bolding mine.

Long-term mortality

Although increased long-term mortality has not been reported in healthy persons after nephrectomy [11], convincing data on long-term survival of kidney donors were first presented by Fehrman-Ekholm et al. in 1997 [12]. Twenty years after kidney donation the observed to expected mortality of these 430 donors was 0.76 compared with the background population adjusted for age and gender. In a larger series of 1332 Norwegian kidney donors followed up for an average of 32 years, we confirmed a survival benefit among the donors. The relative risk of mortality was 0.7 for female and 0.5 for male donors compared with the background population [13]. An increased survival may not be surprising as the donors are positively selected and screened for disease. Therefore, it is of further interest that the Norwegian male donors had the same relative risk for mortality as in another screened population accepted for health insurance. Thus, there are no indications that kidney donation has any negative impact on long-term survival.

Long-term morbidity

Hypertension and kidney impairment are potential risks associated with kidney donation. Earlier studies found little or no effect on blood pressure [2,14]. In a meta-analysis of all studies comprising more than 3100 nephrectomized patients and 1700 appropriate controls, no increment in incidence of hypertension was found. However, there was an average increase in blood pressure of 2–3 mmHg and a further increase in systolic pressure of 1 mmHg for each decade following kidney ablation [15].

Glomerular filtration rate (GFR) is obviously reduced following nephrectomy, the loss of function is on average 17 ml/min with a compensating contralateral kidney [15]. The same meta-analysis actually demonstrated a tendency for improved filtration of ~1.5 ml/min/decade. It is conceivable, however, that GFR will eventually show a natural decline long-term. Proteinuria was negligible after donation and increased by 75 mg/day for each decade. Kidney functional reserve persists after kidney donation but is probably somewhat reduced [16].

Although most centres find the risk of kidney donation acceptable, the risk should not be neglected. Donors with low GFRs may be at particular risk and graft survival of the recipients is decreased with GFRs under 80 ml/min [17]. Relatives of recipients with end-stage kidney disease may also be genetically susceptible for kidney disease, for example diabetes or SLE or for progression of such disease. We have experienced seven cases of end-stage renal disease among our 1800 donors suggesting that this may be true. Most cases had primary kidney disease and not sclerosis due to hypertension or hyperperfusion [18]. Although more long-term data are needed [19], the overall risk of progressive renal failure due to kidney donation appears to be acceptable.

[Zsofia]

Well, assuming you don’t, say, get shot in your only remaining kidney.

[Da_ICON]

@Shmendrik

risk of living kidney donation | Nephrology Dialysis Transplantation | Oxford Academic
Bolding mine.

So if I continue training, saying my prayers and taking my vitamins (in other words, healthy living :D) I can reasonably expect to live out my life as long as I would if I had 2 kidneys…

[Broomstick]

Yep, more or less. There is a risk, but if you take care of yourself and don’t have genetic predisposition to kidney disease it’s small.