by George Taniwaki
Today, I had my (rescheduled) first appointment at the University of Washington Medical Center. The visit consisted of a physical exam by a nephrologist, an interview by the donor advocate, and a variety of medical tests that I’ll describe later.
My second interview is with the living donor advocate, Paige Kayihan, a clinical social worker responsible for representing my interests during the transplant process. The purpose of the interview is to ensure that I am making my donation for the “correct” reasons (altruism) and not for personal gain, ego gratification, or because I don’t understand the risks.
Paige Kayihan (left) with Ethiopian refugee children she mentors. Photo from International Rescue Committee
The interview is done jointly with my wife. Ms. Kayihan begins her interview by asking if I understand that having this surgery will bring me no medical benefits. (Yes.) Do I understand that surgery has rare but serious risks? (Yes, and given my background in statistics, probably better than most.)
Do I understand that I can decline to donate at any time, up to the day of the transplant surgery, even in the operating room, and there will be no consequences. The recipient will never know why the surgery was cancelled. (Yes.)
Do I understand that if I switch insurance providers after my operation, that any complications may be considered a pre-existing condition and not be covered? (Yes, that makes sense, but I didn’t know that until now. Wow, the potential financial costs that may result from post-operative complications are much higher than I thought. For an additional comment on the cost of post-operative complications, see an Aug 2009 blog post.)
Then she asks some emotional stability questions. Do I expect any emotional, financial, or social status benefits from my donation? (No, but would happily accept any that result.)
Am I under the care of a psychologist or psychiatrist. (No.) Have I ever had depression or anxiety? (No, but I can get depressed or anxious.)
Do I smoke, use alcohol or drugs? (I drink beer and wine, but only the good stuff.) Have I ever used illegal drugs? (Gee, yeah, I went to college in California in the ‘70s.) Which ones? (I don’t remember. But only because it’s been so long ago, not because my brain is fried.)
She asks if we (my wife and I) have discussed my decision to donate. (Yes we have.) Does my wife support my decision? (Yes, though she has concerns, especially if the surgery is not performed locally.)
Have I told my family about my decision to donate? (No, I haven’t, but I guess I will now.) Why haven’t I? (I’m not sure. I signed up to be a donor almost two years ago, but it never seemed pertinent enough to tell them until now.) Am I close to my family? (Yes, my parents and brother live in Denver, but I’m in contact with them regularly, by phone or email. I have cousin who lives here in Seattle and see her often.)
Would I continue to pursue the transplant if my wife asked me not to? (No, but I don’t think she will say that.)
I also have interviews with a nephrologist (part 4), a transplant surgeon (Oct 2009 and Mar 2010) and a psychiatrist (Feb 2010). All four interviewers must agree that I am a suitable candidate before the surgery can proceed.
For more information on becoming a kidney donor, see my Kidney donor guide.
[Update: The new Affordable Care Act signed by President Obama on Mar 23, 2010 will forbid insurance companies from excluding pre-existing conditions from coverage. This may improve insurance portability for kidney donors. The ban on excluding pre-existing conditions doesn’t kick in until Jan 2014 though.]