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ORGAN ORGAN
DONATION DONATION

I am grateful to be practicing in San Antonio. Our city has been on
the forefront of championing the living donation path in the attempt
to improve access to kidney transplantation. For over 13 years now, our
city has seen the highest rates in the country of live donor kidney trans-
plants. San Antonio also hosts the largest single-center paired-donor
exchange program in the country created to improve access to living
donor kidney transplants for patients with non-compatible donors.
Further, our city has seen one of the highest numbers of transplanted
ethnic minority patients in the U.S.

This is, without a doubt, all amazing news. But why am I not
at peace?

Currently in the United States, over 100,000 patients await a life-
The End-of-Year Thoughts of a saving organ transplant, and around 90,000 of those are hoping for a

kidney transplant. Yearly, only about a quarter of that number are trans-
Kidney Transplant Professional planted, with about one-tenth of that number either dying while wait-
ing or removed from the list because they are too sick to undergo a
kidney transplant surgery. Sadly, the proportion of patients awaiting
transplant, who have lost a previous one, is steadily rising. The overall
By Matthias H. Kapturczak, MD, PhD wait times have been increasing. This is troubling knowing that the
F ollowing a well-traveled tradition of Dickens’ “A Christmas donors — the families agreeing to donate the organs of their deceased transplant survival. pressure not only on transplant professionals but also the entire medical
sooner the transplant can be performed, the better the patient and
The true miracle of transplantation to me, however, are the organ
Carol,” December always awakens in me the need to reflect on
End-stage kidney disease (ESKD) affects our state the most — over
the past before I look at my current situation and, finally, gather
the courage to ponder on what the future might bring. As most of my loved ones and, above all, the living donors. This is the part of medicine 10 percent of the U.S. ESKD population are Texans. This is, in no small community and the society at large. The above-mentioned ethnic dis-
now all too frequently overlooked — the non-scientific, the un-reim-
parities, for example, do not vanish after transplant. Disease prevention
part, related to staggering rates of diabetes. Over 60 percent of patients
time seems to be dedicated to work, a good portion of this reflection bursed, the “humane” part of our healing endeavors. It is incredibly re- listed for kidney transplant in Bexar County have lost their kidney effort alone is still quite underutilized, and it will require an “it takes a
pertains to my professional life. freshing to see true selflessness, empathy and love at work. It is not just function due to complications of diabetes. This is painfully true espe- village” approach.
For over 25 years now, kidney transplantation has been my passion. family members, but friends, co-workers and the non-directed donors cially for our Hispanic patients, who also represent over 60 percent of
Although I have missed the true pioneering times, I have been fortunate who just want to help someone. Even if things do not work as hoped, the kidney transplant wait list. Although numerically superior, our His- Living donors are still the best.
to be able to witness the miracle of organ transplantation having now the donors rarely have second thoughts. I have recently asked a young panic community is not immune to known national trends in ethnic
followed a few thousand kidney transplant recipients, witnessing their man who donated a kidney to his father, that passed away two weeks healthcare access disparities. Even here, where over 60 percent of the They have contributed more than their fair share — let us work on
suffering prior to the life-saving surgery, and enjoying their recovery later, if he had any regrets. He replied, “Just seeing the hope in his eyes population is Hispanic, Hispanic patients are less likely to get trans- ours. We are, at the end of the day, all in this together — a fact that
and return to a full life: children given the chance to grow up without and joy of being off dialysis was enough for me; I would do it again, planted, which is true for both deceased donor and live donor kidney both frightens me and gives me hope, all at once.
being tethered to dialysis machines, men and women returning to work without a doubt.” This is the part of medicine that is very humbling to transplants. They also wait longer on the list. At least a good part of it
from disability, children being born to transplanted parents, families me and makes me want to get up every day. A powerful cure for pro- seems to be related to general healthcare access as well as a variety of Matthias H. Kapturczak, MD, is the Medical Director of the
growing where they once could not. fessional “burnout,” as I have found it. societal issues. The encouraging fact is that, among the living donor Methodist Transplant Institute | Kidney and Pancreas Transplant
Without a doubt, I am deeply grateful to have been able to partici- The year 2024 will mark 70 years since the first successful living kidney recipients, these differences appear to significantly dissipate. Program and Transplant Section Chief at the Methodist Hospital
pate in medicine of the 20th and 21st centuries. Enormous technolog- donor kidney transplant, which was performed in December of 1954 | Specialty and Transplant in San Antonio, Texas. He is also a member of
ical and pharmaceutical advancements have been made in all areas in Boston between identical twin brothers. Almost two years prior to Now a quick look into the future. And this gives me a lot of the Bexar County Medical Society and serves as the Co-chair of the Physi-
making organ transplantation possible. The 20th century witnessed that, a mother donated a kidney to her teenage son in Paris, France — trepidations. cian Health and Rehabilitation Committee of BCMS. A native of Poland
ground-braking contributions of intellectual giants making overcoming the kidney lasted only three weeks. The development of effective im- and Germany, he obtained his medical degree from the Free University of
the immunological barriers possible. The first six of the Nobel prizes munosuppression allowed the process to continue and, since that time, The success of organ transplantation has become its own worst Berlin, Germany and internal medicine/nephrology training at the Uni-
were awarded to scientists, who contributed to the areas of immunol- more than 180,000 living donor organ transplants were made possible enemy. The ever-growing demand for organs will require other solu- versity of Florida in Gainesville, FL. Prior to arriving in San Antonio, he
ogy and transplantation, and it did not stop there. Organ transplanta- in the U.S. alone. Living kidney donation affords a superior patient and tions and approaches (induction of tolerance, biocompatible devices, was a transplant fellow and faculty member at the University of Alabama
tion became the primary treatment preference for management of transplanted organ survival, and allows for higher rates of early and etc.), the development of which is sadly lagging. We will have to work at Birmingham, AL. His passion is expanding access to and overcoming
end-stage failure of many organs. pre-emptive transplants. very hard to prolong the function of the “gift of life.” This puts extra barriers to kidney transplantation for everyone in need.

12 SAN ANTONIO MEDICINE • February 2024 Visit us at www.bcms.org 13