Saving lives and climbing mountains with Matt Harmody, MD

Many thanks to Matt Harmody, MD, for appearing as a guest on “The Art of Medicine with Dr. Andrew Wilner.” Matt is a retired ER physician and a living kidney donor. At age 56, he donated a kidney to a perfect stranger.

Matt is also a mountaineer who joined a record-setting team to summit the highest peak in every US state, all to raise awareness for living kidney donation.

During this 50-minute discussion, Matt explains why he donated a kidney, the rigorous screening process for kidney donors, and why everyone should consider a live-saving kidney donation. A strong advocate for living kidney donation, Matt chairs the board of the National Kidney Donation Organization. 

Matt also gave us a taste of his new book, “Ascending America,” a true story of courage and achievement.

To contact Matt, go to:
www.mattharmodymd.com

If you need a kidney, or are considering a donation, find resources for donors, recipients, and family members at the National Kidney Donation Organization: Www.nkdo.org and at the National Kidney Registry: Www.kidneyregistry.org 

#kidney #kidneydonation #transplant #organtransplant #artofmedicine

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Transcript

[Andrew Wilner, MD] (0:08 - 1:18)

Welcome to the Art of Medicine, the program that explores the arts, business, and clinical aspects of the practice of medicine. I'm your host, Dr. Andrew Willner. I've planned a great program for today, but first, a word from our sponsor, locumstory.com.

Locumstory.com is a free, unbiased educational resource about locum tenens. It's not an agency. LocumStory answers your questions on their website, podcasts, webinars, videos, and they even have a locums 101 crash course.

Learn about locums and get insights from real-life physicians, PAs, and NPs at locumstory.com. Today, I'm pleased to welcome Dr. Matt Harmody. Matt has an interesting story.

In 2017, he donated kidney to a stranger. Through the National Kidney Registry's paired exchange program. That decision led to a series of mountain climbing adventures with other kidney donors and his new book, Ascending America.

He's here today to tell us all about it. Welcome, Dr. Matt Harmody.

[Matt Harmody, MD] (1:19 - 1:21)

Thank you, Andrew. Glad to be here.

[Andrew Wilner, MD] (1:22 - 1:28)

Okay, Matt, so I know that you are an ER physician. Are you still practicing?

[Matt Harmody, MD] (1:29 - 1:31)

Andrew, I've been retired for about three years now.

[Andrew Wilner, MD] (1:34 - 1:48)

Someday, I'm going to have to retire. Maybe after the show, you can give me some advice because I know it's not an easy transition. Just tell us a little bit about your training and what you used to do as an ER doc.

[Matt Harmody, MD] (1:49 - 4:58)

Sure. I'll answer in part your question about retiring. My first suggestion and probably most important is retire to something and not from something.

I'll just leave it at that. I could probably talk for quite a bit about retirement decision making. It's a little different for everyone, certainly.

But yes, my background, I started actually as a chemical engineer out of undergraduate and through some life experiences, namely my father's dealing with chronic kidney disease and dialysis, it led me to go back to medical school at age 30. And I chose a career in emergency medicine. I just enjoyed knowing something about everything and being able to manage anything.

And as the saying goes, you become an emergency medicine, the jack of all trades and the master of none. So I relied heavily on a specialist like yourself, Andrew, to help solve complicated patients with involved medical decision making. But I moved to North Carolina and had practiced for about 25 years, large community hospital setting, multiple hospital system, and really, of course, a wide range of patients through that time.

I eventually became our practice's president. We were a moderately sized democratic group and enjoyed that leadership role. Most physicians aren't trained for management or leadership roles.

So having had a remote MBA degree and an interest, I think people, most of my partners took one step back and I was in the front of the line. But that was an enjoyable experience. And I was able to retire at a relatively early age from clinical practice.

As you had mentioned in your introduction, I donated a kidney to a stranger in 2017. And I became very interested in doing advocacy work around living kidney donation, educating, mentoring potential donors. And it became such an avocation that I had a hard time doing both full-time clinical practice and leadership roles and advocacy work.

So as I'd mentioned a few minutes ago, I retired to something and that being essentially full-time living kidney donation advocacy. And how old were you then? I was 59.

I probably held on a little bit longer than I might have otherwise. Of course, that time, as I'm sure you can relate to, was the COVID pandemic. And I just didn't feel right in my heart of hearts to retire.

[Andrew Wilner, MD] (4:58 - 4:59)

Yeah, you were needed.

[Matt Harmody, MD] (5:00 - 5:22)

Yes. And I just felt like I'd be deserting my partners, my patients. So I worked through about the first 18 months of it.

And it became a little bit more settled, certainly wasn't behind us at that point in time. But I continued in the leadership role with our physician group for another six months.

[Andrew Wilner, MD] (5:23 - 5:26)

And how old were you when you donated the kidney?

[Matt Harmody, MD] (5:27 - 5:29)

So I would have been 56.

[Andrew Wilner, MD] (5:30 - 5:36)

Okay. So not a young person, certainly a mature, it was a mature kidney.

[Matt Harmody, MD] (5:38 - 6:49)

Yes. And there are pros and cons to that question that you're kind of alluding to. I've met people in their 20s that are in college that have donated a kidney.

And that's just really awe-inspiring. I think back to how mature I was at that age. And I was lucky if I could manage myself, let alone make a decision like that.

I think that I was more comfortable having a career in place. Our boys were well into college. And I just, we can talk about my father and that personal experience, but every dialysis patient I saw, and it was nearly every shift, as you well know, they have very complicated medical histories.

And usually it's not just kidney failure. They all reminded me of my father and what he went through. And I just finally reached a point of, you know, not why should I, but why not?

There was really no reason not to. So that led to my decision at that time to donate.

[Andrew Wilner, MD] (6:50 - 7:33)

Yeah. That's kind of amazing. You know, it can't be a coincidence, right?

That your father was on dialysis and that you ended up donating a kidney. On the other hand, you know, you were doing a lot to help people with kidney failure, you know, every day in your day job. It's not like, you know, you weren't contributing and doing your most.

And, you know, donating a kidney is probably another level. That's a step above where most people are going to go. You only have two of them, right, at birth.

And so that's half your kidneys. And some people need two kidneys, right? Particularly as they get older.

Can you tell us about that? I mean, do you really need two kidneys or one kidney?

[Matt Harmody, MD] (7:33 - 10:44)

Let me give you my father's story briefly. And then we can certainly talk about kidney capacity and how we're designed as humans and what's all involved with donation. So my father at age 50 got dragged into the Cleveland Clinic by my mother.

He's pretty strong-willed, type A personality, and he didn't do much that he didn't decide upon himself. Unfortunately, one of those decisions was for him not to see a primary care provider on a regular basis. So I was away at college, final exam week, got an unexpected call from my mother.

He was at the Cleveland Clinic, kidneys, complete failure, and they were putting him on emergent dialysis, which, especially in his case, was life-saving. And that began the downward spiral of his life and health. He was an outdoorsman, practicing attorney, involved in local politics, and all those activities just disappeared overnight.

He did do what's called peritoneal dialysis, which is an exchange process that, while you don't need sterile conditions, you need to be in relatively clean conditions. So that means at home, in a clean room, not in a public restroom, for example, so he no longer could take cases that might go to court, because if he were in court all day, he wouldn't be able to do his exchanges. Now, there's a lot more liberty and freedom with peritoneal dialysis, but that eventually became not an option for him, so he's back on hemodialysis.

And I'm sure most of your audience knows, but that's three times a week, four hours in a chair, just surviving the rest of the day, recovering the following day, and then rinse, repeat, you're back at dialysis. And he reached a point, Andrew, at about age, well, at age 59, that he didn't want to continue with that lifestyle. It just completely drained him, and he made a decision to withdraw dialysis care at that time.

And as, again, I'm sure everyone knows, within a very short period of time, he passed. Through all that, he never wanted to consider a living kidney donor, and I'm the oldest of three siblings, and would have been on the short list. He also had two brothers that could be considered.

But as he reminded us, he felt he had lived a full life and didn't want to risk the life of someone else by having them donate a kidney to him. So, it always stuck with me as a missed opportunity. Of course, it led me to go back to medical school, and then eventually coming to the decision that, you know, if I couldn't help my father, I could help someone else.

And as I became a little bit more mature and wiser, I didn't so much see that as a missed opportunity, but as my dad being selfless and allowing me to make a difference, save someone else's life.

[Andrew Wilner, MD] (10:46 - 11:07)

Wow. So, a lot of strong-willed people in your family. I mean, those are big decisions to refuse, basically, the transplant option, and knowing that, you know, you turn off the dialysis machine, maybe you got a week or two, and that's the end of that.

That's a big decision.

[Matt Harmody, MD] (11:07 - 11:31)

Yeah, but it certainly was. And as far as kidney donation goes, you know, the process of evaluation of a prospective kidney donor is quite extensive, as you might imagine. And only about one to two out of a hundred of everyone that puts their hand up to say, I want to consider kidney donation, actually makes it through the process.

[Andrew Wilner, MD] (11:31 - 11:32)

Oh, really?

[Matt Harmody, MD] (11:32 - 13:08)

And again, you know, the medical community feels that there's no benefit to the donor. Certainly, all the benefit goes to the recipient. And they are going to be ultra-conservative, in my opinion, about approving someone for donation.

And I would push back a little bit on that. And I think I've received as much benefit, if not more, from being a living kidney donor than my recipient. It's just a feeling that you have every day, especially in the mirror, noticing your incision.

It just reminds you of being able to make a difference in someone's life. And I think those benefits, while maybe not too easy to quantify, are certainly there. So, yeah, the process is very rigorous.

And most centers consider anyone from age 21 to up into their 70s. I know at least a couple of donors that are 70 plus. And some of the philosophy there, Andrew, is that if you've got great kidney function in your 70s, you're very likely not to have any issues with chronic kidney disease as you have a shorter lifespan remaining than if, say, you're in your 20s.

And I've had transplant surgeons telling me I'd rather have a relatively healthy 70-year-old than someone that's...

[Andrew Wilner, MD] (13:08 - 13:10)

Really? So, a proven kidney.

[Matt Harmody, MD] (13:11 - 13:29)

Yes, versus someone that maybe has some early physical challenges. Maybe they're diet-controlled diabetes. And if you're in your 20s facing those conditions, that's going to be a struggle to get your kidneys to the finish line, as you could say.

[Andrew Wilner, MD] (13:30 - 13:49)

Well, that's what I was going to ask you is I'm surprised that so few people qualify. What are the things that... Is it psychological things that disqualify people or borderline diabetes, like you say?

I would think most people are healthy, but we're down to two out of 100. So, what happened to the other half?

[Matt Harmody, MD] (13:51 - 19:10)

Yes. It's multifactorial, as you might expect. The extensive evaluation includes, of course, a physical evaluation, but also a psychological one.

There's a lot of absolute contraindications, which, again, are almost always... Every transplant center generally would be in agreement with that. So, type 1 diabetes is certainly an absolute contraindication.

I somewhat joke with folks that only having one kidney is an absolute contraindication. Yes, I'm ruled out, right? But then there's a lot of relative contraindications.

So, type 2 diabetes now is they're starting to expand the ability of people that have well-controlled, maybe single medication, type 2 diabetes, not on insulin, given consideration for donation, hypertension, diabetes and hypertension being the two biggest risk factors for chronic kidney disease development. As long as that's well-controlled, usually on one or two medications, that patient, that individual would still be a consideration. People that have mental health histories are usually excluded, and some centers are more strict than others with respect to that.

A cancer diagnosis is usually a contraindication. And then people go into their series of testing, and another relatively common example would be unequal size, and that's size of function of your kidneys. And generally, the rule is about 60-40.

So, if you have a kidney that's, say, 65% function in your body and the other only being 35%, quite honestly, no one wants your 35% kidney, right, including yourself. So, that would be an absolute contraindication as well. So, as you start ticking those boxes off, it really whittles the list down considerably.

And I think also, Andrew, people have to understand in that list, you know, if someone in their circle needs a kidney, for example, they may have 5, 10, 20 people want to be considered for a living kidney donation. And some people, and I've mentored, you know, well over 100 potential kidney donors in my advocacy work, so I have not, you know, more so anecdotal information, but some of them are reluctant participants, and it's almost that they hope that someone else qualifies to be a donor before they do. And I wish we could hold on to those other 19 people in that example to have them consider donating to a stranger like myself.

And there are a lot more protections and kind of enticements, maybe a strong word, but encouragement for people to do that these days than there used to be. And we can talk about those, for example, there's a voucher program which has been put in place by the National Kidney Registry and other paired exchange programs since I donated. And that program briefly is, when I donated, I actually have two nieces that are at higher risk for developing kidney disease, and they were teens, pre-teens at the time.

And my brother and sister rightfully asked the question of, well, what if they need a kidney? In this time now, you could get what's called a voucher, and you could, there's primarily a main family voucher, so I could name five, up to five individuals that would get stronger consideration, and I'd be able to give them a voucher, and they would move much closer to the top of the kidney transplant waiting list if they ever needed a kidney. So, that is a great protection.

Organizations like the National Kidney Registry are trying to eliminate the disincentives that do exist to become a living kidney donor. Wage reimbursements, another great example. I actually don't remember.

I'm not sure that, I don't think that was in place. Of course, you know, being a physician, I could be off for the four or so weeks without any financial impact, so I didn't have any wage reimbursement. But nowadays, wages can be reimbursed, so it helps protect people to take the time off necessary.

And that can be as short as a few weeks. If you're more of an office-type perfection, it's up to six to eight weeks, especially if you're kind of, you do a lot of physical work, and my example to folks is always the UPS driver. You're up and down out of the truck all day lifting packages.

You're going to be out for eight weeks without question.

[Andrew Wilner, MD] (19:11 - 19:16)

Because it's a pretty major surgery to get in there and get the kidney.

[Matt Harmody, MD] (19:18 - 20:46)

Yes, it's a major surgery. It requires general anesthesia. The recovery is usually pretty short in duration, and of course, you gradually work your way back to your pre-surgical fitness level.

For me, that was pretty unremarkable. I was in the hospital a couple of nights. I was up in a chair that same afternoon, my surgery in the morning, walk in the hospital halls the next day.

I was very anxious to get moving and get out of there. It's my first and only time being a patient overnight in the hospital. I'm walking a few miles within a couple weeks, and I do a lot of endurance activities, and at the time was running some ultramarathons.

So my final stamp of full recovery was about three and a half to four months later, I ran in a 100K trail race. That I'd done several times before. Now, being somewhat under-trained, that was not my best performance, but I remember that night as if it were last night, and the feeling I had that, yeah, I'm all back.

I'm a little bit more careful nowadays, especially with fluid intake, especially in the summer, and I don't take non-steroidals.

[Andrew Wilner, MD] (20:46 - 20:52)

To stay hydrated, and not to poison your kidney with non-steroidals.

[Matt Harmody, MD] (20:52 - 21:23)

Right, so those are people always ask, well, what, you have to take medication, what changes do you have to do post-operatively, and really, those are the two major ones, if you'd consider them changes. Being an endurance athlete, I would have to say I probably took my fair share of non-steroidals, but Tylenol is perfectly acceptable. So when those aches and pains occur, and at my age, they certainly occur more than they don't occur, yeah, Tylenol is a perfectly safe substitute.

[Andrew Wilner, MD] (21:24 - 21:25)

So, and you were a pound lighter.

[Matt Harmody, MD] (21:26 - 21:49)

That's right, absolutely. I was just talking with a friend about that this morning. Speaking of climbing mountains, he said, well, that had to be, we were talking about others climbing, and he said, well, it's a lot harder for someone that only has one kidney, and I said, no, I'm a pound lighter, so it's probably actually a little bit easier.

[Andrew Wilner, MD] (21:50 - 22:09)

All right, we're going to get to that mountain climbing in a second, but just tell me if somebody wanted to do, say, I just have this burning desire to save a life, and I want, you know, I think I'm pretty healthy, I want to give my, I'm willing to sort of go through this process. I assume it doesn't cost anything, that somehow somebody's insurance will pick it up, is that right?

[Matt Harmody, MD] (22:09 - 22:37)

Yes, that's correct. You can go to kidneyregistry.org, that's the National Kidney Registry's website, and there's a button at the top saying something along the lines of, I'm interesting, it may just say, I want to be a donor, because they also managed potential recipients, so I believe there's a button at the top that also, yeah.

[Andrew Wilner, MD] (22:37 - 22:38)

I need a kidney, or I'll give a kidney.

[Matt Harmody, MD] (22:38 - 23:04)

That's right, I want to give a kidney, or I need one, yep, and it's several key points there, Andrew. First of all, even in the pre-op holding area, as the anesthesiologist is talking to me, I was asked for the final time if I'm certain I want to donate, so you can back out of the process at any time in the evaluation.

[Andrew Wilner, MD] (23:04 - 23:05)

You can't put it back in.

[Matt Harmody, MD] (23:06 - 25:09)

That's right, but yeah, that's a place to go if you're interested, and with regard to cost, it's made perfectly clear early on that you do not assume any of the medical costs of your evaluation, so in my case, which I think is pretty standard at all transplant centers, is they create an account that has my name on it, and it has, you know, potential living kidney donor and big bold letters. You're asked never to show your personal insurance card, and everything, all the testing, again, which is quite extensive, gets charged to that dummy account, if you will, and then once a match and an intended recipient is identified, then those charges are transferred to the insured insurance plan, so as you or maybe your audience know, back in the 80s, I believe, end-stage renal disease qualified you for Medicare, regardless of your age, and if people want an example of kind of single-payer healthcare in this country, that's probably one example that one can turn to, but about 80% of dialysis patients across the country are on Medicare for that very reason.

The other 20% have private health insurance, and, you know, that may be through an employer or other mechanism, so yes, at the end of the day, those charges get transferred to the recipient's side, and, you know, there's, of course, time commitment, and but otherwise, yes, there are no medical costs incurred by a living kidney donor.

[Andrew Wilner, MD] (25:10 - 25:21)

And just to put it in perspective, I mean, I guess most of the kidneys that are donated are donated after death, is that right?

[Matt Harmody, MD] (25:22 - 25:58)

Yes, so there are about 25,000 kidney transplants performed in this country each year, and about two-thirds are deceased donor kidneys, and about one-third, or 6,000, roughly, are living kidney donors. Of those, though, there's only probably a few hundred people that are actually what are called non-directed donors, like myself, so they donated to a stranger. Most, of course, are directed, that being to a family member or close friend in most cases.

[Andrew Wilner, MD] (25:58 - 26:15)

And I guess the advantage of a non-directed kidney is it's going to go into the pool, and then I guess they have to find a compatible match from a very large pool. Is that usually not a problem?

[Matt Harmody, MD] (26:16 - 29:50)

Yes, so ideally, I think most people can appreciate that if your kidney's put into a pool of, say, 10 potential recipients, the ability to match that kidney and to have, not just a match, but a good match, which extends the life of the kidney, and also, in many cases, reduces the amount of anti-rejection medications the recipient must take. That compared to, say, 200 to 300 recipients in a pool, which is roughly what that number might be in the National Kidney Registry, and we can talk about why that's the case. So statistically, you're going to get a much better match, and you're going to lead to those significant benefits.

So the National Kidney Registry works with about half of the U.S.'s transplant centers, and that system pools all the living kidney donations that are going through the NKR with all the transplant centers that work with the NKR. So you end up with a much bigger pool, and yes, kidneys are flown all over the country many days of the week, you know, and it's often, you know, the nurse coordinator in the operating room with the box and preservatives and cooling mechanism, and goes right to your local airport and flies commercial, and then there's someone waiting for it at the other end and right to the operating room at that transplant center.

So those transportation challenges go on each and every day, and it's a very effective means. And living kidney donation, Andrew, is the gold standard. I'm not sure if everyone realizes, but a living kidney usually lasts twice as long as a deceased donor kidney.

So a living kidney might be 10 to 15 years, roughly half of that for deceased donor kidney. And it's also, it's somewhat asynchronous, right, and there's less of a kind of a panic situation. When someone unexpectedly dies, you know, and classically that might be a young person in a car accident, maybe they have just a severe head injury that is unrecoverable from, but they're untouched from the neck down, and they have two uninjured kidneys, and certainly other organs.

But with the focus on kidneys, in this discussion, now there's, you know, the clock starts, and the search for a compatible recipient begins. And, you know, if that's in the middle of the night, and, you know, the surgeons are tied up, that can be a challenge to get those kidneys placed in a recipient. And I think recent studies have shown that about 25% of kidneys don't ever make it to a recipient because of some of those challenges.

Whereas a living kidney donation, you know, if I donated a recipient, I donate my kidney into the pool, and it could be two days, two weeks, two months later that the recipient, especially in a voucher situation, would get a kidney. So it helps to be able to plan those, and they don't necessarily have to be like they were back in the day where the donor is in a stretcher right next to the intended recipient in the same hospital, same operating area.

[Andrew Wilner, MD] (29:52 - 29:53)

Although that would be better.

[Matt Harmody, MD] (29:54 - 30:36)

It would, but not necessary. Correct. And it just broadens the potential for recipients to receive a kidney that's a much better match.

And kidneys can remain outside of the body for up to 24 hours, and they're working at extending that. So it just gives you a little bit more flexibility. And, you know, if you can get a year or two on average out of a living kidney, you know, across the board, it just reduces the total number of kidneys that are needed, and it helps begin to shrink the transplant list, which has been chronically elevated at over 90,000 people in this country.

[Andrew Wilner, MD] (30:37 - 30:57)

Right. So they wouldn't take your kidney until they've lined up the recipient, right? So all the work is done, and then it's like, okay, now we're going to remove your kidney, and the kidney's already got a plane ticket for where it's going, right?

So all the matching is done pre-op?

[Matt Harmody, MD] (30:59 - 33:12)

Yes. And it's, if you're going to be a non-directed donor, especially, you kind of get to name your timeframe. You know, so in my case, my evaluation was through the summer, and it's, you know, typically when, you know, physicians in our group are taking vacations.

So I told my transplant center, you know, early fall is my preference, and I'm O positive. So, you know, my kidney is very easily matched, and they told me, you know, just name your date when you want to be available. And I'll never forget my nurse coordinator telling me, don't worry, you're going to have your surgery within a few days of when you make yourself available, because, you know, O positive kidney can be transplanted in a much broader range of patients.

So I made myself available on a Monday, September 25th, and I had my surgery on September 26th, the following day. So that whole matching process occurred before my surgery, so they knew who my intended recipient was, and they had all the transportation lined up. And the paired exchange process is, helps facilitate that, and people may not be too familiar with that process, but I get to start what's called a chain of paired exchanges.

So let's say my recipient is the wife, and her husband wants to donate to her, but they're not a match. So in a paired exchange process, I would, my kidney would go to her, and then he would be matched with another pair in the same situation. So it may go to, let's just say, a brother and sister.

The sister needs the kidney, that husband sends it to the sister, and her brother is willing to donate to his sister, but again, not a match. So then his kidney will get matched with a part of a third pair, and those pairs can go on to create quite a chain. Those surgeries just keep occurring throughout the day, and sometimes over multiple days.

[Andrew Wilner, MD] (33:12 - 33:24)

And the incentive is, it puts them higher on the list. I mean, you could say, if I was the husband and somebody else shows up with a kidney, it's great, I'm off the hook, I don't have to give my kidney now, or it doesn't work that way.

[Matt Harmody, MD] (33:24 - 34:36)

Right, but bringing a donor with you, even if they're not a match, helps get you into that chain and helps facilitate you receiving a kidney sooner. All my mentoring, I would say that's one of the biggest myths, Andrew, is that most people recognize someone in their circle, and sometimes it's even outside their circle, that they read something on social media, they want to be considered to be a donor, and they start the conversation by saying, I want to be a donor, and I just hope I'm a match. So it's a lot, really the hurdle is only to be a qualified, to be a donor.

That's a much lower hurdle, right, than saying, I want to match, maybe it's a complete stranger, and the odds of that occurring are very low. So once you're a qualified donor, you go through the National Kidney Registry, and that gets you into the system, it gets that person that's in need of a kidney into the system, and you donate into the pool, and that credit goes to the recipient, and they pull out another kidney that's a much better match for them.

[Andrew Wilner, MD] (34:39 - 35:24)

Okay, you know, I used to do some medical mission work in the Philippines, and I've spent quite a bit of time there, and I know the way they work in a lot of the smaller hospitals is, if you need a blood transfusion, one of your family members or friends has to show up and donate, and if they're a match, you'll get theirs, and if they're not a match, you'll get, you know, get one that's a match, but you have to contribute one to get one, because they don't really have a big blood bank.

So the only way you're going to get the blood transfusion that you need is you got to bring somebody so that, you know, here's, okay, here's a pint, and you give me a pint. It might be the same pint or a different pint, but otherwise, you don't get anything.

[Matt Harmody, MD] (35:25 - 35:30)

Yes, that's the exact same concept as a parent exchange and kidney donation.

[Andrew Wilner, MD] (35:30 - 35:34)

So why are we short 90,000 kidneys?

[Matt Harmody, MD] (35:36 - 37:16)

It's really not that there aren't enough kidneys in this country running around. I think it's part awareness and part misunderstanding what's involved with the process. If you do the math and take all the adults in the country, you know, between 18 and 70, let's just say, and a rough estimate of who's healthy enough, it would only take one in every 10,000 adult Americans to donate to eliminate the wait list.

And that's why I tell people that, you know, the deceased donation is necessary. I mean, it provides two-thirds of kidneys roughly every year, but the real bang for your buck and just a much bigger pool of potential donors with all the advantages of living kidney donation that I mentioned earlier, that's really where I think more effort should be spent. And that's part of what I do every day.

I chair the board of the National Kidney Donation Organization, or NKDO for short, and we are the largest advocacy group in the country supporting potential kidney donors and even potential recipients and their families, providing education, experts in the field, coming in to talk on webinars. And it's just a great resource for people that have an interest in donating or have a need on the other side and know someone or even themselves that's in need of a kidney.

[Andrew Wilner, MD] (37:17 - 38:01)

All right. So shout out. Anybody got an extra kidney thinking about sharing?

There'll be a link in the show notes because, you know, it's literally the difference between life and death. And as you pointed out, life on dialysis is very, very different than life with a transplanted kidney. You still need to take medication with your transplanted kidney, I would say, probably just about all the time, but, you know, you're out and about, right?

Nobody necessarily knows the difference. Whereas if you're on dialysis, either peritoneal dialysis, at home every day or hemodialysis every other day, that's a very, very more constricted lifestyle.

[Matt Harmody, MD] (38:02 - 39:39)

Yeah. Two quick facts for your audience, Andrew, related to that point. One, once you're on dialysis, you have a mortality rate of 50% in the next five years.

So it just goes to the devastation that dialysis, being on dialysis causes. Of course, dialysis does not cause it itself, but it just goes to show you that dialysis is not a perfect substitute for a kidney. Number two, living kidney donation, the risk of surgery is on par with a term pregnancy delivery.

It's actually slightly less risky, but not measurably so. So it's very safe. The risk is not zero as it is not the case for a term pregnancy delivery.

But my goal is to normalize living kidney donation for it to be as common as term delivery, to be as common as blood donation. To your point in your mission work, there was a day in time in this country whereby that same policy existed, that if a family member was going in for major surgery, you could really only donate on behalf of your family member. But nowadays, you donate blood and that unit goes to someone, of course, that matches it, but it could go anywhere in your community where there's a need.

So that's what I'm working towards. May or may not see that in my lifetime, but it'll be fun trying.

[Andrew Wilner, MD] (39:40 - 39:55)

What about science? Artificial kidneys, growing kidneys, poor kidneys, genetically engineered kidneys, are we getting anywhere with that or is that still science fiction?

[Matt Harmody, MD] (39:56 - 41:43)

We, you know, the transplant community is making great progress. I don't mean to substitute myself as part of all that work that's being done. There's tremendous effort resources and some brilliant people working on solving that.

And yes, I think the most promising is genetically modified pig kidneys. And I haven't read anything more recently than someone that was alive. So in other words, left the hospital and not a brain dead patient in which they were getting consent from family.

But someone spent over 90 days with a pig kidney and did perfectly well with it. So I am cautiously optimistic. I'm sure that day will come.

I think the debate or question is how far off is that? I remember about five years ago, which I guess is not quite when I donated, but sometime thereafter, reading about that type of solution to end stage renal disease, they were predicting that pig kidneys would be very commonplace in five years. And today when I read, I think that answer is still five years.

So that's, you know, that's science. And it's a tremendous opportunity. I think that's thinking outside the box.

I think that's what our current 90,000 plus transplant list needs. But it takes time to be done safely. And it's challenging, but they're overcoming a lot of those challenges.

[Andrew Wilner, MD] (41:44 - 41:53)

Matt, we got to wrap up soon, but before we do that, we got to talk about this mountain climbing. Why 50 peaks in 41 days? What was that all about?

[Matt Harmody, MD] (41:54 - 42:10)

Yeah. So our captain, Dave Ashley, is a climb, the seven summits, which for anyone interested in climbing and hiking, those are the highest points in each of the seven continents in the world.

[Andrew Wilner, MD] (42:11 - 42:12)

Like Mount Everest?

[Matt Harmody, MD] (42:13 - 42:24)

Yes. Yeah. All the big ones.

And he did that in a very short period of time and he's retired military and was trying to do those with veterans.

[Andrew Wilner, MD] (42:25 - 42:26)

With one kidney?

[Matt Harmody, MD] (42:26 - 45:16)

Yes. Not only one kidney, he's what's called a double donor, Andrew. He donated also part of his liver.

So yeah, he's an incredible individual, but he wanted to raise awareness in living kidney donation and bring something closer to home where more people could relate. And I think most people, when I tell my story and I ask them where they live and what's their state high point, they often not only can recall it, but oftentimes have been there if it's somewhat significant. So he put together a team of five living kidney donors with the goal of summoning each of the highest points in all 50 states.

And I think most of us were pretty competitive by nature with our life experiences before and after kidney donation. So when the team found out that there was a Guinness World Record for that, I think that was kind of the final check mark to say, hey, let's do this. So yeah, we have three climbers, two support people.

We started on Denali, figuring it's the hardest. And if we're not successful there, we may have to reevaluate the project. And then they went to Hawaii, then the whole team gathered in an RV in Chicago.

And we basically went counterclockwise around the country. Six of us, we had a young gentleman who helped videotape and photograph the trip in large part to provide the documentation that Guinness was going to need afterward. And yeah, it was a little bit big brother with six people that didn't know each other terribly well, all tired and hungry and trying to sleep in a moving RV.

And if it were cold and rainy and 2 a.m. when we arrived at a trailhead, the team got out, climbed it, got back in and off to the next one. So, and again, it dispels a myth, Andrew, that you're somewhat less physically capable after kidney donation. And, you know, granted most people that donate a kidney aren't climbing mountains or certainly trying to do them rapidly.

And that's not the point. It's really, you know, to raise awareness, make this a little bit more visible and interesting for people. And a lot of people followed us online as we kept track of where we were moving.

And yeah, and I know a lot of people that have donated a kidney and weren't the healthiest going into that donation and became more healthy, lost weight, and were a little bit more careful about their health afterward.

[Andrew Wilner, MD] (45:17 - 45:19)

And there's a book about this little adventure, right?

[Matt Harmody, MD] (45:20 - 46:15)

Yes. It's called Ascending America. Five kidney donors, 50 peaks in 50 states, one incredible journey.

And it's a narrative about the story and the struggles. And I think my feedback has been, it's very entertaining and hard to put down. You get to follow it.

And, you know, it's like a front row seat to watch it. And then the second part, Andrew, is kind of a short little tour through the transplant community. I couldn't help myself being a physician to write a little bit about that to help people understand, you know, what's life like on dialysis?

How do you qualify to be a donor? What's the future such as pig transplants? And it's written in plain English.

If there's one superpower I have is being able to translate complicated medical information into just common sense language.

[Andrew Wilner, MD] (46:16 - 46:18)

Well, you had years of practice in the ER.

[Matt Harmody, MD] (46:18 - 46:21)

Yes. Absolutely. Practice makes perfect.

[Andrew Wilner, MD] (46:22 - 46:23)

Can we find the book on Amazon?

[Matt Harmody, MD] (46:24 - 46:35)

Yes. And it really is available at all retailers, if your preference is brick and mortar bookstores, but certainly all the major online retailers as well.

[Andrew Wilner, MD] (46:36 - 46:41)

Matt, this has been a great discussion. Is there anything you'd like to add before we close? Sure.

[Matt Harmody, MD] (46:41 - 47:04)

Briefly, I don't expect that everyone will listen to this podcast and run to the NKR website and sign up to be considered for living donation. I think there's many other ways that you can get involved to support people in need. One is taking care of yourself.

So seeing a primary care doctor, watching for hypertension and diabetes.

[Andrew Wilner, MD] (47:04 - 47:07)

You don't need a kidney in the first place, right?

[Matt Harmody, MD] (47:07 - 47:47)

That's right. Secondly, hopefully this educates people so that if in your circle of family or friends, the issue of kidney disease, failure, dialysis comes up that you can point people in the right direction. And I'm sure those resources will be listed with this podcast.

And again, I always hope that people would consider living kidney donation. If that's something that after you read is not your thing, at least go to your department of motor vehicles and check the box on your driver's license to be a deceased donor someday.

[Andrew Wilner, MD] (47:50 - 47:53)

Dr. Matt Harmody, thanks for joining me on the art of medicine.

[Matt Harmody, MD] (47:54 - 47:55)

Absolutely appreciate being here.

[Andrew Wilner, MD] (47:56 - 50:26)

And now a final thanks to our sponsor locumstory.com. Locumstory.com is a free unbiased educational resource about locum tenens. It's not an agency.

Locumstory exists to answer your questions about the how-tos of locums on their website, podcast, webinars, and videos. They even have a locums 101 crash course. At locumstory.com, you can discover if locum tenens make sense for you and your career goals. What makes locumstory.com unique is that it's a peer to peer platform with real physicians sharing their experiences and stories, both the good and bad about working locum tenens, hence the name locum story. Locumstory.com is a self-service tool that you can explore at your own pace with no pressure or obligation. It's completely free.

Thanks again to locumstory.com for sponsoring this episode of the art of medicine. I'm Dr. Andrew Wilner. See you next time.

This program is hosted, edited, and produced by Andrew Wilner, MD, FACP, FAAN. Guests receive no financial compensation for their appearance on the art of medicine. Andrew Wilner, MD, is a professor of neurology at the University of Tennessee Health Science Center in Memphis, Tennessee.

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