To save her brother’s life, Elizabeth is getting in shape.
The 38-year-old Kern County, California, resident, whose last name is not being used to ensure the family’s privacy, changed her cooking and her workout routines and has dropped 32 pounds since September 2020. Keck Medicine of USC physicians told her she would be an ideal kidney donor for her older brother–if it weren’t for her weight, which put her out of range to donate safely.
Her transformation was aided by a donor wellness program launched last year by the USC Transplant Institute. Transplant surgeons realized that as many as a third of living donors were turned away because they didn’t meet the necessary health requirements. The donor wellness program aims to solve two problems: increase the pool of available living donors while also improving the donor’s own health and well-being.
The program is one part of the university’s effort to improve organ transplant outcomes. From helping potential donors get healthy to examining racial disparities to protecting patients from COVID-19, Keck Medicine physicians are searching for more and better ways to keep both donors and recipients healthy and active.
A game plan for success
Elizabeth’s journey began because she wanted to help her brother, who had been on dialysis for several years. He is the third of the six siblings; Elizabeth is the fifth.
The siblings agreed Elizabeth was the best candidate. For one thing, she had one child, a teenage daughter, and didn’t plan to have more.
But USC’s transplant coordinators told her that she would have to lose at least 20 pounds to qualify as a viable donor. She dieted and worked out as many as five times a week, but after a year, lab tests showed she was still 10 pounds over the target weight.
That’s when Elizabeth was introduced to Susan Kim, a nurse and clinical nutrition and wellness manager. Kim headed up the newly launched donor wellness program, and Elizabeth became one of its first participants. Kim knew she was already working out and counting calories, so she started talking about nutrition.
For example, Elizabeth liked to snack on flavored yogurt. Kim advised her to look at the label and see how much added sugar it had. The numbers startled her. “I was like, ‘Wait, I was eating this?'”
Kim suggested she switch to plain Greek yogurt and add fresh fruit. “Less sugar, less calories, but you get the same result,” Elizabeth says. “Small changes like that.”
The small changes added up, and the pounds started to drop off.
When demand exceeds supply
Elizabeth’s success is part of the vision of the living donor program–an initiative born of frustration.
Southern California is one of the most difficult places in the nation to live if you need a new liver or kidney.Aaron Ahearn
Southern California is one of the most difficult places in the nation to live if you need a new liver or kidney, says Aaron Ahearn, associate director of the liver transplantation program at Keck Medicine of USC. That’s partly because of good trends: A healthier population means fewer people collapsing and dying of heart attacks or strokes, which frees up organs for donation. On the other hand, the large metro area also includes many residents whose health is declining, often the result of living for decades in impoverished and underserved neighborhoods. “You essentially have to be in the ICU in multi-organ failure before you can get a liver transplant,” Ahearn says.
One solution to this dilemma is living organ donor transplantation. Keck Medicine has one of the few living donor programs in Southern California, but surgeons were turning away about 30% of candidates.
“We realized it was a problem on both sides,” he says. “The donors were at higher risk of developing their own diseases due to the health consequences of being overweight. And the recipients were in desperate need of an organ. This was an opportunity to improve everyone’s health.”
Saving lives and saving money
It turned out that not only was a donor wellness program “good karma,” as Ahearn puts it, but it also made good financial sense. If a patient couldn’t get a living donor transplant, she would have to wait until she was deathly ill to get one from a deceased donor. The cost of caring for her in the ICU while she awaited that transplant and later recovered was greater than offering free services to potential living donors, he says.
Besides nutrition counseling, the donor wellness program offers participants personalized meal plans and help with time and stress management from occupational therapists. A welcome packet includes a bathroom scale, a blood pressure monitor and a step-tracking watch. “You want to make it all as easy as possible, as manageable as possible,” Kim says.
Addressing health inequities
Keck Medicine also took a hard look at its own team and began examining its own structural biases.
After news reports of racial disparities in kidney transplants, Jim Kim, a surgeon at Keck Medicine specializing in organ transplants, worked with his team to review how they calculated kidney function for patients.
We no longer use equations that take race into account.Susan Kim
They were surprised to realize that the equations they used contained racial biases. These were the same equations used for decades around the country, but Black patients didn’t qualify for transplants until they were at a more advanced state of kidney disease than white patients, he says.
Keck Medicine decided to eliminate those calculations from its system. “We’ve rectified that,” Kim says. “We’re no longer using any of these equations that take race into account.”
Taking Cover From COVID
The coronavirus threw a wrench into the transplant program when it landed in the U.S. in 2020, particularly when a bad COVID-19 wave hit Southern California in November and December of that year.
Ahearn started getting calls from transplant patients who tested positive. Because their immune systems were suppressed, they had a high mortality rate. “We realized COVID was devastating for our recipients, and we needed to do something to retard disease progression,” he says.
Ahearn and his team built a system on the fly. The kidney and liver transplant programs set up regular telemedicine visits, sent patients pulse oximeters to measure oxygen levels and heart rates and provided monoclonal antibody infusions to fight the first signs of disease.
As a result, coronavirus hospitalizations for USC transplant recipients dropped from 54% to 35%, and deaths dropped to zero in a two-month period for transplant patients who received monoclonal antibody infusions.
“It was really important that our transplant patients be educated that their risk is different than the general population,” Ahearn says, “but there are things they could do to reduce their risk, so they needed to communicate with us.”
A Diet Overhaul
They asked me when would I be available to do the transplant. I told them, whenever my brother is ready, I’ll be ready.Elizabeth
Communication has also been key for Elizabeth’s success. Regular telemedicine visits with Susan Kim helped the potential donor overhaul her diet and lose 12 more pounds. She’s now a fan of lentils and brown rice, vegetables and nuts. Her daughter has also embraced the changes to their meals, and her sisters-in-law ask her to share her new recipes. “This is a new lifestyle for me,” she says.
She is hopeful that at her next appointment, the transplant team will give her the green light to proceed with the donation.
“I just want to make my brother feel better,” she says. “They [the transplant team] asked me when would I be available to do the transplant. I told them, whenever my brother is ready, I’ll be ready.”
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