Hey, All -- if you've got questions about life with diabetes, then you've come to the right place! That would be our weekly diabetes advice column, Ask D'Mine, hosted by veteran type 1 and diabetes author Wil Dubois in New Mexico.

Many of us in our D-Community may wonder whether we can donate organs after we pass on, given that our bodies are not technically "healthy." Wil's shared some important insight on blood and organ donating in the past, and today's he's going to share a bit more based on the latest state of affairs in organ donation... so read on.

 

CS, type 2 from Nevada, asks: Are the organs of a type 2 diabetic person acceptable for transplant?  

Wil@Ask D’Mine answers: The short answer is: Yes. So long as you’re dead. I know that sounds strange at first blush, but here’s the deal: There are two types of organ donation. The first is the traditional kind in which you give someone else your parts when you’re all done with them. And then there’s a second kind, called “living organ donation,” in which you donate one of your kidneys or part of your liver to someone else while you’re still alive. Generally living donations are given to family members, but there’s a trend toward anonymous giving.

Damn. Talk about generosity. I’ll sometimes take out my wallet and give to a good cause, but taking out a kidney…?

Anyway, back to people with diabetes, and our parts. The organ banks will be happy to take your parts when you’re dead, probably—more on that in a sec—but they want no part of you while you’re still walking around. We PWDs are excluded from being living donors. Why? Well, partly because it’s too likely we’ll need our parts during our lifetimes, and partly because we heal poorly, and all of that. Bottom line: It’s considered too risky for us, but it has nothing to do with the quality of our organs. 

And what is the quality of our organs? Given how diabetes damages pretty much every part and parcel of your body, you’d expect your used parts would be worthless, wouldn’t you?

In a perfect world, that would probably be true. But the fact of the matter is that spare parts for humans are surprisingly hard to come by, especially given that 7,452 of Americans die every day, and that more than half of all U.S. adults are organ donors.

So why are organs in short supply? The problem is that only about 3 in 1,000 of the willing-to-donate can actually become donors when they die. What’s up with that? Well, organs need to be… uh… harvested (I hate that word in this context) quickly after death to be viable. And that means, realistically, that you need to have the common decency to die in a hospital, rather than in a bar, brothel, or out on the boulevard. 

And frankly, 997 out of 1,000 people die in bars, brothels, or out on boulevards. 

That means that the 114,000 folks languishing on waiting lists for organs (2,000 of them children) can’t be too picky. What are they waiting for, you ask? Mainly kidneys (83%) and livers (12%). Next comes hearts, lungs, and “other” which includes pancreases, intestines. If you are type 1, your pancreas is no good (although you can donate it for research) but the rest of your parts are up for grabs. For type 2s like yourself, you must be thinking: My kidneys? Are you kidding? They’re barely keeping me alive!

It’s true that your kidneys aren’t in top form. Most type 2s have what one organ donation researcher, Dr. Jordanna Cohen of the University of Pennsylvania Perelman School of Medicine, terms “poorer quality kidneys.” But poorer is better than dead, and her research shows that folks fare better with our poorer quality kidneys than they do on dialysis, waiting for a kidney that comes with a full warranty.

Now, at the beginning I said that the banks would “probably” want your parts. So here’s the deal, when it comes to the dead, all parts are considered. It’s your medical condition when you die that rules in, or rules out, the usability of your organs, not your condition when you are alive. Everyone is eligible to sign up as a donor, then the final decision on what you have that’s of use will be made after you depart for the great beyond.

What sort of condition would make your organs useless at death?

Not diabetes, but morbid obesity can rule out your surplus organs, and some PWDs are also morbidly obese (usually defined as more than 100 pounds over “ideal” body weight). Also, recent cancer, and in some cases extreme old age rule out recycling your organs. So here’s hoping you live long enough that your organs are ruled useless! Hmmm…. I rather like that as a new toast: May you live long enough that your organs are rejected for donation!

Sure beats the hell out of “Cheers,” don’t you think?

Note that there’s no set standard for all of this, because organ suitability is decided at the transplant center—usually a large Hospital, and each has its own protocols. How many of these centers are there? At last count there were 244 doing kidneys alone in the U.S.A. Now, that’s not to say that organ work is a free-for-all. Like Tolkin’s One Ring, they’re all overseen by the non-profit United Network for Organ Sharing, or UNOS, based in Richmond, VA, which has been on point as the only organ procurement and transplantation organization since our current transplant laws took effect back in 1984.

UNOS manages the waiting lists, matches donated organs to those in need (human parts ain’t universal), maintains data bases, and more.

And while donateable organs include the heart, kidneys, lungs, pancreas, liver, and intestines, you have other re-usable parts, too. Tissue donations include the cornea of the eye, plus there’s a need for skin, tendons, bone, nerves, and heart valves.

You may see yourself as a wreck; others see you as the salvage yard.

So how many of us PWDs donate? UNOS spokesperson Anne Paschke says, “Diabetes doesn’t rule you out,” as a donor and goes on to point out that, “12% of deceased organ donors last year had a history of diabetes.”

That’s a number that struck me as low, given the prevalence of diabetes, and it made me suspect that many PWDs are under the false impression that their parts are no good. They are, so become a donor today, as it appears we are under-represented in donor sign-ups. Well, that or we are just more likely to die in bars, brothels, or out on boulevards than people without diabetes. Which could be true.

Meanwhile, did you know that getting a transplant can cause diabetes in a sugar-normal person? Yeah, this was news to me, too. It’s called post-transplantation diabetes mellitus, or PTDM, a.k.a. New Onset Diabetes After Transplantation. Here and I thought I knew all the kinds of diabetes! 

How common is it? On average, 18% of kidney, liver, heart, and lung recipients join our family after getting their new parts. And no, it has nothing to do with whether or not the donated organs come from PWDs. Rather, it seems to be a side effect of the anti-rejection drugs. The good news is that these numbers are dropping over the last few years thanks to improved immunosuppression protocols.

Now, I couldn’t let this subject close without touching on the economics of used organs. You can donate your organs here in the U.S.A., but you can’t sell them, which isn’t true of some other parts of the world. If you’re a rich dude who doesn’t want to be one of the 20 people a day who die on transplant waiting lists, you can buy a “transplant tourism” package and travel to a third world country for a no-questions-asked transplant. 

Seriously. I couldn’t make this sh#& up if I tried. 

According to the World Health Organization, a Third World kidney will only set you back somewhere between $70K and $160K—travel and hotel included. For the budget-minded, Pakistan looks like your best bet. Compare that to the estimated costs here in the U.S.A., where a Fed estimate of the cost of a kidney transplant (including labs, surgeons, hospital stay, anti-rejection drugs—basically the whole enchilada) is a whopping $210,000 bucks for a single kidney, and up to $800,000 for a more complex multi-organ transplant.

How does anyone afford a legitimate transplant? Health insurance, although plans vary in how well they cover transplants. But both Medicare and most Medicaid plans do cover transplants, although some state Medicaid programs cover only transplants done in their state, which worsens the odds of finding a match. Not to say there aren’t problems. Check out this NPR report about Medicare covering the surgery, but not the meds that keep the transplanted organs from being rejected!

Still, despite the problems in the system, and despite what you may think of your used parts: donations save lives, your organs are “acceptable” for transplant, and you should absolutely become a donor.

Then stay out of bars and brothels, and be careful on the boulevard.

 

“This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.”