Un-donate a kidney?

September 21, 2005 2:49 PM

Can a kidney be un- or re-donated? A colleague donated a kidney to a friend today. If the friend's body rejects the kidney, can it be put back into its original owner? I'm guessing no, but I'm wondering why not.
posted by clh to science & nature (7 comments total)

No; when an organ is "rejected," it's usually destroyed by the host's immune system, either attacked outright or the blood vessels clot off.
posted by gramcracker at 2:52 PM on September 21, 2005

The little blood vessels that supply the meat of the organ, as gramcracker says, get totally wrecked by the immune response of the rejecting host. By the time it's time to give up and say 'this kidney's not working, let's take it out' those blood vessels are ruined. The organ is not good for anything any more.

Cyclosporine is rough on those blood vessels too and often produces a vasculitis. Then you reduce the cyclosporine dose and presto - rejection. This kind of thing is why transplant medicine is for, like, smart doctors, not handwaving neurologists.
posted by ikkyu2 at 4:11 PM on September 21, 2005

Immune suppressive drugs have gotten a lot better lately. The way that Tacrolimus is used now, rejection (given that the match was ok and not too extreme) is (historically relatively, but that's not saying much) low.

I know that it's technically possible to return the donated kidney if the host, er, gets into a motorcycle accident but does anyone know if it's ever been done?
posted by PurplePorpoise at 5:04 PM on September 21, 2005

My dad received a donated kidney. They have all sorts of tricks that they do to the kidney, during rejection, in an attempt to "jump-start" the kidney, and get the body to accept it. The doctors wait as long as humanly possible before giving up and removing the kidney. By the time they take the kidney out, consider what it is... meat that has been kept warm and moist for days. It is unfit to be returned to the donor, and the recipient (at least in my dad's case) has a nasty, disgusting infection.
posted by websavvy at 5:53 PM on September 21, 2005

It's still a magnificent gift, even if it's rejected. Quick googling suggests that " Kidney transplants have a success rate between 80 percent and 97 percent."

Good luck to your dad, websavvy.
posted by Mom at 6:43 PM on September 21, 2005

I don't think you'd want the kidney back anyway. You can live with one kidney just fine, whereas adding the shock of a severly injured organ throws your body completely out whack - you'd get so severely sick from your body trying to heal the injured kidney that it would be much much worse than not having it all.

(I speak from my knowledge of homeostasis gained in biology classes and from living with a nurse for my whole life. There's the off chance that I'm completely off base here, IANAD.)
posted by grapefruitmoon at 5:24 AM on September 22, 2005

Not off base at all.

I recall trauma surgery rotation as a med student. A patient came in having been stabbed in the back while waiting in line for his hot buttered roll at the breakfast cart. The stab wound penetrated the cortex of the right kidney.

During the operation, the trauma fellow looked at me and said, "What do you think? Take out the kidney, or try to wrap it and let it heal?" I had no clue, so I said, "Wow, he's only 21 - maybe try to wrap it?" So he wrapped it in some kind of gelfoam-based gauze.

That guy died 8 days later after having blood pressure fluctuations from 65 to 300+ systolic that were totally uncontrollable, even with drips. I don't know all of what was going on but I can tell you that next time someone asks me that question I'm going to tell them to take the sick kidney OUT.
posted by ikkyu2 at 10:28 PM on September 22, 2005