Los Alamos Veterinarian Dr. Bob Fuselier changed the life of a man he never met when he gave him his left kidney earlier this year. The man had been on daily dialysis for more than five years.
Fuselier decided to go public about his kidney donation knowing it will likely lead to helping many men and women live more freely.
“I have yet to meet the man or his family, but have learned that he is well and that, according to a thank you card from his 8-year old daughter, are planning to go camping for the first time as a family,” Fuselier said. “While I’m mainly addressing those who, like me, are in their 50s, I hope this information will plant a seed in the hearts of those who are younger. My decision was at least 13 years in the making, so I wouldn’t expect anyone to consider donating anytime soon. However, if you are one of those who have thought about helping to extend another’s life, even while putting yours at a bit of risk, please consider this amazing opportunity for giving.”
Fuselier explained that as of January of this year, some 122,000 people are waiting for an organ transplant in the United States. Of that number, more than 100,000 are waiting for a kidney. In 2014, a little over 17,000 kidney transplants were performed. Of these, about 5,500 were from living donors.
“Each year, almost 5,000 people die while waiting for a new transplant (see www.kidney.org),” he said.
Making the Decision
Since his donation would not be for someone he knew, the powers-to-be classify Fuselier as an altruistic donor. Being labeled altruistic sounds great, he said, but if he’s going to be honest about his decision to donate, he says it was not fully altruistic.
“While it may not be the typical starting point, knowing that all of our major decisions are biased with self-interest is a critical part of any decision-making process,” Fuselier said. “My story begins almost 13 years ago. A father, whose daughter was in kidney failure, spoke at our church and asked us to consider donating a kidney. The kidney he had donated to her was now failing as well. I decided to at least see if I would qualify as a donor.”
The first step was tissue typing, and Fuselier was an early winner, matching the daughter’s tissue type fairly closely.
“I then began the testing program, which basically is a lot of lab work paid by someone else,” he said. “Part of the way through the program, I was told that a closer match was found, and I was benched. While I didn’t get to donate, I was given the opportunity to go through the decision-making process. I also discovered that my body was in pretty good health.”
As Fuselier was rethinking the donation option a few months ago, he discovered that the cut off for living donation is, with few exceptions, 60 years of age. Since he hit 58 last year, he said he figured it was now or never for his donation opportunity. Although he was the one giving the kidney, Fuselier said he very much appreciated his wife Susie’s full support.
“Deciding to donate a kidney, like all decisions, is a cost/benefit analysis. For the most part, the equation is heavily biased toward the recipient: the physical costs are borne mainly by the donor while the benefits go mostly to the recipient,” Fuselier said. “Obviously, the recipient of living donor kidneys faces risk as well, both physical and psychological, when they receive a living donor’s kidney. But, if you’ve read this far, I’d imagine you’re more interested in why an apparently sane person would want to give a part of his body to a stranger.”
The simple answer is that, for Fuselier, the possible benefits outweigh the possible risks. The risks are easy to define; they’ve been recorded in medical records and evaluated in many studies, he said. Aside from seeing a loved one get off dialysis and live a better life, the benefits are a bit more difficult to detail since they vary with the donors.
The risks of donating a kidney revolve mainly around the risks associated with surgery and the risks of having only one kidney. Some are short-term risks; others are long-term, he said.
“Short-term risks include the possibility for hemorrhage during and after the procedure, acute pain, infection, pneumonia, pulmonary embolism, deep vein thrombosis, loss of employment income for at least three weeks, some financial costs of traveling and hotels if you don’t live in the area of the hospital (the law states that the donor cannot receive any compensation for the donation aside for the direct costs of the donation), and death,” Fuselier said. “Long-term risks include the possibility for nerve damage, chronic pain, surgical incision hernia, the need to avoid NSAID-type pain relievers (ibuprofen, etc.), the need to avoid activities that might damage the one remaining kidney, and kidney disease and failure.”
Two items on the list of long-term risks strike Fuslelier as very important: death and kidney failure, he said.
“The risk of dying from anesthesia and surgical complications has been noted as between 0.03 percent and 0.06 percent, which is up to a 1 in 1,700 chance of dying. The risk of developing kidney disease is reported to be similar to that of the general population (about 1 in 100),” he said. “However, as my transplant urologist pointed out, the 1 in 100 risk of developing kidney failure for the donor is a misleading comparison. A person who qualifies for a donor belongs to a group of healthy adults whose risk of developing kidney disease may be as low as 1 in 600.”
At first glance, these risks seem overwhelming. As a veterinarian who has read countless product information sheets of pharmaceuticals and has to look at risks/benefits each day of practice, I know risks are always present. As someone who has an interest in emotional neuroscience, I understand how the emotion of fear (in this case, the anxiety – the feeling of being overwhelmed – that comes with thinking of harm and death) often influences us excessively when we look at risks. To avoid deferring too much to the emotional part of decision-making, we need to focus on the facts. For my risk of complications, those facts will be determined by looking at my current level of health (lots of diagnostic procedures and lab work), my age, my lifestyle, my medical history and that of my family.
The results of all the diagnostic workup and lab tests gave me a good idea of where I stand today in regard to overall health. It was the foundation I needed to make an informed decision of whether or not to proceed as a kidney donor.
“One risk of which I was surprised to learn is the increased risk of depression for the donor that’s seen in the first few months following donation,” Fuselier said. “The cause is thought to be multifactorial and includes the physical effect of adapting to one less kidney and a sense of a letdown as the excitement of the prospect of helping someone who is very sick turns back into the routine of daily life.”
The first benefit of seeking to become a living donor is learning that you’re in good health, he said, adding that the reason for gathering that information is to become a donor by losing part of your body – an important body part that has contributed to your good health. Another potential benefit, Fuselier said, is the added incentive to eat well, exercise, and stay active that comes with the realization you have to take very good care of that one remaining kidney.
“Although I haven’t seen any studies, I would expect that turning this incentive into practice would minimize the chance during the post-donation years of developing diabetes and hypertension, the two big destroyers of renal tubules,” he said.
The other benefits are less obvious and are directly related to how the perspective donor views his or her relationship with family, community and humanity in general, Fuselier said.
“As I see it, the more one sees himself or herself as part of something larger, the greater will be the chance for seeing a benefit in becoming a living donor,” he said. “I’m sure some of this view originates from nature, the genetic contribution to our personality. I’m equally sure that nurture, which includes the presence or absence of compassionate mentors during our upbringing, plays a much greater role.”
As Fuselier went through the process of qualifying as a donor, it became clear that the reason he wanted to become a donor was a major concern for the transplant team. It is the one question that everyone – the urologist, the surgeon, the social worker, and my patient advocate – asks, he said. In case that’s not enough, when all the tests came out okay, he also won the privilege of a 3-hour psychological evaluation.
“I think it’s important to have a good idea of the answer to the ‘why’ question from the beginning of the process. While many from my past had contributed to the answer, the answer had to be fully mine and mine alone,” he said.
Fuselier explained that for him, the answer goes back to how he was raised by his parents and extended family and how that early view of life was reinforced by teachers, coaches and mentors.
From an early age he was taught by word and example that it is ‘good’ to help those who have not be given the opportunities that he had been given and to leave things better than he found them.
“The ‘good’ that resulted at that time had a lot to do with my father’s attention and approval of my actions,” Fuselier said. “With time, acting from the need of approval slowly developed into a belief system that included the concept that happiness comes from giving to others, especially those who have not had the opportunities that I’ve been given.”
Fuselier said he has been blessed with good health, a great family and a successful career, each important in providing him the ability and opportunity to help others.
“As I approach 60 years of age, donating part of my body to someone in need seemed like a great way to contribute to the greater good,” he said. “For me, the benefits greatly outweighed the risks.”
It was clear to Fuselier that all those involved at the transplant center at Presbyterian Hospital in Albuquerque understood how critical it was that the decision to become a donor be made as objectively and openly as possible, he said. For all to benefit, whether that be the donor, the recipient, the transplant center, or living donor programs in general, the donor’s decision must be thoroughly thought out and well-critiqued by the donor, his or her family, and the transplant team.
“The donor should never feel obligated, whether from outside or within, that he or she must finish the process,” Fuselier said. “Toward that end, the decision to donate or not remains open until the moment the first medication for anesthesia is given; I could have opted out at any time if I decided the risks were too great.”
The surgery went smoothly for Fuselier and the recipient. Although they would like to meet each other, the transplant team will wait until later for the introduction to allow them each to heal without distractions.
“I would imagine this is more critical for the recipient, whose body is healing and, at the same time, facing a transition from dialysis to a foreign kidney while being immunosuppressed,” Fuselier said.
Early that January morning Fuselier was admitted to the hospital and soon taken to preop, where an IV was started, monitors placed, and everyone asked him why he was there, which is standard operational procedure, he said.
“Just before the Versed, my primary surgeon came to tell me all was ready and to ask if I had any questions. I did have one request,” he said. “As a veterinarian who has seen its benefit in postop pain control with animals, I asked if she wouldn’t mind splashing a bit of lidocaine on the area dissected to remove the kidney once all was done. I wanted to minimize the chance of referred pain that has occurred in some donors. She said she hadn’t used it before but saw no reason not to. I thanked her and then was given the Versed.”
The next thing Fuselier remembered was a nurse in postop asking him how his pain was. Between that point and the Versed the following happened:
“I was anesthetized and positioned on the OR table with my left side up and bent in a bit of a teepee shape to facilitate exposure of my left kidney area. The surgical area (pretty much the entire left side and front of my abdomen) was prepped for surgery. The endoscopic removal of my left kidney then began.
“In the end, five small incisions were scattered around the left side of my abdomen to accommodate the endoscopic equipment. A larger incision just below my umbilicus was used to remove the kidney. Carbon dioxide was pumped into the abdominal cavity to provide a ‘bubble’ that lifted the kidney away from the other organs to allow the surgeons a good view of what they were doing. Good exposure is important when one is cutting next to the aorta.
“At some point during my three or so hour operation, the recipient’s surgery was started so there would be as little down time as possible between the removal of the kidney from my body and the installation of it in his. As soon as the kidney was removed, it was placed on ice and flushed with a solution to help improve its downtime outside either body. My incisions were closed and the kidney was taken to an adjoining OR where it was connected in the recipient to its new artery and vein. Its ureter was then connected to the recipient’s bladder, and everyone waited.”
It turned out they didn’t have to wait long. When she finished with the recipient’s surgery, the primary surgeon came to visit Fuselier in postop. She told him the kidney was already working well. Although a bit groggy,he remembers asking her how she knew that his was working. She answered that the recipient’s kidneys had not been producing any urine; whatever he was making was from the new one.
“A sense of joy was added at that moment to my feeling of relief that it was over and all were well,” Fuselier said.
Fuselier is a 1982 graduate of the LSU School of Veterinary Medicine. His childhood interests in nature, animals, and science evolved into a desire to be a veterinarian. His career has included farm animal medicine and surgery in western North Carolina, public health work in rural Honduras, vascular research in Louisiana, and small animal medicine and surgery in Louisiana, North Carolina and New Mexico. He has shared his career with his wife and fellow veterinarian, Susie Park Fuselier. The couple joined the Animal Clinic of Los Alamos in 1993. Today, his veterinary interests include emergency medicine, surgery, dentistry and behavioral medicine.
Fuselier’s interest in his community has taken him beyond veterinary medicine. In 1995, he helped establish a sister-parish relationship between his church in Los Alamos and the Nuestro Pequeños Hermanos in Honduras, an orphanage where his wife and he volunteered in the late 1980’s. In addition to raising funds for the orphanage, the relationship has enabled nearly 100 Los Alamos area high school students and adults to visit and volunteer in rural Honduras.
Since the late 1990’s, Fuselier has been a director of the Los Alamos Housing Partnership. The LAHP, a nonprofit corporation, works with government and for-profit companies to bring affordable housing to Los Alamos County.
In 2011, Fuselier founded the Afghan Sister Village Project. The ASVP is modeled on the concepts of Sister Cities International.One of the ASVP’s goals is to connect the youth from Afghanistan with those from the US. As part of that goal, the ASVP has helped connect LAHS students with students in Lashkar Gah and Jalalabad, Afghanistan through letter exchanges and social networking programs.
Fuselier’s interest in behavior medicine has led to him teaching countless elementary-aged children how to avoid being bitten by dogs. Accompanied by his dog Cherie, Fuselier demonstrates the role that nonverbal communication has in human-dog relationships and teaches how the proper use of nonverbal communication can lessen the chance of being attacked.
Fuselier’s other hobbies include hiking the mountains around Los Alamos, writing and spending time with his four grandchildren.