June 2, 2022 • 47 mins
Kidneys are one of the few organs that you can donate while you’re alive. And the vast majority of donors experience no complications and their remaining kidney functions just fine. Yet thousands of people die each year waiting for a donated kidney. Why?
See omnystudio.com/listener for privacy information.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to Stuff you should know, a production of I
Heart Radio. Hey, welcome to the podcast. I'm Josh Clark.
There's Charles w to Kidney Bryant, and there's Jerry over there,
and this is stuff you should know. The kid kidney
(00:25):
donation addition. Yeah, we did one on Oregon donation, right, Yeah,
and we did one on kidney stones and put them together.
You get this episode. That's right, And this is from
Dave Bruce or pal and uh this good? Should we
should we? This good? It's that kind of day, how
it's going. Yeah, we're we're in person again, by the way. Yeah,
(00:49):
we should just tell everyone that I'm making a fool
of myself right in front of you for a change.
It's nice to see in person. Um. And I should
also point out them that this is a double Dave
Day because he did the last one too. Inflation right,
interest rates? Yeah, I forgot what we talked about. I've
already forgotten all of it. So Dave did some digging
(01:10):
for us UM and came up with some pretty surprising
stats that I certainly had no idea about. With kidney
disease in particular, but something like, of all American adults
have some form of chronic kidney disease. Thirty seven million
people right now, thirty seven million and ninety thousand Americans
(01:32):
are on the list waiting for a kidney transplant. And
each year, this is very sad, about five thousand Americans
die while waiting and another three thousand more become too
sick to get that transplant. So basically, eight thousand ish
people are either dying or on their way to dying
because they don't have a kidney that they can get right.
(01:53):
And then with you know, thirty seven million adults, just
the adults alone with some form of chronic kid of diseases,
their disease progresses, uh, they end up on the list,
the transplant list. So um, what we'll talk about in
this second. What's what's really interesting about kidneys, and in
particular kidney donations is it's one of a very select
(02:14):
few organs that you could donate while you're alive and
then whistle off back to your normal life. Down one kidney. Yeah,
you can't donate your heart to somebody. It's very sweet gesture,
but you've got two kidneys, you only need one. I
think the number the percentages if you donate a kidney
(02:36):
which is interesting because the one kidney you have must
ramp up production because your kidney function only goes down
what was it fifteen or something like that, Yeah, something nothing, maybe, Yeah,
it's not right, and that's definitely doable. Like you can
go through life with one kidney performing of your previous function.
(03:01):
That's right, that's not bad. And we should probably just
kind of point out some of the amazing things the
kidneys do. There are these two fist size organs or
one um depending on whether you've donated or not. That's right,
back to the show. Just just under your rib cage,
on either side of your spine. So have your loved
(03:21):
one make a fist with each and come up behind you,
put their fist under your rib cage gently. Yeah, just
on either side of your spine, and there's your kidneys,
right uh. And kidneys do a lot of things. The
main you know, like sort of the money job that
the kidneys do is they act as the filter system
for your for your blood. And that's the big thing.
(03:43):
They filter about two arts fluids every day. And that's
not just blood, that's blood and waste fluid. That's so much.
That's a lot a lot. Kidneys are always working. And
within the kidneys there are about one to one and
a half a mill allion tiny little filters inside the
kidney called nephrons. If you just think Nora ephron or
(04:07):
nefert d or nefert d uh, And those nephrons are
what's doing the actual filtering. They're just tiny little filters. Uh.
They also what else they do? They also release a
hormone called uh erythra poton e p O. It regulates
production of red blood cells and bone marrow. Very big deal. Yeah. Um.
They also convert vitamin D from a non usable form
(04:29):
from like the sun, into a usable form, which is
pretty important because vitamin D helps you retain and absorbed
calcium and phosphorus for building bones, reduces inflammation, possibly combats
tumor growth. Um. And all this is coming from your
kidneys doing its thing. And then one other thing we
kind of skipped over a little bit, I think is
worth pointing. Out of those two hundred quarts of fluid
(04:52):
every day, two courts of it, I think you said,
is waste. You pee it out, It gets converted into
your and sent to the bladder and you pee it
out and finally chuck. Finally, the eight eight ounce classes
of water a day makes sense. It's not arbitrary anymore.
You never realized that, No, I never understood. I thought
(05:15):
it was actually made up an arbitrary number. That sixty
four ounces because that's how much you pee out on
a normal day, because that's how much your kidneys filter out.
Is waste, so you gotta replenish it. Yeah, this is
funny that. Well, I'm this day's old when I finally realized, Uh,
what else? They also release a hormone called rennan regulate
(05:38):
your blood pressure, and we'll see blood pressure and kidneys
have a lot to do with one another. Yep. And
what else anything? You know what? I bet you there's
other things that kidney does it. It It just didn't like
to take credit for her. So. Um. One of the
problems with your kidneys is that they can break down.
They're susceptible to all sorts of other stuff going on
(05:59):
in your body. Um. And one of the big things
that put stress on your kidneys, well, two of the
big things that put stress on your kidneys is such
chuck colon. You've got blood pressure, high blood pressure, which
exerts pressure on the walls of your blood vessels. Which
in turn exerts pressure on your kidneys, damaging their function.
(06:21):
And the big one, the big daddy of what causes
kidney chronic kidney disease is diabetes. That's right, that's the
number one. High blood pressure is number two. And uh,
you know, basically high blood sugar is going to damage
the blood vessels in the kidney. It's gonna kill those
nephrons that we were talking about. Those are the filters
that actually do the filtering. And chronic c DK chronic
(06:44):
kidney sorry c KD, chronic kidney disease. Uh. They call
it the silent disease because you can be in you
can be through the first few stages of chronic kidney
disease and not feel any symptoms at all and not
know what's going on. So it's very dangerous. There are
(07:04):
five total, and stages one through four your kidneys are
still doing their thing, they're struggling. But stage five is
when you're in in stage renal disease or renal failure,
and that's when you your kidneys maybe aren't working at
all and you're going to dialysis every day and you
need a new kidney. Yes, um, And we'll talk a
(07:25):
little more about dialysis. But yes, once you hit stage five,
you're like, you, your kidneys just aren't doing the work anymore.
And you know it's not like they're just stop functioning
little by little, they're unable to filter out waste. So
the waste starts to accumulate and build up and you
have all sorts of terrible symptoms like nausea, UM, fatigue, vomiting.
(07:48):
You feel poisoned, is what I've heard. Yeah, I think
that's basically what's going on. And your body is being
poisoned because it's no longer able to filter it out.
So UM. There's a lot of racial disparities too as
far as kid new diseases go, and apparently it tracks
very closely to UM uh diabetes. UM. Apparently, if you're
a Black American, you are four times more likely to
(08:11):
have kidney failure UM than a white American, Hispanic Americans
one point three times, in Native Americans one point two times,
and again like that's those same rates are pretty close
to the disparity in diabetes. But also it has to
do with things like access to healthcare, access to certain
kinds of food that may not lead to diabetes or
(08:33):
will lead to diabetes. Um, there's a lot of stuff
kind of caught up into it that. Um, it's not
entirely straightforward that everybody has an equal opportunity to develop
kidney disease. Yeah, it's just I mean, it's really sad
that it it. You know, it seems like everything comes
down to money and access to money. And if you
(08:53):
live in the United States and you are somewhere on
the poverty spectrum, then you're more likely to not have healthcare,
not go to the doctor, eat worse food, get diabetes,
have kidneys fail. It's all sort of in lockstep with
one another. And then it gets even more insidious than
that because once you get the stage five you might
not have reliable transportation to go to dialysis, and dialysis
(09:16):
is extremely time consuming. It is, so it's going to
be hard for you to keep doing a job. Yeah,
my neighbor before they moved and sadly he passed away,
Miss Jesse and Mr Otis he had his Uh, he
had the ambulance come or you know, it looks like
an ambulance, but it's not an emergency one. It's just
the transpo. They picked him up every day, took him
(09:36):
to dialysis. Brought him home and this was for the
last couple of years of his life, you know, going
every single day, and it's good. Dude. I wish I
would have gotten to him a little bit better before
he passed. But um so dialysis is short for hemo dialysis,
and it is literally just a machine that does the
filtering that your kidneys do. So you sit there for
(10:00):
or what is it like four hours, usually about three
times a week. Yeah, three times a week, four hour sessions,
and they just clean your blood in full with each session. Yeah,
there's like a little membrane that um doesn't let the
important stuff like red blood cells get through, but it
does let those waste products get through and they just
get slashed out, whereas the blood that doesn't go through
(10:22):
the membrane gets put back into your body. Yeah, and
you're on dalysis for life until unless you can get
a new kidney, and then even if you do get
a new kidney, you might be on dalysis for a
little while, as we'll see. Yeah, So, Chuck, I feel
like this is a good time to take a break.
Just off the top of my head, let's do it, Okay,
So we're gonna take a break and we'll be right
back everybody. Okay. So it's not fun to have kidney failure,
(11:11):
especially stage five kidney failure, because you're going to dialysis
a lot um and there's a lot of terrible symptoms
involved in it. Um. If you are at that point,
you're going to be put on UM an organ donation list.
You're going to become a m a recipient or potential
(11:32):
recipient of a donated kidney. That's right, and that means
you have signed up with UH, the Organ Procurement and
Transplantation Network, which is managed by a nonprofit called the
United Network for organ sharing a lot worse places. You
can donate your money too, by the way, and it's UH.
(11:52):
You know, Day points out astutely that it's not like
a waiting list, as in, you know, there's ninety thousand
people or more away eating for a kidney. So if
you sign up for one, then you have eighty nine
people in front of you, and it just very slowly,
you know, that time ticks away. It's a network, it is,
it's a pool of candidates. And because you have to
(12:14):
get matched with a kidney, and there are all these criteria,
one of which is blood type UM don't have to
have necessarily exact blood type. I think if you have
like A, you can get a b uh So, there's
a little bit across over there and oh is universal right?
How is it? Oh negative? We did a thing on
blood it was. It was a good one. We did
a live one, that's right. Remember my father in law
(12:36):
spoke up when I did a blood test. He said,
Josh is pregnant. That's right. He got more last than
all of mine combined that night. I remember that that
was a very like one of the only funny audience
jokes that we've ever had. It really was was yelled out,
it's high quality. Heckline. That was like, that's for the
Atlanta Science vessel Um. Where was that? That just totally
(12:58):
through me that I'm trying to picture your break it
now we'll get a load of me, buddy. Uh So, Yeah,
blood type is one the size of the organ. It's
got to be a good fit. So like a little
kid can't get a big adult kidney. You wouldn't think
about that, but it is true. And I mean it's
not just true with kidneys, with any oregan like I
saw it, put like a basketball players a long mon't
fit in a child. Right, It's like sure, yeah, those
(13:20):
are wise words. Good point. Uh. And then geography is
one because as you'll see, if you get a kidney
donated from someone that you don't know, it's not like
a family member, then that kidney is going to be
on ice basically for a little while. That's gonna be
transported maybe or maybe you're transported, but there's gonna be
a little bit of time. Uh. They don't just like
(13:42):
you know, put you on the table like in the
movies that put you on the table next to your brother,
and they would just like slide one kidney right in,
you know, just across the room to the other. Right. So,
uh so geography is a consideration. So within this network,
you know, there's a big garrhythm that's going to match
blood types and all these things. And like, hey, you
(14:03):
live in Birmingham. We got a kidney in Tuscaloosa, So
you guys are pretty good match. Yeah. And so with
each new organ that comes up for UM donation, uh,
you get a new a new score calculated by the computer.
Like it's not like you get your score as signed.
It's all contextual based on your relation to that organ.
(14:26):
That's that's being considered, that's being donated. Yeah, and also
we should point out that it's also based on your need,
like if you're you know, how urgent it is in
a lot of cases. Yeah, it's also based though on
on some other stuff too, which is, you know, kind
of calculating. But it makes sense. Um, your age, the
younger you are, the higher your score, which makes it
(14:48):
likelier for you to get that um, the likelihood that
you will survive the procedure, the likelihood that you will
um reject the organ or not. Sensitization, I think is
what they call it. There's a bunch of different factors.
And this is fairly recent, this pool um um method. Uh,
and I it's kind of revolutionized things and apparently made
(15:10):
it a lot better a lot um it's from what
I understand, it's a lot more sensible and fair. Yeah,
and it also makes sense, like once you see the numbers,
like every kidney is super important, and so they want
to give them to people where you have the best
chance for that kidney to work over you know, for
ten to fifteen twenty years. Yeah. I can't waste no
(15:32):
kidney left behind. No, Oh man, can you imagine if
they were just like, oh, we left it on the plane,
just forget about it. You're like, I just donated that
kidney for nothing, Right, it's in the trash. Now there's
a story out there, and I kind of want to
hear it. See. I pictured more like Cheech and Chong.
(15:53):
We're piloting the plane and they're like, what's in the
cooler man? And all of a sudden it's a movie
they're looking for like some some ah good marijuana. That
reminds me of Snoop Dogg as the pilot. Sole Plaine.
I never saw that was like, you know, it wasn't
at all at all. Yeah. It looked like a sort
of homage to the sort of bad seventies comedies. You know.
(16:16):
It was where there was no It was like, hey,
here's an idea. Let's get a bunch of like funny
people and get them really high or drunk, and there's
your movie. That that was exactly what is an airport? Right?
That's the that's the twist, all right, I'm not going
to see it twist. Yeah, no, there's no reason to.
(16:38):
I demand that you not see it. Actually, how are
you gonna sign up to be an organ donor? What
are the couple of good ways you can do that. Well.
One way is whenever you go get your license renewed
at the old d m V in the United States,
uh or the d m V in France. Um, they're
gonna ask you if you want to be an organ
(16:59):
donor and and you can say yes, and they will
put it on your license, yes organ donor. So that
if you you know, by the farm out and about,
and you've got your driver's license on you, the doctors
and the people at the hospital are going to look
at your I D. And if they see yes, they're
going to go to your family and say, your your
loved one here, um who's now regretfully deceased, said that
(17:22):
they want to donate their organs or will you sign
off on this? It seems to have been their wishes.
And you can still say no if you're a family member,
but um, probably you're going to say yes, especially if
you're deceased loved one said Hey, I marked yes my
that I want to donate organs on my driver's license.
If I die, make sure my organs get donated. They're
(17:44):
probably gonna go along with it. Yeah, I think it's
kind of funny that I wonder what percentage of people
that sign up at the d m V for organ
donation and the kid needs that actually go to other
people and organs that successfully save lives. How many of
those start with the two words why not? Yet you're
(18:05):
at the d m V, you're bored out of your mind,
you've been there for far too long, and they ask
you this question, you go, yes, why not? Yeah, that
is the most interesting question you've been asked in that
whole experience, Like, maybe the biggest question you can answer
in your life is whether or not you will donate
your kidneys and your organs to save a human life.
And people probably just go, yeah, why not. So if
(18:27):
you've been to the d m V and you said no,
and you okay, But if you said no you wanted
to your you can still go in register right, Yeah,
You've got to register me m E dot org and
you can register there. Uh, and here's the deal in one,
here's some more stats for you. There were forty thousand
(18:50):
total organ transplants. I think most of those are I
think was it like or kidney transplants? Far and away
the most are kidney transplants, and only six hundred of
those forty five. Uh, came from living donors, which was
I have a relative or I'm just a benevolent human
(19:11):
who wants to give a kidney to anonymously to somebody.
I mean, yeah, talk about st hood. Uh So two
thirds of all kidney transplants are from deceased donors. So,
like you said, it's a lot of times it's accidents,
car and motorcycle accidents where there's like traumatic head injury,
uh in the but the organs are still in pretty
good shape. You're young, you're in good shape, and so um,
(19:35):
you know, you may be brain dead, and they can
the word harvests always sounds so cruel, but they can,
they can harvest borrow your organs. No, it's hardly, it's
definitely harvest. Remember in our our book of that chapter
in Jack Kevorkian he had that that idea in the
I think sixties or seventies where he was like, well,
we're going to execute people, let's just execute them through
(19:57):
organ harvesting. You know, we' started to perform surgery on
him and we harvest their organs and then once we're done,
they're just they're dead, right, Yeah, then we're joining their
organs and everybody's like, it's a really great idea, but
you're creepy, dude, and I think you're the last person
who should be espousing this kind of stuff. Well, maybe
he shouldn't have expressed this idea while imitating Verner Hertzog, right,
(20:22):
and where are your pants? That's right? Uh? So that
means at the end of the day, one human body
can save uh up to Nold does a pretty good
Verna herd so he's yeah, but the best ever is
Paula Tompkins his Verner fantast Just look it up on
the internet. It's great, one single human body an organ
(20:45):
donor can save up to eight lives. Uh. And that
is just with the organs. And then you've got tissue donation.
You've got eyes that can bring sight to someone. We
should totally do one on Ie the transplants. Yeah, might
also show you the killer of the person whose eyes
you got, in which case you're morally responsible for chasing
(21:06):
that killer down and turning them into bringing the justice
or exacting revenge. If it's a really good movie, a
bridget Fon type movie, was that then the actual plot
of one? Or was it was that just a typical
movie plot? I don't remember who was in it though,
Jennifer eight, I don't know. No No, Jennifer eight was a
blind woman, a sightless woman who was going to be
(21:30):
the eighth victim of a serial color who's targeting blind women.
And I could spoil it for everybody. I'm not going to.
It's actually we're seeing it's a good Nighties movie with
Andy Garcia and yeah, I don't remember what was it. Yeah,
it's good, good movie. I think it's out there still,
or I'm thinking of the movie, uh where the guy
(21:52):
got the hand transplant and the hand was from a
serial killer and so he got a bad hand that
wanted to do bad things. Jeff Fahey, I think the
lawnmower man. But Jeff Ahey was the lawnmower man. Okay,
I never saw that one. I mean it might have
been called something as basically like bad Hand. Was it
(22:13):
called idle Hands? No, that was different, and that was
not good. I'll look it up, and well, well how
about this, so folks stick around for the stormail. We'll
look it up. In the interim, we'll announce it at
the beginning of Finally, year fourteen, we've got a new
hook for the show. Or maybe I can just make
up an email that fake Jeff Ahey sent in. Remember me,
(22:34):
we need to fake Jeff Ahey sound effect like side effect? Uh? Alright,
So living donation is something we should talk about. This is,
like you said at the beginning, one of the only
organs you can donate, I mean, is it the only one? No,
you can also donate his portion of your uterus and
a portion of your liver, okay portions, yes, But other
(22:58):
than that, that's it. Right. So I got a little
bit of history here. Um, if you're talking kidney transplants,
you gotta go back to nineteen o two was when
they did a dog kidney transplant in Austria. The dog
did not make it, of course, but the it did
produce urine for a couple of days. The kidney man
(23:20):
not bad, I know. And that really just kind of
takes you back to some nineteen o two really unseatily
black and white view of like some terrible experiment. Yeah, um,
let me see. In nineteen o nine, apparently there were
efforts to transplant kidneys from humans dead humans to monkeys
(23:41):
as you do. Thirty nine, the first deceased human donor
I think was performed in Russia. But the organ it
didn't take. Organ never worked, but they tried it. In
thirty nine, they tried their best. From human to human. Uh.
Fifty three, you finally had your first successful temporary human
kidney trans in Paris. It was twins, right, Uh sixteen,
(24:03):
your boy received one from his mother as a living donor.
And then fifty four I think was the twins. It
was the first long term successful kidney transplant by Joseph Murray.
He won a Nobel Prize for that, sure. And then
sixty two is the first non related no genetics involved whatsoever.
So it's only been since the nineteen fifties nineteen sixties
(24:25):
that we've been able to successfully transplant kidneys. But once
we got it, we got it pretty good. Yeah, we
have it down path. Let's do this a lot, guys.
This is fun. So um. If you are a living
donor and you do donate your kidney, I think it
makes out about a quarter of kidney donations today, right, Yeah,
is a living donor somebody saying, take my kidney, put
(24:48):
it in somebody else. More often than not, it's put
it in my brother, put it in my spouse. Three
quarters of the time it's you're related. Um, but there's
that still means that of all kidney donations, So that means, however,
many thousand kidney donations are are donated by people who
(25:13):
are just saying like, here, take my kidney and give
it to whoever needs it. That's right. And sometimes that
it's anonymously. Sometimes it's a friend, sometimes it's a spouse.
Sometimes you hear about someone in your community. But yeah,
sometimes it's you don't even know anybody, and you're just like,
you know what, I'm gonna save a life. Yeah, I'm
at the d m V right, I don't want to
(25:35):
save a life. Yeah, I'm gonna do it. So if
you do do that, you're a living donor UM. And
there's a lot of advantages to a living donation compared
to a dead deceased donation donation. You know, an organ
taken from somebody who's died, right, UM. So if you
donate your kidney, UM, there's like the chances of the
(26:00):
kidney being rejected are lower compared to a deceased donor UM.
The the kidney will probably start functioning independently, like on
its own UM much more quickly than a deceased donor
one because the deceased donor one is going to be
um basically put on ice for a little while while
(26:21):
it's transported kept you know kind of you know, yes, exactly. Um.
There's also, um, a difference in the amount of time
that the average kidney lasts between a deceased donor and
a living donor. Right. Yeah, Well you tend to live
longer and your kidney last between fifteen and twenty years
on average from a living donor. Uh, It's only about
(26:43):
a decade from a deceased owner. And you also have
a better chance if you are genetically related of avoiding rejection.
So living genetically related living donor is like the crime
dela crime of getting a kidney, right exactly. Um. There's
also more convenient to um if you are a living donor.
(27:06):
You can say, let's do this like a week from Tuesday.
That works best for me, not this guy just died.
We need to we need to get this into a
recipient like as soon as possible. Um it, let's find
somebody kind of thing, you know what I mean? Um,
So that that's that's another big advantage too. So I
think we've established here living kidney donations are the way
(27:29):
to go if you can do it from a relatively
So let's take a break, because, um, there's actually ways
to maximize how kidneys get donated, chuck, and we're gonna
tell everybody about it after this. Let's do it alright.
(28:07):
So on the kidney exchange, it's pretty cool how they've
worked this out over the years. Uh. There's something called
paired exchanges, and it goes a little something like this.
You want to donate a kidney to your relative, to
your to your niece, but you don't have the right
(28:27):
blood type. You can get paired up with someone who
does have the right blood type who needs your kidney.
They'll be like, wait a minute, my niece needs a kidney.
You've got her blood type and I've got your nieces
blood type. So let's just get together and make this
all work out criss cross paired exchange. But then that
(28:48):
is multiplied exponentially by the donor chain, right, yes, So
like if if you have a good computer handy to
run an algorithm for you, because apparently it's very difficult
to do, Um, you can take a bunch of these
mismatched pairs rather than four people, you can take I
think up to seventy people, and one good Samaritan donor
(29:12):
who says, take my kidney, I don't care who gets
it can set off a chain of paired matching that
can satisfy up to seventy seventy recipients through the through
a combination of one person donating it without any you know,
just saying take my kidney, put in somebody, and then
a bunch of paired, paired matches all all like seventy people.
(29:37):
So it makes it really difficult to say, like, I
don't really want to donate my kidney, when not only
are you saving one person's life, you're setting off a
chain reaction that allows for seventy different people to get
their kidney because you donated yours without without directing it
towards anybody in particular. And if that's not the first
(30:00):
thing you say on every first date you go to
for the rest of your life, right, then you're doing
it wrong. We should mention that the there was a
Nobel Prize winning economist named Alvin Roth who who came
up with his donor chain idea. And I don't think
we said you, um, you have to be eighteen to
donate a kidney you have to be in good health
and you have like rock and kidneys basically, and also
(30:23):
in good health otherwise, Yeah, like a sixteen year old
can't donate a kid That's the other reason why a
living donor is advantageous because of that luxury of time,
because you can run a battery of tests. Yes, you
have time to run tons of tests to make sure
they're a perfect match for this other person. That's right.
So when you do say okay, I'm gonna do it.
(30:44):
And by the way, uh Dave said from researching this,
he was inspired to do it. I think he may
have put himself on a list or was going to
although it may have worn off by now, who knows,
we'll have to ask him. But if you do this, um,
you are going to undergo surgery. Um. It's just as
simple as that. And it's a serious surgery, like they're
(31:05):
removing your kidney. Like I said, we've got it down
pat since we've been doing it since the fifties or sixties,
and now they can usually do it laparoscopically. How does
that work? I think they just squeeze it real tightened.
It's really long, pencil like really, Now, how do they
get the kidney out. I don't know. I have no idea.
That's the one thing that Flum makes me and I
(31:26):
almost like Google to see if I could find, you know,
a surgery. I could watch laparoscopic kidney removal, because laparoscopic
means it's like a very small incision using very very
thin like cameras and very thin tools. But then how
do you get the kidney out if it's fist size?
I don't know. I mean this is larger than a
(31:47):
laparoscopic you know in decision, Yeah, this is a window
maker right here? Uh and here to me is the
fact of the show. I never knew this. They don't
take out your bad kidney. Did not know that. They
just leave it in there. I guess they did the
(32:08):
research and found out that they didn't need to and
that doesn't do any harm and maybe me more dangerous
to take it out, you can see that than to
leave it in. But you end up if you have
a kidney with three kidneys. Yeah, so I don't I mean,
surely they detach those kidneys, yeah, because you got to
attach the other right, Yeah, I guess so, so that's
(32:28):
what they do. The surgery is to they take it out.
Of you. And at that point you're like, okay, I'm done.
It's all recovery for me. But they have to put
it in the other person. And like you said, they
leave the other kidneys. They attached the one to the
blood vessels so that it's you know, getting the blood
supply to filter, and then also they attach it to
your reader, um, so that it can transport waste to
(32:50):
your bladder. And I supposedly it's actually a pretty effective
surgery and with minimal um uh negative outcomes. Yeah. Recovery
time for the donors, a couple of days in the hospital,
one to two weeks at home, six to eight weeks total,
and then you've got to come in at six, twelve
(33:11):
and twenty four months for checkups. Um. Like uh, we said,
you lose twenty five to thirty five of your kidney function,
but that's not fifties, so your one kidney must like
ramp it up. Um. And then you said, pretty good
outcomes there. I think this is between two thousand and
six and two thousand eight of the seventeen thousand. Oh,
(33:32):
there's your number right there. If the numbers hold, that
would be seventeen thousand over three years, So about five,
five thousand and change year at least back then unless
there's been a rush. Um. Only twelve donor deaths out
of the seventeen thousand, four hundred and two, and only
one of those was from the surgery from like hemorrhaging, hemorrhaging, hemorrhagering.
(33:59):
It's close him, hemoraging, hemorrhaging. God, that sounds weird. Hemorrhaging, hemorrhaging. Yeah, okay,
it was purposely weird during surgery. Yeah, bleeding too much
and don't forget to complete the sentence. That was very
porky pick of me. So um, yeah, that's a pretty
(34:20):
good trek record. Twelve deaths out of four hundred and
two transplants. Um. They also studied people for long term
effects and found that somebody who had donated kidney had
about the same um chance of suffering and stage renal
failure as the general population, so it didn't increase their
(34:42):
chances one bit. And I was like, okay, alright, Internet,
let me go a few more pages deep, like where's
where's the where's the real talk about the long term
consequences of donating a kidney? And from what I can see,
study after study is shows like there's really not any
long term effects. Um that after about six or eight
(35:06):
weeks of recovery, you can go back to a normal life.
During that time, you're gonna feel very fatigued. Your function
is going to be decreased. But if you say I'm
donating my kidney, I'm just gonna take two months off
basically um of life, you know, like stressful life. Um,
that's really not too bad considering that you basically go
back to normal life after two months and your kidney,
(35:29):
the one kidney you have, is still doing of the
original function. Yeah, like if you work from home, you
have no excuse exactly. Uh, Dave did put in here,
And I looked into this a little more that a
drawback might be, Um, it might affect your life insurance
or disqualify you or increase your rates. So I poked
around that because that sounded like a horrible thing. Uh,
(35:51):
And it wouldn't have surprised me. But it looks like
there are a lot of protections in place from the
Affordable Care Act for stuff like this. Thankfully, And if
you have never had insurance, you have your kidney removed
and you go to get life insurance for the first time,
then you may not be able to get it as easily.
But you know, you're not booted from your life insurance
(36:14):
policy because you donated a kidney, or your rates aren't
gonna skyrocket because you donated a kidney. It's against the law.
It should be. Yeah, So, um, there's a risk of rejection,
Like that's something you have to go into it knowing,
like you might donate your kidney and it just might
not work, probably just by all the tests, despite all
of the um the care given into matching you and
(36:37):
your kidney with a recipient, it still might get rejected.
But they have developed um a lot of different drugs
to cut down on the chance of rejection. Right. Yeah,
they're called anti rejection drugs or immunosuppressants, And there are
a couple kinds. There's one that they that are super
powerful that they give you at the time of the
(36:59):
transplant called induction agents, and then you've got maintenance agents. Uh.
And there were basically four different kinds of maintenance agents.
And the way this one website I saw put it,
I think it was a kidney dot org or whatever
uh was that they said, look at it, it's like
a mortgage, your down payment is the induction agent like
(37:21):
the heavy duty drugs they give you when they do
the transplant, and the maintenance agents are like your monthly payment,
and the bigger the down payment, the lower the monthly
So if you if the induction agents are really really
work well, then you're not going to be on as
many long term medications for maintenance. And I didn't really
recognize any of the drugs except for pregnisone, the steroid. Yeah,
(37:42):
I didn't either. I saw the most common combination of
drugs is three things, one called tachra limits which is
a calcine calcinevrin inhibitor, one called mico finilate mo fatil
which is an anti proliferate, and then pregn his own.
(38:04):
And I saw that you're generally on these for life,
but they can, you know, scale down. I don't know
if you're ever off of them completely. But um, yeah,
I think of kidney recipients experienced some sort of rejection,
so those But it doesn't necessarily it doesn't mean that
like that's it didn't work. I don't think the square
(38:26):
one necessarily. Yeah. I think like in a lot of
those cases, you can keep that kidney if the drugs
are working. So um the the entire thing, this entire thing.
But whether it's a dead donor, a deceased donor, sorry,
keep calling it dead donor, I know it's not quite right,
even though it's accurate, um or living donors of kidneys.
All of this is based on altruism. The entire organ
(38:50):
procurement organ donation system everywhere in the world save for
one country, is based on the kindness of of in
generosity of donors who do it for no money whatsoever,
just out of the goodness of their hearty. And that's
the way that a lot of people think it should be.
That's the way that it's um. It's enshrined in law,
(39:14):
that that's the way that it has to be. In
the United States, there's an UH law called the National
Organ Transplant Act of nine four UM that says you
cannot gain financially um or I can't remember exactly how
they put it, but you can't make any kind of
like gain from from donating your organ. And I was like, well,
(39:38):
where did that law come from? What prompted that? Well,
probably the black market for organs. H It turned out
there was there was a guy. So that was the
Act N two there was a doctor in Virginia named H.
Barry Jacobs who announced that he was setting up a
market for organs. He was going to create a brokerage
for organs. There's no federal law. Again, that's exactly right,
(40:02):
and so they went and made a federal law against
it because they're like, that is objectively unethical and immoral,
and that's kind of the basis for organ donation in
this country, and again every country in the world except
for Iran, that it's unethical to make money selling organs
or to pay someone for the organs, because they're worried
(40:23):
that it sets off a whole cascade of problems. Yeah,
I think they try and make it cost neutral for
the donor, which means your expenses are covered, like you're
not gonna be paying like the recipient's insurance is going
to be paying for all the operations and surgeries and
all that stuff. And then there are uh, you know,
private nonprofits that can also help cover like travel and
(40:45):
if you're a low income donor, help pay for stuff
like that, but you're still not getting like paid to
do it. And the idea there is ethically is that um,
you know, the dystopian science fiction plot, which is there's
a class of wealthy people who harvest the poor on
organ farms. And you know, it's like something out of
(41:07):
a movie, but it's also something that could very well
happen if you let that kind of thing, you know,
take place, uh, you know, black market human trafficking again
like you mentioned. And then another one I didn't think of,
is that, um the motivation for someone doing it if
you're getting paid like you may not, you may fudge
a little bit on your questionnaires, like fake something to
(41:31):
make money to get an organ taken out of your body.
It's almost like they've identified it as such a valuable
thing that you can't you can't assign any kind of
monetary value to it. You you can't allow that to
happen or else nothing but bad things are going to happen.
And there's actually polls that support this, although some people
(41:51):
say that's stupid, we should we No matter how how
many um generous people are donating organs, the demand is
still not there. I mean, you said it yourself. Like
five thousand people die on organ transplant waiting lists every
year in the United States alone. That's just in the
U S alone. People die all over the world on
(42:13):
organ transplant lists every year, and so people say that's stupid.
If people are willing to sell like their kidney in particular, UM,
let them do it. It's a free world, it's a
free country at least. So what's the problem. Yeah, I mean,
I think the idea. I'm not libbying for this, but
they have floated things like a like a fifty dollar
(42:37):
tax rebate that you can absorb over like a decade,
or wipe out your student loans or something like that,
Like they're not literally just cutting you a check. Things
like that are interesting because, um, donating a kidney saves
taxpayers close to a hundred and fifty thousand dollars in
medical costs paid out by Medicare for dialysis and things
(42:59):
like at and there was another analysis that found that
paying donors forty dollars for kidney would result in a
net gain of forty six billion dollars in lowered medical
costs and better health overall health and outcomes. So like,
something like that is interesting, not just like harvesting organs
for cash, but if people want to take a big
(43:22):
fat tax rebate over a decade, it leads to less
taxpayer payouts for Medicaid and UH or for Medicare better
health outcomes. I don't know some we're thinking about. Yeah,
and other people would say this, that's already going on.
There's a very healthy black market for organs all around
the world. I saw an estimate on some human trafficking
(43:43):
website that was something like ten thousand kidneys a year
are procured and transplanted on the black market. But then, Chuck,
ultimately you have there is one country, Iran it allows
payment for organs. Its something like and then also like,
you're right, it's a pretty in substantial amount if you're
(44:05):
selling a kidney compared to say, like the forty five
grand the US is considering, or I shouldn't say the
US is considering people Americans have come up within a study,
but um, the there is the one stat that stood
out to me that I think kind of suggests, you know,
not applying money to organ procareman, is that of a
(44:27):
two thousand one study of three hundred Iranian paid organ
donors said that if they could go back, they would
not have sold their kidney. There you have it. Pretty
much anything else about kidney transplants and donations and all that. Well, again,
if you want to uh donate your organs uh and
(44:47):
you aren't going to the d m V anytime soon.
Go to register me dot org. Uh. And since I
said register me dot org, it's time for a listener mail.
I'm gonna call this dB Cooper follow up. Oh wow, no,
pretty interesting And this is from Holly. Hey, guys, Holly
(45:09):
from Texas here. I've been listening about six months and
I'm obsessed. Turned to the Facebook groups to suggest some
fan favorite episodes, and dB Cooper the live episode was
mentioned a lot, and it reminded me of a story
you might enjoy several years ago, as it a small
family gathering at my grandparents and we were sitting around
chatting about different topics of memories, and my grandma casually says, Oh,
(45:30):
that's just like the time when the FBI tapped our
phones because they thought Grandpa was TP Cooper WHOA. I
of course did a dramatic double take, slam both of
my hands on the table and exclaimed what I mean.
I was floored. At the time, I was in l
a thirties and never heard this story in my whole life.
That's the thing with grandparents, You hear this stuff like
how did I not know that I know? Um, I
(45:53):
of course had to dramatically turn to my grandpa with
narrowed eyes and say, who are you. My grandma was
very nonchal line about the whole thing, and I was like, wait, wait, wait,
explain please. She didn't have much more info, but I
guess my grandpa was cleared obviously. Uh. And it's still
a mystery why they suspected my grandpa, mainly considering the
fact that they lived in New Mexico at the time.
(46:13):
We sadly lost my grandma in July, but I'm happy
to report that my grandpa is still doing well. Even
though I could never picture my cowboy boot levin heavily
starched wrangler gene wearing Grandpa and a skinny tie from J. C. Penny,
although he does enjoy his daily bourbon. And that's a clue.
Maybe that was it. So that's from Holly, And that's
(46:35):
a great email. Holly as one of the all time greats. Holly.
I love that she's like. Also, my grandpa pays for
everything from a bag of money that he keeps the
ship out back. Yeah, we always got unmarked dollar bills
for birthdays. If you want to be like Holly, and
tell us one of the great family stories that you
(46:57):
heard from your grandparents about. We want to hear those two.
You can send them to us at stuff Podcasts at
i heart radio dot com. Stuff you Should Know is
a production of I heart Radio. For more podcasts my
heart Radio, visit the i heart Radio app, Apple Podcasts,
or wherever you listen to your favorite shows. H
Welcome to Stuff you should know, a production of I
Heart Radio. Hey, welcome to the podcast. I'm Josh Clark.
There's Charles w to Kidney Bryant, and there's Jerry over there,
and this is stuff you should know. The kid kidney
(00:25):
donation addition. Yeah, we did one on Oregon donation, right, Yeah,
and we did one on kidney stones and put them together.
You get this episode. That's right, And this is from
Dave Bruce or pal and uh this good? Should we
should we? This good? It's that kind of day, how
it's going. Yeah, we're we're in person again, by the way. Yeah,
(00:49):
we should just tell everyone that I'm making a fool
of myself right in front of you for a change.
It's nice to see in person. Um. And I should
also point out them that this is a double Dave
Day because he did the last one too. Inflation right,
interest rates? Yeah, I forgot what we talked about. I've
already forgotten all of it. So Dave did some digging
(01:10):
for us UM and came up with some pretty surprising
stats that I certainly had no idea about. With kidney
disease in particular, but something like, of all American adults
have some form of chronic kidney disease. Thirty seven million
people right now, thirty seven million and ninety thousand Americans
(01:32):
are on the list waiting for a kidney transplant. And
each year, this is very sad, about five thousand Americans
die while waiting and another three thousand more become too
sick to get that transplant. So basically, eight thousand ish
people are either dying or on their way to dying
because they don't have a kidney that they can get right.
(01:53):
And then with you know, thirty seven million adults, just
the adults alone with some form of chronic kid of diseases,
their disease progresses, uh, they end up on the list,
the transplant list. So um, what we'll talk about in
this second. What's what's really interesting about kidneys, and in
particular kidney donations is it's one of a very select
(02:14):
few organs that you could donate while you're alive and
then whistle off back to your normal life. Down one kidney. Yeah,
you can't donate your heart to somebody. It's very sweet gesture,
but you've got two kidneys, you only need one. I
think the number the percentages if you donate a kidney
(02:36):
which is interesting because the one kidney you have must
ramp up production because your kidney function only goes down
what was it fifteen or something like that, Yeah, something nothing, maybe, Yeah,
it's not right, and that's definitely doable. Like you can
go through life with one kidney performing of your previous function.
(03:01):
That's right, that's not bad. And we should probably just
kind of point out some of the amazing things the
kidneys do. There are these two fist size organs or
one um depending on whether you've donated or not. That's right,
back to the show. Just just under your rib cage,
on either side of your spine. So have your loved
(03:21):
one make a fist with each and come up behind you,
put their fist under your rib cage gently. Yeah, just
on either side of your spine, and there's your kidneys,
right uh. And kidneys do a lot of things. The
main you know, like sort of the money job that
the kidneys do is they act as the filter system
for your for your blood. And that's the big thing.
(03:43):
They filter about two arts fluids every day. And that's
not just blood, that's blood and waste fluid. That's so much.
That's a lot a lot. Kidneys are always working. And
within the kidneys there are about one to one and
a half a mill allion tiny little filters inside the
kidney called nephrons. If you just think Nora ephron or
(04:07):
nefert d or nefert d uh, And those nephrons are
what's doing the actual filtering. They're just tiny little filters. Uh.
They also what else they do? They also release a
hormone called uh erythra poton e p O. It regulates
production of red blood cells and bone marrow. Very big deal. Yeah. Um.
They also convert vitamin D from a non usable form
(04:29):
from like the sun, into a usable form, which is
pretty important because vitamin D helps you retain and absorbed
calcium and phosphorus for building bones, reduces inflammation, possibly combats
tumor growth. Um. And all this is coming from your
kidneys doing its thing. And then one other thing we
kind of skipped over a little bit, I think is
worth pointing. Out of those two hundred quarts of fluid
(04:52):
every day, two courts of it, I think you said,
is waste. You pee it out, It gets converted into
your and sent to the bladder and you pee it
out and finally chuck. Finally, the eight eight ounce classes
of water a day makes sense. It's not arbitrary anymore.
You never realized that, No, I never understood. I thought
(05:15):
it was actually made up an arbitrary number. That sixty
four ounces because that's how much you pee out on
a normal day, because that's how much your kidneys filter out.
Is waste, so you gotta replenish it. Yeah, this is
funny that. Well, I'm this day's old when I finally realized, Uh,
what else? They also release a hormone called rennan regulate
(05:38):
your blood pressure, and we'll see blood pressure and kidneys
have a lot to do with one another. Yep. And
what else anything? You know what? I bet you there's
other things that kidney does it. It It just didn't like
to take credit for her. So. Um. One of the
problems with your kidneys is that they can break down.
They're susceptible to all sorts of other stuff going on
(05:59):
in your body. Um. And one of the big things
that put stress on your kidneys, well, two of the
big things that put stress on your kidneys is such
chuck colon. You've got blood pressure, high blood pressure, which
exerts pressure on the walls of your blood vessels. Which
in turn exerts pressure on your kidneys, damaging their function.
(06:21):
And the big one, the big daddy of what causes
kidney chronic kidney disease is diabetes. That's right, that's the
number one. High blood pressure is number two. And uh,
you know, basically high blood sugar is going to damage
the blood vessels in the kidney. It's gonna kill those
nephrons that we were talking about. Those are the filters
that actually do the filtering. And chronic c DK chronic
(06:44):
kidney sorry c KD, chronic kidney disease. Uh. They call
it the silent disease because you can be in you
can be through the first few stages of chronic kidney
disease and not feel any symptoms at all and not
know what's going on. So it's very dangerous. There are
(07:04):
five total, and stages one through four your kidneys are
still doing their thing, they're struggling. But stage five is
when you're in in stage renal disease or renal failure,
and that's when you your kidneys maybe aren't working at
all and you're going to dialysis every day and you
need a new kidney. Yes, um, And we'll talk a
(07:25):
little more about dialysis. But yes, once you hit stage five,
you're like, you, your kidneys just aren't doing the work anymore.
And you know it's not like they're just stop functioning
little by little, they're unable to filter out waste. So
the waste starts to accumulate and build up and you
have all sorts of terrible symptoms like nausea, UM, fatigue, vomiting.
(07:48):
You feel poisoned, is what I've heard. Yeah, I think
that's basically what's going on. And your body is being
poisoned because it's no longer able to filter it out.
So UM. There's a lot of racial disparities too as
far as kid new diseases go, and apparently it tracks
very closely to UM uh diabetes. UM. Apparently, if you're
a Black American, you are four times more likely to
(08:11):
have kidney failure UM than a white American, Hispanic Americans
one point three times, in Native Americans one point two times,
and again like that's those same rates are pretty close
to the disparity in diabetes. But also it has to
do with things like access to healthcare, access to certain
kinds of food that may not lead to diabetes or
(08:33):
will lead to diabetes. Um, there's a lot of stuff
kind of caught up into it that. Um, it's not
entirely straightforward that everybody has an equal opportunity to develop
kidney disease. Yeah, it's just I mean, it's really sad
that it it. You know, it seems like everything comes
down to money and access to money. And if you
(08:53):
live in the United States and you are somewhere on
the poverty spectrum, then you're more likely to not have healthcare,
not go to the doctor, eat worse food, get diabetes,
have kidneys fail. It's all sort of in lockstep with
one another. And then it gets even more insidious than
that because once you get the stage five you might
not have reliable transportation to go to dialysis, and dialysis
(09:16):
is extremely time consuming. It is, so it's going to
be hard for you to keep doing a job. Yeah,
my neighbor before they moved and sadly he passed away,
Miss Jesse and Mr Otis he had his Uh, he
had the ambulance come or you know, it looks like
an ambulance, but it's not an emergency one. It's just
the transpo. They picked him up every day, took him
(09:36):
to dialysis. Brought him home and this was for the
last couple of years of his life, you know, going
every single day, and it's good. Dude. I wish I
would have gotten to him a little bit better before
he passed. But um so dialysis is short for hemo dialysis,
and it is literally just a machine that does the
filtering that your kidneys do. So you sit there for
(10:00):
or what is it like four hours, usually about three
times a week. Yeah, three times a week, four hour sessions,
and they just clean your blood in full with each session. Yeah,
there's like a little membrane that um doesn't let the
important stuff like red blood cells get through, but it
does let those waste products get through and they just
get slashed out, whereas the blood that doesn't go through
(10:22):
the membrane gets put back into your body. Yeah, and
you're on dalysis for life until unless you can get
a new kidney, and then even if you do get
a new kidney, you might be on dalysis for a
little while, as we'll see. Yeah, So, Chuck, I feel
like this is a good time to take a break.
Just off the top of my head, let's do it, Okay,
So we're gonna take a break and we'll be right
back everybody. Okay. So it's not fun to have kidney failure,
(11:11):
especially stage five kidney failure, because you're going to dialysis
a lot um and there's a lot of terrible symptoms
involved in it. Um. If you are at that point,
you're going to be put on UM an organ donation list.
You're going to become a m a recipient or potential
(11:32):
recipient of a donated kidney. That's right, and that means
you have signed up with UH, the Organ Procurement and
Transplantation Network, which is managed by a nonprofit called the
United Network for organ sharing a lot worse places. You
can donate your money too, by the way, and it's UH.
(11:52):
You know, Day points out astutely that it's not like
a waiting list, as in, you know, there's ninety thousand
people or more away eating for a kidney. So if
you sign up for one, then you have eighty nine
people in front of you, and it just very slowly,
you know, that time ticks away. It's a network, it is,
it's a pool of candidates. And because you have to
(12:14):
get matched with a kidney, and there are all these criteria,
one of which is blood type UM don't have to
have necessarily exact blood type. I think if you have
like A, you can get a b uh So, there's
a little bit across over there and oh is universal right?
How is it? Oh negative? We did a thing on
blood it was. It was a good one. We did
a live one, that's right. Remember my father in law
(12:36):
spoke up when I did a blood test. He said,
Josh is pregnant. That's right. He got more last than
all of mine combined that night. I remember that that
was a very like one of the only funny audience
jokes that we've ever had. It really was was yelled out,
it's high quality. Heckline. That was like, that's for the
Atlanta Science vessel Um. Where was that? That just totally
(12:58):
through me that I'm trying to picture your break it
now we'll get a load of me, buddy. Uh So, Yeah,
blood type is one the size of the organ. It's
got to be a good fit. So like a little
kid can't get a big adult kidney. You wouldn't think
about that, but it is true. And I mean it's
not just true with kidneys, with any oregan like I
saw it, put like a basketball players a long mon't
fit in a child. Right, It's like sure, yeah, those
(13:20):
are wise words. Good point. Uh. And then geography is
one because as you'll see, if you get a kidney
donated from someone that you don't know, it's not like
a family member, then that kidney is going to be
on ice basically for a little while. That's gonna be
transported maybe or maybe you're transported, but there's gonna be
a little bit of time. Uh. They don't just like
(13:42):
you know, put you on the table like in the
movies that put you on the table next to your brother,
and they would just like slide one kidney right in,
you know, just across the room to the other. Right. So,
uh so geography is a consideration. So within this network,
you know, there's a big garrhythm that's going to match
blood types and all these things. And like, hey, you
(14:03):
live in Birmingham. We got a kidney in Tuscaloosa, So
you guys are pretty good match. Yeah. And so with
each new organ that comes up for UM donation, uh,
you get a new a new score calculated by the computer.
Like it's not like you get your score as signed.
It's all contextual based on your relation to that organ.
(14:26):
That's that's being considered, that's being donated. Yeah, and also
we should point out that it's also based on your need,
like if you're you know, how urgent it is in
a lot of cases. Yeah, it's also based though on
on some other stuff too, which is, you know, kind
of calculating. But it makes sense. Um, your age, the
younger you are, the higher your score, which makes it
(14:48):
likelier for you to get that um, the likelihood that
you will survive the procedure, the likelihood that you will
um reject the organ or not. Sensitization, I think is
what they call it. There's a bunch of different factors.
And this is fairly recent, this pool um um method. Uh,
and I it's kind of revolutionized things and apparently made
(15:10):
it a lot better a lot um it's from what
I understand, it's a lot more sensible and fair. Yeah,
and it also makes sense, like once you see the numbers,
like every kidney is super important, and so they want
to give them to people where you have the best
chance for that kidney to work over you know, for
ten to fifteen twenty years. Yeah. I can't waste no
(15:32):
kidney left behind. No, Oh man, can you imagine if
they were just like, oh, we left it on the plane,
just forget about it. You're like, I just donated that
kidney for nothing, Right, it's in the trash. Now there's
a story out there, and I kind of want to
hear it. See. I pictured more like Cheech and Chong.
(15:53):
We're piloting the plane and they're like, what's in the
cooler man? And all of a sudden it's a movie
they're looking for like some some ah good marijuana. That
reminds me of Snoop Dogg as the pilot. Sole Plaine.
I never saw that was like, you know, it wasn't
at all at all. Yeah. It looked like a sort
of homage to the sort of bad seventies comedies. You know.
(16:16):
It was where there was no It was like, hey,
here's an idea. Let's get a bunch of like funny
people and get them really high or drunk, and there's
your movie. That that was exactly what is an airport? Right?
That's the that's the twist, all right, I'm not going
to see it twist. Yeah, no, there's no reason to.
(16:38):
I demand that you not see it. Actually, how are
you gonna sign up to be an organ donor? What
are the couple of good ways you can do that. Well.
One way is whenever you go get your license renewed
at the old d m V in the United States,
uh or the d m V in France. Um, they're
gonna ask you if you want to be an organ
(16:59):
donor and and you can say yes, and they will
put it on your license, yes organ donor. So that
if you you know, by the farm out and about,
and you've got your driver's license on you, the doctors
and the people at the hospital are going to look
at your I D. And if they see yes, they're
going to go to your family and say, your your
loved one here, um who's now regretfully deceased, said that
(17:22):
they want to donate their organs or will you sign
off on this? It seems to have been their wishes.
And you can still say no if you're a family member,
but um, probably you're going to say yes, especially if
you're deceased loved one said Hey, I marked yes my
that I want to donate organs on my driver's license.
If I die, make sure my organs get donated. They're
(17:44):
probably gonna go along with it. Yeah, I think it's
kind of funny that I wonder what percentage of people
that sign up at the d m V for organ
donation and the kid needs that actually go to other
people and organs that successfully save lives. How many of
those start with the two words why not? Yet you're
(18:05):
at the d m V, you're bored out of your mind,
you've been there for far too long, and they ask
you this question, you go, yes, why not? Yeah, that
is the most interesting question you've been asked in that
whole experience, Like, maybe the biggest question you can answer
in your life is whether or not you will donate
your kidneys and your organs to save a human life.
And people probably just go, yeah, why not. So if
(18:27):
you've been to the d m V and you said no,
and you okay, But if you said no you wanted
to your you can still go in register right, Yeah,
You've got to register me m E dot org and
you can register there. Uh, and here's the deal in one,
here's some more stats for you. There were forty thousand
(18:50):
total organ transplants. I think most of those are I
think was it like or kidney transplants? Far and away
the most are kidney transplants, and only six hundred of
those forty five. Uh, came from living donors, which was
I have a relative or I'm just a benevolent human
(19:11):
who wants to give a kidney to anonymously to somebody.
I mean, yeah, talk about st hood. Uh So two
thirds of all kidney transplants are from deceased donors. So,
like you said, it's a lot of times it's accidents,
car and motorcycle accidents where there's like traumatic head injury,
uh in the but the organs are still in pretty
good shape. You're young, you're in good shape, and so um,
(19:35):
you know, you may be brain dead, and they can
the word harvests always sounds so cruel, but they can,
they can harvest borrow your organs. No, it's hardly, it's
definitely harvest. Remember in our our book of that chapter
in Jack Kevorkian he had that that idea in the
I think sixties or seventies where he was like, well,
we're going to execute people, let's just execute them through
(19:57):
organ harvesting. You know, we' started to perform surgery on
him and we harvest their organs and then once we're done,
they're just they're dead, right, Yeah, then we're joining their
organs and everybody's like, it's a really great idea, but
you're creepy, dude, and I think you're the last person
who should be espousing this kind of stuff. Well, maybe
he shouldn't have expressed this idea while imitating Verner Hertzog, right,
(20:22):
and where are your pants? That's right? Uh? So that
means at the end of the day, one human body
can save uh up to Nold does a pretty good
Verna herd so he's yeah, but the best ever is
Paula Tompkins his Verner fantast Just look it up on
the internet. It's great, one single human body an organ
(20:45):
donor can save up to eight lives. Uh. And that
is just with the organs. And then you've got tissue donation.
You've got eyes that can bring sight to someone. We
should totally do one on Ie the transplants. Yeah, might
also show you the killer of the person whose eyes
you got, in which case you're morally responsible for chasing
(21:06):
that killer down and turning them into bringing the justice
or exacting revenge. If it's a really good movie, a
bridget Fon type movie, was that then the actual plot
of one? Or was it was that just a typical
movie plot? I don't remember who was in it though,
Jennifer eight, I don't know. No No, Jennifer eight was a
blind woman, a sightless woman who was going to be
(21:30):
the eighth victim of a serial color who's targeting blind women.
And I could spoil it for everybody. I'm not going to.
It's actually we're seeing it's a good Nighties movie with
Andy Garcia and yeah, I don't remember what was it. Yeah,
it's good, good movie. I think it's out there still,
or I'm thinking of the movie, uh where the guy
(21:52):
got the hand transplant and the hand was from a
serial killer and so he got a bad hand that
wanted to do bad things. Jeff Fahey, I think the
lawnmower man. But Jeff Ahey was the lawnmower man. Okay,
I never saw that one. I mean it might have
been called something as basically like bad Hand. Was it
(22:13):
called idle Hands? No, that was different, and that was
not good. I'll look it up, and well, well how
about this, so folks stick around for the stormail. We'll
look it up. In the interim, we'll announce it at
the beginning of Finally, year fourteen, we've got a new
hook for the show. Or maybe I can just make
up an email that fake Jeff Ahey sent in. Remember me,
(22:34):
we need to fake Jeff Ahey sound effect like side effect? Uh? Alright,
So living donation is something we should talk about. This is,
like you said at the beginning, one of the only
organs you can donate, I mean, is it the only one? No,
you can also donate his portion of your uterus and
a portion of your liver, okay portions, yes, But other
(22:58):
than that, that's it. Right. So I got a little
bit of history here. Um, if you're talking kidney transplants,
you gotta go back to nineteen o two was when
they did a dog kidney transplant in Austria. The dog
did not make it, of course, but the it did
produce urine for a couple of days. The kidney man
(23:20):
not bad, I know. And that really just kind of
takes you back to some nineteen o two really unseatily
black and white view of like some terrible experiment. Yeah, um,
let me see. In nineteen o nine, apparently there were
efforts to transplant kidneys from humans dead humans to monkeys
(23:41):
as you do. Thirty nine, the first deceased human donor
I think was performed in Russia. But the organ it
didn't take. Organ never worked, but they tried it. In
thirty nine, they tried their best. From human to human. Uh.
Fifty three, you finally had your first successful temporary human
kidney trans in Paris. It was twins, right, Uh sixteen,
(24:03):
your boy received one from his mother as a living donor.
And then fifty four I think was the twins. It
was the first long term successful kidney transplant by Joseph Murray.
He won a Nobel Prize for that, sure. And then
sixty two is the first non related no genetics involved whatsoever.
So it's only been since the nineteen fifties nineteen sixties
(24:25):
that we've been able to successfully transplant kidneys. But once
we got it, we got it pretty good. Yeah, we
have it down path. Let's do this a lot, guys.
This is fun. So um. If you are a living
donor and you do donate your kidney, I think it
makes out about a quarter of kidney donations today, right, Yeah,
is a living donor somebody saying, take my kidney, put
(24:48):
it in somebody else. More often than not, it's put
it in my brother, put it in my spouse. Three
quarters of the time it's you're related. Um, but there's
that still means that of all kidney donations, So that means, however,
many thousand kidney donations are are donated by people who
(25:13):
are just saying like, here, take my kidney and give
it to whoever needs it. That's right. And sometimes that
it's anonymously. Sometimes it's a friend, sometimes it's a spouse.
Sometimes you hear about someone in your community. But yeah,
sometimes it's you don't even know anybody, and you're just like,
you know what, I'm gonna save a life. Yeah, I'm
at the d m V right, I don't want to
(25:35):
save a life. Yeah, I'm gonna do it. So if
you do do that, you're a living donor UM. And
there's a lot of advantages to a living donation compared
to a dead deceased donation donation. You know, an organ
taken from somebody who's died, right, UM. So if you
donate your kidney, UM, there's like the chances of the
(26:00):
kidney being rejected are lower compared to a deceased donor UM.
The the kidney will probably start functioning independently, like on
its own UM much more quickly than a deceased donor
one because the deceased donor one is going to be
um basically put on ice for a little while while
(26:21):
it's transported kept you know kind of you know, yes, exactly. Um.
There's also, um, a difference in the amount of time
that the average kidney lasts between a deceased donor and
a living donor. Right. Yeah, Well you tend to live
longer and your kidney last between fifteen and twenty years
on average from a living donor. Uh, It's only about
(26:43):
a decade from a deceased owner. And you also have
a better chance if you are genetically related of avoiding rejection.
So living genetically related living donor is like the crime
dela crime of getting a kidney, right exactly. Um. There's
also more convenient to um if you are a living donor.
(27:06):
You can say, let's do this like a week from Tuesday.
That works best for me, not this guy just died.
We need to we need to get this into a
recipient like as soon as possible. Um it, let's find
somebody kind of thing, you know what I mean? Um,
So that that's that's another big advantage too. So I
think we've established here living kidney donations are the way
(27:29):
to go if you can do it from a relatively
So let's take a break, because, um, there's actually ways
to maximize how kidneys get donated, chuck, and we're gonna
tell everybody about it after this. Let's do it alright.
(28:07):
So on the kidney exchange, it's pretty cool how they've
worked this out over the years. Uh. There's something called
paired exchanges, and it goes a little something like this.
You want to donate a kidney to your relative, to
your to your niece, but you don't have the right
(28:27):
blood type. You can get paired up with someone who
does have the right blood type who needs your kidney.
They'll be like, wait a minute, my niece needs a kidney.
You've got her blood type and I've got your nieces
blood type. So let's just get together and make this
all work out criss cross paired exchange. But then that
(28:48):
is multiplied exponentially by the donor chain, right, yes, So
like if if you have a good computer handy to
run an algorithm for you, because apparently it's very difficult
to do, Um, you can take a bunch of these
mismatched pairs rather than four people, you can take I
think up to seventy people, and one good Samaritan donor
(29:12):
who says, take my kidney, I don't care who gets
it can set off a chain of paired matching that
can satisfy up to seventy seventy recipients through the through
a combination of one person donating it without any you know,
just saying take my kidney, put in somebody, and then
a bunch of paired, paired matches all all like seventy people.
(29:37):
So it makes it really difficult to say, like, I
don't really want to donate my kidney, when not only
are you saving one person's life, you're setting off a
chain reaction that allows for seventy different people to get
their kidney because you donated yours without without directing it
towards anybody in particular. And if that's not the first
(30:00):
thing you say on every first date you go to
for the rest of your life, right, then you're doing
it wrong. We should mention that the there was a
Nobel Prize winning economist named Alvin Roth who who came
up with his donor chain idea. And I don't think
we said you, um, you have to be eighteen to
donate a kidney you have to be in good health
and you have like rock and kidneys basically, and also
(30:23):
in good health otherwise, Yeah, like a sixteen year old
can't donate a kid That's the other reason why a
living donor is advantageous because of that luxury of time,
because you can run a battery of tests. Yes, you
have time to run tons of tests to make sure
they're a perfect match for this other person. That's right.
So when you do say okay, I'm gonna do it.
(30:44):
And by the way, uh Dave said from researching this,
he was inspired to do it. I think he may
have put himself on a list or was going to
although it may have worn off by now, who knows,
we'll have to ask him. But if you do this, um,
you are going to undergo surgery. Um. It's just as
simple as that. And it's a serious surgery, like they're
(31:05):
removing your kidney. Like I said, we've got it down
pat since we've been doing it since the fifties or sixties,
and now they can usually do it laparoscopically. How does
that work? I think they just squeeze it real tightened.
It's really long, pencil like really, Now, how do they
get the kidney out. I don't know. I have no idea.
That's the one thing that Flum makes me and I
(31:26):
almost like Google to see if I could find, you know,
a surgery. I could watch laparoscopic kidney removal, because laparoscopic
means it's like a very small incision using very very
thin like cameras and very thin tools. But then how
do you get the kidney out if it's fist size?
I don't know. I mean this is larger than a
(31:47):
laparoscopic you know in decision, Yeah, this is a window
maker right here? Uh and here to me is the
fact of the show. I never knew this. They don't
take out your bad kidney. Did not know that. They
just leave it in there. I guess they did the
(32:08):
research and found out that they didn't need to and
that doesn't do any harm and maybe me more dangerous
to take it out, you can see that than to
leave it in. But you end up if you have
a kidney with three kidneys. Yeah, so I don't I mean,
surely they detach those kidneys, yeah, because you got to
attach the other right, Yeah, I guess so, so that's
(32:28):
what they do. The surgery is to they take it out.
Of you. And at that point you're like, okay, I'm done.
It's all recovery for me. But they have to put
it in the other person. And like you said, they
leave the other kidneys. They attached the one to the
blood vessels so that it's you know, getting the blood
supply to filter, and then also they attach it to
your reader, um, so that it can transport waste to
(32:50):
your bladder. And I supposedly it's actually a pretty effective
surgery and with minimal um uh negative outcomes. Yeah. Recovery
time for the donors, a couple of days in the hospital,
one to two weeks at home, six to eight weeks total,
and then you've got to come in at six, twelve
(33:11):
and twenty four months for checkups. Um. Like uh, we said,
you lose twenty five to thirty five of your kidney function,
but that's not fifties, so your one kidney must like
ramp it up. Um. And then you said, pretty good
outcomes there. I think this is between two thousand and
six and two thousand eight of the seventeen thousand. Oh,
(33:32):
there's your number right there. If the numbers hold, that
would be seventeen thousand over three years, So about five,
five thousand and change year at least back then unless
there's been a rush. Um. Only twelve donor deaths out
of the seventeen thousand, four hundred and two, and only
one of those was from the surgery from like hemorrhaging, hemorrhaging, hemorrhagering.
(33:59):
It's close him, hemoraging, hemorrhaging. God, that sounds weird. Hemorrhaging, hemorrhaging. Yeah, okay,
it was purposely weird during surgery. Yeah, bleeding too much
and don't forget to complete the sentence. That was very
porky pick of me. So um, yeah, that's a pretty
(34:20):
good trek record. Twelve deaths out of four hundred and
two transplants. Um. They also studied people for long term
effects and found that somebody who had donated kidney had
about the same um chance of suffering and stage renal
failure as the general population, so it didn't increase their
(34:42):
chances one bit. And I was like, okay, alright, Internet,
let me go a few more pages deep, like where's
where's the where's the real talk about the long term
consequences of donating a kidney? And from what I can see,
study after study is shows like there's really not any
long term effects. Um that after about six or eight
(35:06):
weeks of recovery, you can go back to a normal life.
During that time, you're gonna feel very fatigued. Your function
is going to be decreased. But if you say I'm
donating my kidney, I'm just gonna take two months off
basically um of life, you know, like stressful life. Um,
that's really not too bad considering that you basically go
back to normal life after two months and your kidney,
(35:29):
the one kidney you have, is still doing of the
original function. Yeah, like if you work from home, you
have no excuse exactly. Uh, Dave did put in here,
And I looked into this a little more that a
drawback might be, Um, it might affect your life insurance
or disqualify you or increase your rates. So I poked
around that because that sounded like a horrible thing. Uh,
(35:51):
And it wouldn't have surprised me. But it looks like
there are a lot of protections in place from the
Affordable Care Act for stuff like this. Thankfully, And if
you have never had insurance, you have your kidney removed
and you go to get life insurance for the first time,
then you may not be able to get it as easily.
But you know, you're not booted from your life insurance
(36:14):
policy because you donated a kidney, or your rates aren't
gonna skyrocket because you donated a kidney. It's against the law.
It should be. Yeah, So, um, there's a risk of rejection,
Like that's something you have to go into it knowing,
like you might donate your kidney and it just might
not work, probably just by all the tests, despite all
of the um the care given into matching you and
(36:37):
your kidney with a recipient, it still might get rejected.
But they have developed um a lot of different drugs
to cut down on the chance of rejection. Right. Yeah,
they're called anti rejection drugs or immunosuppressants, And there are
a couple kinds. There's one that they that are super
powerful that they give you at the time of the
(36:59):
transplant called induction agents, and then you've got maintenance agents. Uh.
And there were basically four different kinds of maintenance agents.
And the way this one website I saw put it,
I think it was a kidney dot org or whatever
uh was that they said, look at it, it's like
a mortgage, your down payment is the induction agent like
(37:21):
the heavy duty drugs they give you when they do
the transplant, and the maintenance agents are like your monthly payment,
and the bigger the down payment, the lower the monthly
So if you if the induction agents are really really
work well, then you're not going to be on as
many long term medications for maintenance. And I didn't really
recognize any of the drugs except for pregnisone, the steroid. Yeah,
(37:42):
I didn't either. I saw the most common combination of
drugs is three things, one called tachra limits which is
a calcine calcinevrin inhibitor, one called mico finilate mo fatil
which is an anti proliferate, and then pregn his own.
(38:04):
And I saw that you're generally on these for life,
but they can, you know, scale down. I don't know
if you're ever off of them completely. But um, yeah,
I think of kidney recipients experienced some sort of rejection,
so those But it doesn't necessarily it doesn't mean that
like that's it didn't work. I don't think the square
(38:26):
one necessarily. Yeah. I think like in a lot of
those cases, you can keep that kidney if the drugs
are working. So um the the entire thing, this entire thing.
But whether it's a dead donor, a deceased donor, sorry,
keep calling it dead donor, I know it's not quite right,
even though it's accurate, um or living donors of kidneys.
All of this is based on altruism. The entire organ
(38:50):
procurement organ donation system everywhere in the world save for
one country, is based on the kindness of of in
generosity of donors who do it for no money whatsoever,
just out of the goodness of their hearty. And that's
the way that a lot of people think it should be.
That's the way that it's um. It's enshrined in law,
(39:14):
that that's the way that it has to be. In
the United States, there's an UH law called the National
Organ Transplant Act of nine four UM that says you
cannot gain financially um or I can't remember exactly how
they put it, but you can't make any kind of
like gain from from donating your organ. And I was like, well,
(39:38):
where did that law come from? What prompted that? Well,
probably the black market for organs. H It turned out
there was there was a guy. So that was the
Act N two there was a doctor in Virginia named H.
Barry Jacobs who announced that he was setting up a
market for organs. He was going to create a brokerage
for organs. There's no federal law. Again, that's exactly right,
(40:02):
and so they went and made a federal law against
it because they're like, that is objectively unethical and immoral,
and that's kind of the basis for organ donation in
this country, and again every country in the world except
for Iran, that it's unethical to make money selling organs
or to pay someone for the organs, because they're worried
(40:23):
that it sets off a whole cascade of problems. Yeah,
I think they try and make it cost neutral for
the donor, which means your expenses are covered, like you're
not gonna be paying like the recipient's insurance is going
to be paying for all the operations and surgeries and
all that stuff. And then there are uh, you know,
private nonprofits that can also help cover like travel and
(40:45):
if you're a low income donor, help pay for stuff
like that, but you're still not getting like paid to
do it. And the idea there is ethically is that um,
you know, the dystopian science fiction plot, which is there's
a class of wealthy people who harvest the poor on
organ farms. And you know, it's like something out of
(41:07):
a movie, but it's also something that could very well
happen if you let that kind of thing, you know,
take place, uh, you know, black market human trafficking again
like you mentioned. And then another one I didn't think of,
is that, um the motivation for someone doing it if
you're getting paid like you may not, you may fudge
a little bit on your questionnaires, like fake something to
(41:31):
make money to get an organ taken out of your body.
It's almost like they've identified it as such a valuable
thing that you can't you can't assign any kind of
monetary value to it. You you can't allow that to
happen or else nothing but bad things are going to happen.
And there's actually polls that support this, although some people
(41:51):
say that's stupid, we should we No matter how how
many um generous people are donating organs, the demand is
still not there. I mean, you said it yourself. Like
five thousand people die on organ transplant waiting lists every
year in the United States alone. That's just in the
U S alone. People die all over the world on
(42:13):
organ transplant lists every year, and so people say that's stupid.
If people are willing to sell like their kidney in particular, UM,
let them do it. It's a free world, it's a
free country at least. So what's the problem. Yeah, I mean,
I think the idea. I'm not libbying for this, but
they have floated things like a like a fifty dollar
(42:37):
tax rebate that you can absorb over like a decade,
or wipe out your student loans or something like that,
Like they're not literally just cutting you a check. Things
like that are interesting because, um, donating a kidney saves
taxpayers close to a hundred and fifty thousand dollars in
medical costs paid out by Medicare for dialysis and things
(42:59):
like at and there was another analysis that found that
paying donors forty dollars for kidney would result in a
net gain of forty six billion dollars in lowered medical
costs and better health overall health and outcomes. So like,
something like that is interesting, not just like harvesting organs
for cash, but if people want to take a big
(43:22):
fat tax rebate over a decade, it leads to less
taxpayer payouts for Medicaid and UH or for Medicare better
health outcomes. I don't know some we're thinking about. Yeah,
and other people would say this, that's already going on.
There's a very healthy black market for organs all around
the world. I saw an estimate on some human trafficking
(43:43):
website that was something like ten thousand kidneys a year
are procured and transplanted on the black market. But then, Chuck,
ultimately you have there is one country, Iran it allows
payment for organs. Its something like and then also like,
you're right, it's a pretty in substantial amount if you're
(44:05):
selling a kidney compared to say, like the forty five
grand the US is considering, or I shouldn't say the
US is considering people Americans have come up within a study,
but um, the there is the one stat that stood
out to me that I think kind of suggests, you know,
not applying money to organ procareman, is that of a
(44:27):
two thousand one study of three hundred Iranian paid organ
donors said that if they could go back, they would
not have sold their kidney. There you have it. Pretty
much anything else about kidney transplants and donations and all that. Well, again,
if you want to uh donate your organs uh and
(44:47):
you aren't going to the d m V anytime soon.
Go to register me dot org. Uh. And since I
said register me dot org, it's time for a listener mail.
I'm gonna call this dB Cooper follow up. Oh wow, no,
pretty interesting And this is from Holly. Hey, guys, Holly
(45:09):
from Texas here. I've been listening about six months and
I'm obsessed. Turned to the Facebook groups to suggest some
fan favorite episodes, and dB Cooper the live episode was
mentioned a lot, and it reminded me of a story
you might enjoy several years ago, as it a small
family gathering at my grandparents and we were sitting around
chatting about different topics of memories, and my grandma casually says, Oh,
(45:30):
that's just like the time when the FBI tapped our
phones because they thought Grandpa was TP Cooper WHOA. I
of course did a dramatic double take, slam both of
my hands on the table and exclaimed what I mean.
I was floored. At the time, I was in l
a thirties and never heard this story in my whole life.
That's the thing with grandparents, You hear this stuff like
how did I not know that I know? Um, I
(45:53):
of course had to dramatically turn to my grandpa with
narrowed eyes and say, who are you. My grandma was
very nonchal line about the whole thing, and I was like, wait, wait, wait,
explain please. She didn't have much more info, but I
guess my grandpa was cleared obviously. Uh. And it's still
a mystery why they suspected my grandpa, mainly considering the
fact that they lived in New Mexico at the time.
(46:13):
We sadly lost my grandma in July, but I'm happy
to report that my grandpa is still doing well. Even
though I could never picture my cowboy boot levin heavily
starched wrangler gene wearing Grandpa and a skinny tie from J. C. Penny,
although he does enjoy his daily bourbon. And that's a clue.
Maybe that was it. So that's from Holly, And that's
(46:35):
a great email. Holly as one of the all time greats. Holly.
I love that she's like. Also, my grandpa pays for
everything from a bag of money that he keeps the
ship out back. Yeah, we always got unmarked dollar bills
for birthdays. If you want to be like Holly, and
tell us one of the great family stories that you
(46:57):
heard from your grandparents about. We want to hear those two.
You can send them to us at stuff Podcasts at
i heart radio dot com. Stuff you Should Know is
a production of I heart Radio. For more podcasts my
heart Radio, visit the i heart Radio app, Apple Podcasts,
or wherever you listen to your favorite shows. H
Stuff You Should Know News
Hosts And Creators
Chuck Bryant
Josh Clark
Show Links
AboutOrder Our BookStoreSYSK ArmyRSSPopular Podcasts
Cold Case Files: Miami
Joyce Sapp, 76; Bryan Herrera, 16; and Laurance Webb, 32—three Miami residents whose lives were stolen in brutal, unsolved homicides. Cold Case Files: Miami follows award‑winning radio host and City of Miami Police reserve officer Enrique Santos as he partners with the department’s Cold Case Homicide Unit, determined family members, and the advocates who spend their lives fighting for justice for the victims who can no longer fight for themselves.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.