Altruistic kidney donors are often motivated by personal or prosocial reasons. They tend to exhibit strong social and emotional responsiveness, on both psychological and neurological measures. Distinct demographic and neurobiological characteristics support the extraordinary altruism of people who donate a kidney to a stranger.

What is the difference between altruistic kidney donation and directed kidney donation?

Altruistic kidney donation is when a living person donates a kidney to someone they don’t know who needs a transplant. This differs from directed donation, where the donor knows and intends to donate to a specific individual.

Altruistic kidney donation is also known as non-directed kidney donation.

What are the motivating factors for altruistic kidney donors?

Common motivations include:

• Personal connections to kidney disease (including having had a family member on dialysis)
• Having a friend, relative, or acquaintance who previously donated
• Many altruistic kidney donors are also engaged in other altruistic behaviors

What do we know about the brains of altruistic kidney donors?

Neuroimaging studies show that altruistic kidney donors have increased right amygdala volume and heightened responsiveness to others’ distress. This suggests a biological basis for the strong social and emotional responsiveness that motivates altruistic kidney donation.

The personality and biological indicators for altruistic kidney donors tend to be the opposite of patterns seen in individuals with antisocial traits.

What are the mental health characteristics of altruistic kidney donors?

Altruistic donors generally have mental health profiles similar to or better than those of the general population and other organ donors. They report high satisfaction and positive psychological outcomes post-donation, with low rates of regret and no increase in psychological distress.

Bottom line: altruistic kidney donors tend to experience positive mental health outcomes after donation.

What does the research say about altruistic kidney donors?

Marsh, A., Stoycos, S., Brethel-Haurwitz, K., Robinson, P., VanMeter, J., & Cardinale, E. (2014). Neural and cognitive characteristics of extraordinary altruists. Proceedings of the National Academy of Sciences, 111, 15036 – 15041. https://doi.org/10.1073/pnas.1408440111.

Massey, E., Kranenburg, L., Zuidema, W., Hak, G., Erdman, R., Hilhorst, M., Ijzermans, J., Busschbach, J., & Weimar, W. (2010). Encouraging Psychological Outcomes After Altruistic Donation to a Stranger. American Journal of Transplantation, 10. https://doi.org/10.1111/j.1600-6143.2010.03115.x.

Mor, E., Hod, T., Ghinea, R., Bar, A., & Singer, J. (2022). 247.1: Conditional Altruistic Living-Donor Kidney Donation in Israel and Its Impact on Living-Donor Kidney Transplant Growth. Transplantation. https://doi.org/10.1097/01.tp.0000886188.99222.ab.

Okidi, O., Sharma, V., Piscoran, O., Biggins, F., Singh, R., & Augustine, T. (2022). The altruistic elderly, a valuable but unrecognised kidney donor group. A case report of an 85-year-old unspecified kidney donor. BMC Geriatrics, 22. https://doi.org/10.1186/s12877-022-03511-8.

Rees, M., Kopke, J., Pelletier, R., Segev, D., Rutter, M., Fabrega, A., Rogers, J., Pankewycz, O., Hiller, J., Roth, A., Sandholm, T., Ünver, U., & Montgomery, R. (2009). A nonsimultaneous, extended, altruistic-donor chain.. The New England journal of medicine, 360 11, 1096-101 . https://doi.org/10.1056/NEJMoa0803645.

The kidneys are unsung heroes of the body—filtering blood, balancing electrolytes, and excreting waste in a silent symphony of survival. But when these vital organs falter, life takes a sharp turn. For millions living with chronic kidney disease (CKD), the specter of dialysis or a kidney transplant looms large. Yet amidst this uncertainty lies a powerful truth: while kidney damage is often irreversible, proactive steps can preserve their function for as long as possible.

Understanding Renal Disease: The Slow Fade

Chronic kidney disease doesn’t happen overnight. It creeps forward quietly, often unnoticed, until significant damage has occurred. Conditions like diabetes and hypertension are frequent culprits, silently straining the kidneys over the years. By the time CKD is diagnosed, the kidneys may already be functioning at a fraction of their capacity.

But there’s good news: the progression of CKD can often be slowed—or even halted—through a combination of medical intervention, lifestyle changes, and careful self-monitoring.

The Power of Nutrition: Eat for Your Kidneys

What you eat has an outsized impact on kidney health. For CKD patients, the right diet is both a shield and a strategy. Key nutritional principles include:

• Limiting sodium: High salt intake increases blood pressure, a major stressor for compromised kidneys. Aim for less than 2,300 mg daily—or lower if recommended by a doctor.
• Moderating protein intake: While protein is essential, too much can overwork the kidneys. Work with a dietitian to find the sweet spot that meets your nutritional needs without adding unnecessary strain.
• Managing potassium and phosphorus levels: Foods rich in potassium (like bananas and potatoes) or phosphorus (such as dairy and processed foods) can build up in the blood when kidneys aren’t functioning properly. Careful tracking and substitutions are key.
• Staying hydrated—but not too much: Adequate water intake supports kidney function, but overhydration can be harmful, especially for advanced CKD patients. Individual needs vary, so consult a healthcare provider.

Medications and Monitoring: The Science of Staying Stable

For CKD patients, the medicine cabinet is both a toolbox and a potential minefield. Managing underlying conditions like diabetes and hypertension is critical, and prescribed medications—like ACE inhibitors or ARBs—can help protect the kidneys from further damage. But over-the-counter remedies like NSAIDs (ibuprofen, naproxen) can be harmful, underscoring the need for clear communication with healthcare providers.

Regular monitoring of kidney function through blood and urine tests provides a vital roadmap, allowing patients and doctors to adjust treatment as needed.

Exercise and Stress Management: The Hidden Allies

Physical activity might seem counterintuitive for someone grappling with a chronic illness, but moderate exercise has profound benefits for kidney health. By improving cardiovascular fitness and managing blood pressure, activities like walking, yoga, and light strength training contribute to overall stability.

Equally important is managing stress. Chronic stress can exacerbate underlying conditions and increase cortisol levels, which may negatively affect kidney health. Mindfulness, therapy, and relaxation techniques are invaluable tools for emotional and physical well-being.

Avoiding Toxins: A Silent Threat

The kidneys filter not just the natural byproducts of life but also the toxins we encounter every day. For CKD patients, minimizing exposure to harmful substances is crucial. Avoid smoking, limit alcohol consumption, and steer clear of unregulated herbal supplements, which can contain ingredients toxic to kidneys.

Building a Collaborative Care Team

Renal disease is not a solo journey. A robust care team—including a nephrologist, dietitian, and primary care physician—offers the expertise and guidance needed to navigate the complexities of CKD. Regular check-ups and open dialogue ensure patients stay informed and empowered.

Facing the Future: Optimism Amid Uncertainty

For those with CKD, the prospect of eventual dialysis or transplantation is daunting but not inevitable. Many patients live for years—even decades—without needing advanced intervention, thanks to proactive management and emerging treatments. Innovations in medicine, from stem cell therapies to wearable dialysis devices, continue to push the boundaries of what’s possible.

Living with CKD is, in many ways, an exercise in resilience. It demands vigilance, discipline, and a willingness to adapt. But the rewards are undeniable: more time, better health, and the hope that a transplant might be a distant, rather than immediate, necessity.

In the quiet battle to protect their kidneys, patients hold more power than they often realize. Every choice—whether to skip the salt, take a walk, or schedule a check-up—tilts the balance toward preservation. And in that deliberate, determined care lies the possibility of holding the line, one day at a time.

In New Jersey, where nearly nine million people crisscross lives between beaches, boardrooms, and bustling cities, another kind of intricate network hums quietly in the background: the organ transplantation system. For those in need of a kidney transplant, the journey from diagnosis to new life is a complex odyssey through medicine, policy, and sheer human resilience.

At its heart lies the United Network for Organ Sharing (UNOS), a national organization tasked with maintaining the transplant waitlist and matching donor organs to recipients. However, for a patient in New Jersey, this nationwide system is filtered through a local lens—one shaped by the state’s hospitals, transplant centers, and healthcare regulations.

Thinking about becoming an altruistic or undirected kidney donor? Learn more about altruistic kidney donors.

The First Steps: Referrals and Evaluation

For most, the journey begins with a diagnosis of chronic kidney disease (CKD) or end-stage renal disease (ESRD). These conditions often mark the point at which dialysis becomes a lifeline and transplantation a necessity. Referral to one of New Jersey’s transplant centers—such as those at RWJBarnabas Health or Hackensack Meridian Health—sets the wheels in motion. Here, patients undergo a rigorous evaluation process, where medical, psychological, and logistical factors are scrutinized.

This evaluation is no mere formality; it is an exhaustive assessment of a patient’s ability to withstand the surgery and care for the transplanted organ. Questions of compatibility take center stage: What is the patient’s blood type? Does their immune system bristle with antibodies that might reject a donor kidney? Each answer inches them closer—or further away—from being listed.

The Waitlist: A Race Against Time

Once deemed eligible, a patient is added to the national kidney transplant waitlist, but their place in line is not fixed. The list operates less like a queue and more like a dynamic algorithm, where variables such as blood type, tissue compatibility, waiting time, and medical urgency constantly recalibrate the order. In New Jersey, as in other states, this wait can stretch into years.

For those fortunate enough to have a living donor—a family member, friend, or altruistic stranger willing to part with a kidney—the wait may be bypassed altogether. Living donor transplants, often facilitated by programs like the National Kidney Registry, offer better outcomes and shorter recovery times. Yet not every patient has access to this option, leaving many tethered to hope and dialysis as they wait for a kidney from a deceased donor.

The Donor Shortage and Regional Realities

The scarcity of organs casts a long shadow over the system. Nationally, over 100,000 people await organ transplants, with kidneys accounting for nearly 85% of that total. In New Jersey, the disparity between the need for kidneys and the availability of donors is acute. Factors like the state’s diverse population can complicate matching, as ethnic and genetic differences affect organ compatibility.

Geography also plays a subtle but significant role. New Jersey is part of Region 2 in the UNOS system, sharing donor organs with neighboring states like Pennsylvania and Delaware. The region’s transplant centers collaborate and compete in equal measure, with the flow of organs dictated by policies aimed at balancing fairness and efficiency.

Surgery and Beyond: The Long Road Ahead

For those who receive the life-changing call that a kidney is available, the surgery itself is a culmination of hope, skill, and logistics. But the journey doesn’t end there. Post-transplant care requires an unwavering commitment to anti-rejection medications, regular monitoring, and lifestyle changes. Even with these measures, complications like infection or organ rejection remain risks.

In New Jersey, as across the nation, the success of a kidney transplant hinges not just on medicine but on access. Socioeconomic factors—insurance coverage, transportation to appointments, and the ability to afford lifelong medications—can mean the difference between thriving and struggling.

A System in Transition

The landscape of kidney transplantation is evolving. Recent policy changes by UNOS aim to improve equity, allocating organs based on a broader geographic radius to reduce disparities in wait times. Meanwhile, advancements in technology—such as paired kidney exchanges and artificial organs—offer a glimpse of a future where the donor shortage might be mitigated.

But for the thousands of New Jersey residents waiting today, the system remains a balancing act: a blend of science, sacrifice, and the enduring belief in a second chance. It’s a journey that underscores the fragility of life—and the resilience of those determined to reclaim it.

Kidney disease is often referred to as a “silent” condition, revealing itself only when significant damage has already occurred. So, being newly diagnosed with kidney disease can feel overwhelming, and it’s natural to have questions about what this means for your health and lifestyle. This guide is designed to offer clarity, present the key aspects of managing kidney disease, and provide some encouragement along the way.

What is Kidney Disease?

Your kidneys are essential to filtering waste and excess fluids from your blood, balancing electrolytes, and regulating blood pressure. Kidney disease, also called chronic kidney disease (CKD), occurs when these functions are impaired over time. There are five stages of CKD, ranging from mild to severe, and in some cases, the kidneys may eventually lose function entirely.

While the diagnosis can be serious, many people with kidney disease live long, healthy lives with proper management. Understanding the condition and working closely with your healthcare team are the first steps toward controlling it.

The Stages of Kidney Disease

Kidney disease is categorized into five stages, measured by your glomerular filtration rate (GFR), a key metric indicating how well your kidneys are filtering blood:

1. Stage 1: Kidney damage with normal kidney function (GFR 90 or higher)
2. Stage 2: Mild kidney damage with a slight reduction in GFR (60-89)
3. Stage 3: Moderate decrease in kidney function (30-59)
4. Stage 4: Severe reduction in kidney function (15-29)
5. Stage 5: Kidney failure, also known as end-stage renal disease (GFR below 15)

Your stage will determine your treatment plan and guide how aggressively you need to manage your condition.

Immediate Next Steps After Diagnosis

When you first receive your diagnosis, it’s essential to focus on two things: gathering the right information and starting the appropriate care.

1. Understand Your Specific Situation: Talk to your doctor about your GFR, what stage of kidney disease you have, and what your specific health goals should be. Ask about the underlying cause of your kidney disease, whether it’s diabetes, high blood pressure, or something else, as treatment may differ depending on the cause.
2. Meet with a Nephrologist: A kidney specialist, or nephrologist, will help manage your treatment plan. They’ll provide expertise in slowing the progression of kidney disease and minimizing complications.
3. Get Tested for Related Conditions: Your kidney health is connected to other parts of your body. Blood tests to check for anemia, bone disease, and heart health issues are typically recommended for newly diagnosed patients.
4. Start or Adjust Medications: If you have high blood pressure or diabetes, your doctor will likely adjust or start medications to protect your kidneys. Some medications may also help control the amount of protein in your urine, another key indicator of kidney function.

Lifestyle Changes: The Cornerstone of Kidney Health

Managing kidney disease often involves making changes to your daily habits. The silver lining is that many of these changes benefit your overall health, too.

1. Dietary Adjustments: Nutrition is a key factor in kidney disease management. You may need to limit salt, potassium, phosphorus, and protein intake, depending on your stage of CKD. A dietitian familiar with kidney disease can help craft a meal plan that works for you. Small changes like reducing processed foods, avoiding fast food, and focusing on fresh, whole ingredients can have a big impact on kidney health.
2. Stay Hydrated—But Not Too Much: Staying hydrated is essential, but people with kidney disease may need to moderate their fluid intake depending on their condition. Your healthcare provider will help you determine how much water is right for you.
3. Control Blood Pressure: High blood pressure is both a cause and a result of kidney disease. Medications, coupled with regular exercise and a low-sodium diet, can help keep your blood pressure within healthy limits.
4. Manage Blood Sugar: If you have diabetes, controlling your blood sugar is critical to preventing further damage to your kidneys. Medications, monitoring your glucose levels, and dietary changes will be central to this effort.
5. Stay Active: Regular physical activity, even something as simple as daily walks, can help manage weight, reduce blood pressure, and improve overall health. Talk to your doctor about what level of exercise is appropriate for your condition.
6. Avoid Smoking and Excess Alcohol: Smoking and heavy drinking can accelerate kidney damage, making it essential to quit smoking and limit alcohol consumption.

Emotional Health: Coping with the Diagnosis

It’s perfectly normal to feel anxious, upset, or overwhelmed after a kidney disease diagnosis. Managing a chronic illness can be emotionally taxing, and it’s important to take care of your mental health along the way.

1. Lean on Your Support System: Whether it’s friends, family, or a support group, sharing your concerns with others can help you process your diagnosis and manage any stress or anxiety.
2. Consider Therapy: Many people find it helpful to talk to a mental health professional about their feelings around chronic illness. Cognitive-behavioral therapy (CBT) and mindfulness practices can be especially helpful for managing anxiety and depression.
3. Educate Yourself: Arming yourself with knowledge about kidney disease will empower you to take control of your health. It will also help you feel more prepared when discussing treatment options with your healthcare team.

Looking Ahead: Long-Term Management

Your kidney disease diagnosis isn’t a death sentence. Many people manage the condition successfully for years by following a carefully crafted care plan. Here’s what to expect as you move forward:

1. Regular Monitoring: Ongoing tests to monitor your GFR, blood pressure, and other health markers will be essential. These routine checks help your doctor track your progress and make necessary adjustments to your treatment plan.
2. Potential for Dialysis or Transplant: While some people progress to Stage 5 and require dialysis or a kidney transplant, many people live for decades without needing such interventions. And if you do reach that stage, your nephrologist will work closely with you to plan for dialysis or explore the possibility of a transplant.
3. Stay Vigilant: Even in the early stages of kidney disease, it’s important to stay on top of your health. Continue seeing your healthcare providers regularly, take your medications as prescribed, and follow your lifestyle plan to maintain kidney function and overall well-being.

Final Thoughts: Embracing the Challenge

Kidney disease can be a heavy diagnosis, but it is not without hope. Through informed care, lifestyle adjustments, and emotional support, you can lead a fulfilling life while managing your condition. Remember, your healthcare team is there to guide you, and with each step, you’ll become more confident in navigating this journey.

You are not alone in this—many have walked this path and continue to thrive. Stay informed, stay empowered, and take it one day at a time.

References and more information

• Mayo Clinic resources for chronic kidney disease.
• American Society of Nephrology website.
• Educational material on kidney failure from the Cleveland Clinic.
  Complete care for kidney and blood pressure disorders.

Blausen.com staff (2014). “Medical gallery of Blausen Medical 2014”. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436., CC BY 3.0 <https://creativecommons.org/licenses/by/3.0>, via Wikimedia Commons

Dialysis is the process of filtering waste and excess fluids out of the blood when the kidneys are not functioning properly. Dialysis has been around since the 1960s, and it has saved countless lives over the years since its inception. Here’s what you may not know about dialysis, including its history and how it can save lives today

1) Dialysis can be done at home

Dialysis is a treatment for kidney disease that takes place outside of the body, which means that it can be done at home. With modern technology, not only can many people with kidney disease enjoy a more normal life by doing dialysis on their own time and without having to go to a clinic or hospital, they can also continue working while they are being treated.

This procedure typically involves two treatments per week, one in the morning and one in the evening. Many patients experience better results in a dialysis center, but home dialysis can work for you with sufficient training and support.

2) Dialysis takes 4–6 hours

Dialysis is a process that removes waste products from the blood. It occurs in cycles where there is a cleansing phase and an ultrafiltration phase. The cleansing phase is when the machine filters out toxins, such as urea and creatinine, while the ultrafiltration phase removes excess fluid from the body. It usually takes four to six hours to complete one cycle of dialysis.

During each treatment, dialysis uses a tube and machine to take over for your damaged kidney so that waste can be removed from your blood. This is called hemodialysis, where blood from an artery is run into a machine containing artificial membranes to filter impurities from it. The clean blood is then returned to your body through another tube.

3) Dialysis helps with fluid overload

Dialysis helps with fluid overload by removing fluids from the blood. This process is called hemodialysis or peritoneal dialysis, and it can be done at home. For hemodialysis, a tube called a catheter is inserted into a large vein in the arm, chest, or neck and threaded into an artery near the lungs.

4) Not all dialysis machines are created equal

There are two kinds of kidney disease; chronic kidney disease (CKD) and acute kidney injury. Kidney failure is a form of CKD that can be treated with hemodialysis (HD) or peritoneal dialysis (PD). HD is an outpatient treatment in which blood is cleaned by running it through a tube connected to a machine called a dialyzer. PD is an in-home treatment where the inside lining of the person’s abdomen acts as their dialyzer.

Dialysis machines can be broken into two groups: hemodialyzers and peritoneal dialyzers.

5) The quality of dialysis can vary greatly

Dialysis is the process of filtering waste and extra water from the blood when kidneys cannot do this themselves. Dialysis is a life-saving treatment for patients with kidney failure. The quality of dialysis can vary greatly, depending on a variety of factors including the type of machine used, how often treatments are done, what other treatments are being used in addition to dialysis, and how well the patient follows their prescribed treatment regimen.

6) There are different types of treatments available

Dialysis treatments are designed to filter and clean the blood of people with kidney disease. There are two types of treatment, hemodialysis and peritoneal dialysis. Hemodialysis is a process that removes waste from the body through an artificial kidney machine by filtering the blood outside of the body. Peritoneal dialysis is a process that cleanses your bloodstream using your natural peritoneum which acts as a natural filter inside your abdomen.

7) Medications must be taken in between treatments

Dialysis is often done three times a week, with treatments lasting four hours each. Medications must be taken in between treatments. There are medications to help manage blood pressure, diabetes, and cholesterol.

8) Home training makes a huge difference

Kidney disease is a serious medical condition that can be treated by dialysis. Dialysis is a process that removes wastes, extra fluid, and other substances from the body. It allows people with kidney failure to live a more normal life.

If you will be doing dialysis at home, in order to get the most benefit out of this process, it’s important to train at home on your own machine before you stop going into a center for treatment. There are many factors involved in getting the right amount of fluid removed.

9) You will likely have flares from time to time

Kidney disease is when your kidneys don’t work correctly. This can happen if they are damaged, diseased, or if there isn’t enough blood flow to them. Your kidneys are the organs that remove waste and excess fluids from the body. When kidney disease happens, they don’t work well and they can’t do their job of removing the waste and excess fluids from your body properly which can cause a variety of problems such as high blood pressure and too much protein in your urine.

Dr. Feygina is a pediatric nephrologist, physician on the transplant team, and faculty member at the Rutgers-Robert Wood Johnson Medical School in New Brunswick.

Her affiliations include:

• Robert Wood Johnson Medical School
• Robert Wood Johnson University Hospital
• RWJBarnabas Health Medical Group
• The Bristol-Myers Squibb Children’s Hospital at RWJUH

At Geisinger Medical Center in Danville, PA, Dr. Feygina was a pediatric nephrologist on the renal transplant team.

Dr Feygina focuses on providing care for children. Her practice covers chronic kidney disease in children, renal replacement therapy, renal transplantation in children, and immunosuppressive and supportive therapy after a kidney transplant.

Training

Pediatric nephrology at SUNY Downstate Medical Center in Brooklyn, NY. Her training includes pediatric nephrology and transplant medicine.

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