Kidney Living Donor Video

Narrator: The purpose of this video is to give you information so that you can make an informed decision whether to be a living kidney donor. You'll be seen by members of the transplant team who will ask you questions, examine you and, more important, answer any questions you have. It's important that you ask all the questions you have about living kidney donation because we want you to make the best decision you can whether to be a living kidney donor.  

Errol Williams: My brother's had kidney disease for the majority of his life, and when I found out that there was a possibility for me to, to donate and to help him out, I didn't think twice and didn't hesitate, and I was very happy to do it.  

Natalia Williams: I wasn't nervous. I just wanted to make sure that we knew as much as possible and to make sure that my husband was as healthy as he could be.  

Cathy Garvey: I always advise a potential donor to make sure they've reviewed the materials they've gotten from us, ask any questions if they don't understand, or any other clarification. And it's a good idea to write those questions down and bring them to their appointments. You know, they always think of that one last question when we've walked out of the room.  

Cathy: Good morning, Errol. 

Errol: Hi, Cathy. Good morning.…

[cross talk] 

Cathy: Hi, Cathy Garvey. Nice to meet you.

Natalia: Hi.

Cathy: Natalia, welcome.

Natalia: Thank you.

Cathy: Did you get the information we sent you?

Natalia: We did, and I wrote down all the questions

Cathy: Oh, good. Well, let's get started then.

Come on this way.

Errol: We did a lot of research. My wife researched a lot of things on the Internet, a lot of articles, and she pretty much — she was the trooper. She was the information gatherer. She went on fact-finding missions about what was going on, about what actions and what questions to ask.

Cathy: Well, Errol and Natalia, it's good to have you here, and what's going to happen today for your donor eval is, we're going to run you through all the medical evaluation tests. It's going to be a lot of tests.

Natalia: Who will we see?

Cathy: You'll see several people. One of them will be an internist, and that doctor will do a physical exam and review what test results are back. The other person you'll see is a surgeon, and that's a person that you can ask questions about the surgery —

Natalia: OK.

Cathy: — the recovery, your hospitalization.

Errol: Um-hmm.

Natalia: Um-hmm.

Cathy: And you'll see our donor social worker, and that person will go over recovery issues, financial issues, any insurance questions you might have.

Errol: OK. Well, when will we know that I can donate?

Cathy: That'll take us some time. It usually takes a week or ten days for us to turn the tests around and have everybody that's seeing you today review the results. But I'll call you with those results, and we'll tell you, "Yes. You can donate" or "No. You can't be a donor" or "perhaps you'll need a — some further testing, depending on the results of today's test."

Errol: OK.

Cathy: Other questions?

Errol: No.

Natalia: Not right now. [laughter]

Cathy: OK. Well, let's get going, and we're going to start by getting some blood drawn. So, I'll take you down to the lab.

Errol: OK.... 

Cathy: Your medical evaluation will be set up according to the guidelines of your transplant center, and that, uh, evaluation will include a lot of testing, including blood work, chest X-ray, EKG. You'll see an internist who will do a physical examination as well as get a detailed medical history. You'll also see a surgeon to discuss the actual procedure, go over your hospitalization and your recovery. An important test that you'll have is a, a scan of your kidneys to make sure that there are two of them and that they're normal.

When you meet with the transplant surgeon, that's your chance to ask questions about the actual surgical procedure, the hospitalization and your period of recovery.

Errol, Natalia, I'd like you to meet Dr. Distant, one of your surgeons.

Errol: How're you doing?

[cross talk]

Dr. Distant: ... Errol.

Cathy: He's going to talk to you a little bit today about the risks and benefits of donation, and later, you'll meet Dr. Howard, another surgeon, and he'll talk to you about the specifics of your surgery.

Errol: OK.

Natalia: OK.

Dr. Distant: Donating a kidney is a big decision, and although we utilize the most modern surgical techniques that limit pain and scarring, it still is a big operation, and it's appropriate to be concerned about having the surgery.

So, I know that you're here because you're interested in becoming a living donor —

Errol: Um-hmm.

Dr. Distant: — for your brother.

Errol: Um-hmm.

Dr. Distant: But there are some issues that we need to talk about, and probably the first is, whether or not you can be a living donor. I know that you're healthy, but still, it's not a foregone conclusion that you will be able to donate.

Once the evaluation is completed, it's possible that we might find that you have preexisting conditions, which may not be major illnesses at this point, but might develop into an illness in the future.

Errol: OK.

Natalia: Um-hmm. So, if he can't be a donor, then what are the alternatives? What do we do?

Dr. Distant: We can still help your brother even if you can if you cannot donate. Well, the alternatives for your brother, who is in need of a transplant, would be to get on the waiting list for a deceased donor kidney transplant, which on average, takes about four to five years in the United States, or to go on dialysis or continue on dialysis.

Natalia: Um-hmm.

Dr. Distant: Those are really the major options. So, we can still help your brother even if you cannot donate.

Errol: OK.

Natalia: But it's better if he gets a live donor.

Dr. Distant: That's correct. Probably the main advantage is that a living donor transplant will function better and will last longer than the deceased donor transplant. That's the major advantage.

Natalia: Um-hmm.

Dr. Distant: The risk of having the kidney fail within a year after the surgery —

Natalia: Um-hmm.

Dr. Distant: — for a living donor transplant is approximately 5 percent. But it's about twice that for a deceased donor kidney transplant; so approximately a 10 percent risk of failure within the first year.

Errol: OK.

Dr. Distant: And over the long term, the chances of success are also higher. So, in about five to 10 years, most living donor transplants will be functioning ... at about 80 percent, whereas, for the deceased donor kidney transplants, only about 60 percent will still be functioning at that period of time.

Errol: OK. Well, I just want to do what's best for my brother. So, if I can, I want to donate.

I didn't want my brother to wait at all, and I didn't waiver from the the fact that I wanted to go ahead and donate and get it done. He was worried about me donating, about my health, coming in perfectly healthy, about the precautions. But I didn't want him to wait. I told him, "You know what's best for you," and eventually, he caved in and said, "OK. Well, we'll go ahead and do it."

Dr. Distant: The second reason why living donor transplantation is preferable is the issue of timing. As you know, the wait for a deceased donor kidney transplant is four to five years —

Errol: Um-hmm.

Dr. Distant: — and a lot of things can happen in four to five years. With living donor transplantation, the surgery can be performed as soon as you and your brother are ready to go. The third major reason why living donor transplantation is preferable is the issue of affording dialysis.

Errol: OK. Yeah. Because he's going to have to go on dialysis.

Dr. Distant: Right. That's correct. If a living donor transplant can be performed, he could avoid dialysis altogether.

Errol: OK.

Dr. Distant: Once a patient goes on dialysis, the chances of success with the transplant decrease slightly every year that they remain on dialysis. So, to receive the transplant before dialysis ever begins gives him the best chance for long-term success with the transplant.

Errol: OK.

Dr. Distant: Only you, the donor, can make the decision as to whether or not you want to donate. No one else can make the decision for you. If you're feeling pressured by your family, you let us know. You speak with the coordinator, the social worker or myself, and we'll help you to explain why you cannot be a donor to you family. So, that would take the pressure off of you.

Natalia: We knew that it was major surgery, and in any major surgery, there's a possibility that you could die.

Dr. Distant: There is a risk of dying with any major operation. Fortunately, with living donor surgery, it is rare. The reason why the risk of death is so small is because we know that we're operating on perfectly-healthy individuals.

Errol: Um-hmm.

Dr. Distant: So, you cannot have any preexisting illnesses or major chronic illnesses, no heart disease, lung disease, hypertension, diabetes, kidney problems, nothing of that sort. And if we're certain that your health is perfect, then we know that the risk of surgery is very, very low.

Errol: OK.

He gave us all the pros and cons about the procedure, what could possibly happen and it made us feel a lot better. I was very glad that he told us everything that could possibly happen.

Dr. Distant: Besides the risk of dying, there are other major complications that can occur. Probably one of the major complications is the risk of bleeding.

Errol: OK.

Dr. Distant: That occurs 1 to 2 percent of the time, and bleeding might necessitate transfusion during the operation.

Natalia: Right.

Dr. Distant: It might also require converting the surgery from the laparoscopic to the open operation.

Errol: Um-hmm.

Dr. Distant: Or bleeding can occur after the operation and might require going back into surgery in order to stop the bleeding.

Natalia: OK.

Dr. Distant: Those are some of the major issues that can occur with bleeding.

Natalia: OK.

Dr. Distant: But again, 1 to 2 percent.

Errol: OK.

Dr. Distant: One of the major other complications is infection.

Errol: Um-hmm.

Natalia: OK.

Dr. Distant: We need to make some small incisions in order to perform the surgery, and a little bigger incision in order to remove the kidney.

Errol: Um-hmm.

Natalia: OK.

Dr. Distant: And it's possible for infection to develop at the site of any one of those incisions. That doesn't happen very often, about 2 percent of the time.

Natalia: OK.

Dr. Distant: Some other major issues that can occur include bladder infection —

Natalia: OK.

Dr. Distant: — pneumonia. Blood clots can develop. All of those are quite rare.

Natalia: Um-hmm.

Dr. Distant: The vast majority of patients will come in, have their surgery, be discharged in one to two days, and they're very happy with the result.

Errol: ... that's — that's good to know.

[cross talk]

Errol: That's good to know.

Natalia: Our biggest concern was: Would he be able to live with one kidney, and how would his body handle that if he were to get sick?

Dr. Distant: Living with one kidney should be essentially the same as living with two kidneys. In fact, there are people who are born with only one kidney, and they live a perfectly normal life. In fact, you wouldn't know that they had only one kidney unless special testing were done to determine if you had one or two kidneys.

Errol: Um-hmm.

[cross talk]

Dr. Distant: Just on routine physical examination or routine blood testing, that's not something that a doctor would ordinarily pick up.

Natalia: Um-hmm.

Dr. Distant: There was a very good study that was done on a military population from World War II.

Natalia: Um-hmm.

Dr. Distant: And this study looked at young men that experienced trauma on the battlefield. One group of young men required one kidney to be removed. The other group of young men had trauma and surgery, but they kept both kidneys.

Errol: Um-hmm.

Dr. Distant: And when those two groups were followed over time, they had the same life expectancy —

[cross-talk]

Dr. Distant: — the same renal failure rates and so on, and this was over many years. There have also been some very good studies that have looked at people who have donated and have looked at them 20 years down the road and have found that they've done quite well in terms of life expectancy and rates of renal failure.

Natalia: Um-hmm.

Dr. Distant: So, the message really is that living life with one kidney —

Natalia: Um-hmm.

Dr. Distant: — should be essentially the same as living life with two kidneys.

Errol: Now, is there a higher risk of me getting kidney disease with me just having one kidney?

Dr. Distant: No. There's not a higher risk. There's some risk because you have someone in your family with kidney disease.

Errol: Um-hmm.

Dr. Distant: But the risk for you is not higher, and it's not lower.

Natalia: What if he has one kidney and he develops kidney disease?

Dr. Distant: Under those circumstances, we might expect that developing kidney failure might occur faster, but the risk of developing kidney disease is not increased or decreased.

Natalia: OK.

Dr. Distant: If, for example, he had an accident —

Natalia: Um-hmm.

Dr. Distant: — if he were in trauma, having one kidney is not an advantage; it's a disadvantage.

Natalia: Right.

Errol: Um-hmm.

Dr. Distant: Or if he developed cancer, that would be a disadvantage.

Errol: Um-hmm.

Natalia: OK.

Dr. Distant: So, under those circumstances, having one kidney would be a disadvantage. But fortunately, those circumstances are rare.

[cross talk]

Natalia: OK.

Dr. Distant:What's important for you to understand about becoming a living donor and future illness is that, donating one kidney will not prevent you from developing a major, chronic illness in the future. So it is still possible to develop heart disease, lung disease, diabetes, high blood pressure and cancer. If those things are destined to happen to you, they will happen to you with one or two kidneys. 

Many female patients are concerned about whether or not they can go on to bear children after donating. In my experience, there is no difference in terms of carrying the pregnancy or getting pregnant with one or two kidneys, and we have many young women who have donated and have gone on to have several children without any problems. So — and also, the studies support that, that there is no disadvantage to carrying a pregnancy to term with one or two kidneys.

Natalia: My husband has never had any kind of surgery, and my main concern was how he was going to feel coming out of the surgery.

Errol: I basically wanted to know how much pain I would be in and what to expect after that.

Dr. Howard: Good morning.

Errol: Good morning.

Natalia: Good morning.

Dr. Howard: Mr. Williams, I'm Dr. Howard.

Errol: How're you doing, Doctor?

Dr. Howard: Good morning, Mrs. Williams.

Natalia: Good morning.

Dr. Howard: I'm one of the transplant surgeons, and first of all, I think it's an absolutely wonderful thing you're considering doing, giving up one of your kidneys —

Errol: Thanks.

Dr. Howard: — for your brother. It'll really make a big difference in his life. What I'm going to do this morning is to talk to you about the operation, about the hospital stay and about life after having donated a kidney.

Errol: OK.

Dr. Howard: If you ... — either of you has any questions, please interrupt me at any time. I want to make sure I answer every concern and every question you have.

Natalia: OK.

Errol: OK.

Dr. Howard: There are two techniques we used to remove kidneys for transplantation. The first is called the open technique. With this procedure, we make an incision through the abdominal wall muscles and work directly on the kidney. Then, when the kidney is ready, we remove it for transplantation. The second procedure is called the minimally invasive, laparoscopic technique.

We'll plan to do the operation laparoscopically. With this technique, we make four tiny incisions about a quarter to a half inch long, and through one of the incisions, we put a camera, so we can see what we're doing, and through the other incisions, we put long instruments that we can work on the kidney with.

Errol: OK.

Dr. Howard: When the — and we actually do the operation by looking on a television screen.

Errol: Um-hmm.

Dr. Howard: When the kidney is ready to come out, then we have to make an incision about the length of my fist —

Errol: Um-hmm.

Dr. Howard: — so that we can get the kidney out in one piece.

Natalia: If you do the surgery that way, how much pain would he be in?

Dr. Howard: We have more pain medicine than he has pain. But that doesn't mean he's not going to have any pain.

Errol: OK.

Dr. Howard: Because we do have to make an incision to remove the kidney, and there is pain associated with that.

[cross-talk]

Dr. Howard: But we'll make sure he has enough pain medicine so that the pain can be relieved and that the pain is minimal.

Errol: OK. So, how long will I have to stay in the hospital?

Dr. Howard: Most people go home after one to three days.

Errol: OK.

Dr. Howard: If it were to be done "open," that usually requires a little longer hospitalization, three to five days.

Errol: OK.

Dr. Howard: Whenever we do surgery, there are always risks. We hate to keep bringing up the negatives and talking about risks, but they do exist, and you have to understand them so that you can become a fully informed, potential kidney donor.

Errol: What are the risks if you do the laparoscopic surgery?

Dr. Howard: The risk of the operation, of the laparoscopic procedure, is one, bleeding (that's true of any operation we do) and the risk is about 1 percent, and we may have to open — make an open operation, make an incision, to control the bleeding —

Errol: Um-hmm.

Dr. Howard: — because our primary concern is your safety.

Errol: OK.

Dr. Howard: There's another 1 percent chance that we may have to do an open operation, convert it to an open operation, because of the anatomy of the kidney is unusual; it's something we hadn't anticipated before.

There's also a risk that we might injure another organ, the liver, the spleen or the intestine. If that occurs, usually, we can fix it, and it's usually bleeding. But usually, we can fix it through the laparoscopic procedure.

[cross talk]

Dr. Howard: But again, if there is any question of your safety, we will open — make an open operation.

Errol: OK.

Dr. Howard: There's also the risk of bleeding after the operation in the first day or two.

Errol: Um-hmm.

Dr. Howard: And you might have to be taken back to the operating room to control the bleeding. That risk is also very small, much less than 1 percent.

Errol: OK.

Dr. Howard: But we, again, can never make the risk zero. There's a risk of infection in one of the sites where we made the laparoscopic procedure or the incision that we use to remove the kidney.

Errol: Um-hmm.

Dr. Howard: That risk is about 2 to 3 percent, and usually, you don't have to do anything; just wash it. Rarely, you need antibiotics. But usually it takes care of itself.

Errol: OK.

Dr. Howard: Late after donation, there's a risk of developing a hernia in one of the incisions.

Errol: Um-hmm.

Dr. Howard: That's probably 1 percent also.

Errol: Um-hmm.

Dr. Howard: And because we've operated on your abdomen, you will likely develop some adhesions.

Errol: OK.

Dr. Howard: Whenever someone has adhesions, there is a tiny risk that sometime down the road, you could develop a blockage or obstruction of your intestine.

Errol: OK.

Dr. Howard: And that might require an operation. The risk of that really isn't known because we haven't been doing these for long enough. But it's small.

Errol: OK.

Natalia: They told us what to expect as far as the recovery time, how long we would be there and how he would feel coming out of surgery?

Errol: How will the day of surgery go?

Dr. Howard: Well, you'll come into the hospital early in the morning. You'll come up to the pre-operative area. A nurse will start an intravenous in you.

Errol: Um-hmm.

Dr. Howard: And then you'll be taken back to the operating room. An anesthesiologist will put you to sleep. After that, he'll start another intravenous line, and he'll also put a catheter into your bladder. Then, we'll prepare you for the operation by washing your skin and putting sterile drapes on.

Errol: Um-hmm.

Dr. Howard: And do — then, we'll do the operation.

Natalia: How long will the operation take?

Dr. Howard: The whole procedure takes about five hours, from the time you enter the operating room until it's done.

Errol: Um-hmm.

Dr. Howard: After that, you'll be in the recovery room for two to three hours, until you're awake enough.

Errol: Are there any restrictions on my diet?

Dr. Howard: No. You'll be given fluids to drink that evening. You won't feel like eating much the first night. But the next morning, you'll be able to eat a regular diet.

Errol: OK.

Natalia: Will he need any medications when he goes home?

Dr. Howard: We'll send him home with some pain medication. He can use it if he wants to. But if he doesn't have any pain, he doesn't have to take them.

Natalia: OK.

Dr. Howard: But there'll be no new medicines that he's not taking already.

Natalia: OK.... 

[cross talk]

Errol: ... Are there any things that I won't be able to do?

Dr. Howard: Well, yes. First, we don't want you to get the incisions wet for about four to five days, just so they seal, so that risk of infection is lower.

Errol: OK.

Dr. Howard: Second, we don't want you to lift anything heavy, and by that, I mean, anything over ten pounds, for about six weeks, just so the incisions heal and you don't develop a hernia.

Errol: OK.

Dr. Howard: That means that if you have a job that involves lifting, you may have to take time off, or if you can, switch to a job temporarily that doesn't involve lifting heavy things.

Errol: OK. Well, no. I work at a computer and a desk. OK.

Dr. Howard: The effect of the anesthesia, it just makes people tired more easily, and they get fatigued earlier in the day. So, you have to listen to your body.

Errol: Will I be able to drive?

Dr. Howard: We wouldn't want you to drive for the first couple of weeks after the donation procedure. With the anesthetic and with your taking pain medicines, your reaction time might be slower, and we don't want you to get into an accident. But we will see you in the clinic afterward, just to make sure the incisions are healing well and you're doing fine and there aren't any other concerns.

Cathy: Errol, Natalia, I'd like you to meet Rebecca, our donor social worker.

Errol: Hey, how're you doing?

Rebecca Hays: Hi, it's so nice to meet you..

[cross talk]

Rebecca: Come on back to my office....

The clinic day involves meeting a lot of people and having too much information thrown at ya. We don't expect you to remember everything, and we hope that you'll continue to ask questions as the day goes along.

So, how's the day going so far for you guys?

Natalia: It's going good.

Errol: Oh, pretty good.

Rebecca: Yeah?

Natalia: We've done all our research. So, we feel pretty good about it. So —

Errol: Yeah. Pretty much informed. So, we're ready to do it.

Rebecca: Yeah. You guys sound really confident.

Errol: Yeah.

Rebecca: And at ease.

Errol: Yeah.

Rebecca: OK. And honestly, I think our job, in some ways, is to be more medically conservative than you are at this point.

Natalia: Um-hmm.

Errol: Right.

Rebecca: And how does your brother feel about you proceeding with donation?

Errol: I think at first, he just didn't want me to feel pressured to do it, and he kept telling me, "You don't have to do this if you don't want to." But he knew that I was going to do it and I wanted to do it, and he knows that this is the best thing for him. So, he's on board; he's ready to do it.

Rebecca: I think anybody who's approached about living donation is going to want to help, and at the same time, it's normal to feel scared and worried about what's involved.

We want to help you feel ready to pursue donation and feel like you want to, and that you can cope with any fears are worries that you might have about it.

So, after the surgery, you know you'll be out of work four to six weeks, maybe longer.

Errol: Um-hmm.

Rebecca: Have you thought about — how that'll affect your family financially?

Natalia: Well, we've talked about it and figured out a budget, and we're just ready to go.

Rebecca: OK.

Rebecca: Living donation can be a financial strain. One level of preparation that can make a huge difference is to work out concretely, ahead of time, how much money you will need during your time off to cope, and whether or not that's something that your family can deal with.

So, during that recovery time, you won't be able to do a lot of the things that you normally like to do, and it's pretty normal to feel kind of cooped up during that time.

Errol: Yeah. I probably will.

Rebecca: [laughter] OK.

Natalia: [laughter]

Rebecca: Well, we should probably plan ahead ways to keep you occupied —

Errol: Um-hmm.

Rebecca: — get some more family involved and things to keep you going.

Errol: OK.

Rebecca: After living donation, you can go through a period of depression. If depression has been a factor for you in the past, discuss it with your social worker, and if addiction, alcohol or illegal drugs have been a problem for you in the past, make sure that you tell us. Surgery can be a risky time for relapse, and we want to help you develop a relapse-prevention plan ahead of time.

Errol: My brother's insurance is going to pay for this? Right?

Rebecca: Yeah. No living donor should ever get a medical bill for charges related to the donation itself. It all gets billed under the recipient's insurance.  

Errol: OK.

Natalia: But we have insurance, too.

Rebecca: OK. I mean, that's just good in life.

Natalia: OK.

Rebecca: But it's also good because if a medical problem is discovered during your workup today —

Errol: Um-hmm.

Natalia: Um-hmm.

Rebecca: — that could be considered a preexisting condition for insurance down the line.

Errol: OK.

Rebecca: And you'll also be able to use your insurance to get healthcare for that problem. So, if for example, you got diagnosed with diabetes today —

Errol: Um-hmm.

Rebecca: — which I hope doesn't happen, but if it does, you'll have access to health care to get it treated.

Natalia: OK.

Errol: OK.

Rebecca: It's important to have your own medical insurance. We recommend that all living donors have yearly checks to make sure that your kidney is working OK and that your blood pressure is under control, and having health insurance can help pay for those  appointments.

Before you go into living donation, you should know that at a later time, if you ever go through a period of being uninsured, and apply for health insurance, having one kidney can be considered a preexisting condition. That means that you'd have health insurance for most things, but kidney-related problems would be uncovered for a period of up to a year.

Rebecca: So, one thing I'd like to talk with you about is an advanced medical directive, or a durable power of attorney form. Have you ever heard of that or filled one out before?

Errol: Uh, no, we haven't. But we were thinking about doing that.

Natalia: And that's in case something goes wrong? Right?

Rebecca: Basically, an advanced medical directive is a form that you can fill out that is a legal form, although you don't need a lawyer to help you fill it out, and basically, it states that in general, you are in charge of your own health care decisions. 

Errol: OK.

Rebecca: But, in the case of an emergency, where you can't make a decision for yourself, you name somebody in your life to make decisions for ya. It's a hard form to fill out because it sort of forces you to think about worst case scenarios.

Errol: Right.

Rebecca: And that's why a lot of people put it off.

Natalia: OK.

Rebecca: And I strongly recommend that you fill one out before the day of surgery. 

Errol: OK.

Rebecca: I can give you a form to take home —

Natalia: OK.

Rebecca: — and think about if you'd like.

Natalia: Good.

Rebecca: And then if, when you get home, you have questions, please feel free to give me a call.

Natalia: OK. Good.

Errol: OK.

Cathy: Before you leave, the day of evaluation, your coordinator will go over the tests to make sure that they were completed, and give you an idea of when to expect the results of those tests. At that time, she's also probably going to ask you for results of routine cancer screening tests. For women, Pap smears, results of their most recent mammogram. Patients older than 50, colonoscopies are usually requested. And those aren't usually done as part of the donor eval, but they are important. We want to know they're done, they're current and they're normal. We don't include those tests because we feel they're routine cancer screening tests and should be done as part of your routine health maintenance, and they can be done with your primary doctor and are usually done under your own health insurance.

Well, Errol, it looks like we've finished all the tests we said we were going to do on you. So, I'll gather those up, get them reviewed by everybody that saw you today —

Errol: OK.

Cathy: — and I'll call you with an answer. Again, that'll take a week or 10 days.

Errol: OK.

Cathy: So, unless you have any more questions today —

Natalia: I'm pretty sure we'll have some....

[cross talk]

Cathy: OK.

[laughter]

Cathy: Alright. Good. Well, feel free to give me a call or shoot me an email.

Errol: Um-hmm.

Cathy: Here's another card.

Errol: Um-hmm.

Cathy: I would be happy to talk to you. But again, I'll let you know as soon as I know something. OK?

[cross talk]

Errol: Thank you so much.

Cathy: You're welcome. Thank you, and my pleasure. I'll talk to you soon.

Natalia: OK.

Errol: See you later.

Cathy: Bye now.

Errol: I think the best way to find out if you would like to be a donor is to get as much information as you can, maybe ask persons that have been donors, or maybe talk to a transplant team, or try to get as much information that way. And the more informed you — that you are, the better it will be for you.

Natalia: My advice would definitely be to — to do your research, communicate with one another, talk to each other about how you're feeling because it can be an overwhelming situation and definitely talk to the transplant coordinators.

If you have questions that come up, reach out to your clinical coordinators and get those questions answered because that's what they're there for.