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Dr. Campsen: If you are being evaluated for an organ transplant, you're going to come in to the University of Utah for a full day workup, and one of the people that you'll meet is our social worker. Today, we're going to talk about that part of the organ transplant visit.

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Dr. Campsen: My name is Jeff Campsen. I'm a transplant surgeon at the University of Utah and I'll be talking with Melissa Morales, one of our social workers at the University of Utah Transplant Clinic.

So we have people that come in who are in organ failure and need an organ transplant and we try to have them come in during a full day visit to meet a medical doctor, to meet our financial advisors, but also to meet you as the social worker. And I'd like to talk to you a little bit about what that visit's like and what is your role in that visit?

Melissa: Anytime I've kind of explained to patients what I do, I sort of start with, "I'm here to make sure that they are a good candidate and I want them to not be at risk." I take a detailed social history and some of the things that we talk about is their mental health history. We talk about having adequate support, this is family support, emotional support, making sure that they have sufficient resources. A lot of our patients are from out of state and so they have to stay here for up to four weeks.

And overall, it's about compliance. It's about making sure that they are going to be a good candidate, they're going to follow the medical team's recommendations so they have excellent results after transplant.

Dr. Campsen: So that's what they can expect from your visit. Is there anything else that they should be prepared for when they come in?

Melissa: I think it's important for them to know that the reason why we're here is because we want successful results. This isn't necessarily to rule someone out or to find out anything negative about them but it's really to see who they are and what resources they already have in place and what's available to them, how we can further help them if they need to be.

Dr. Campsen: So once you see them, you're going to give them recommendation to the Transplant Selection Committee on whether or not they should receive an organ transplant. And based on what you're saying, have you ever actually said no to somebody? And if you have, are there avenues for them to change and then proceed with their organ transplant?

Melissa: So I actually haven't ever said no. I would say that most of the patients are doing well. Again, they have this support, these resources in place. There are times where patients come in with unmanaged mental illness and they need additional support from either an individual therapist or a psychiatrist, and we help make those referrals to community services and get the help that they need.

Dr. Campsen: So as part of the transplant team then, how does your interview really affect the transplant process?

Melissa: So I sort of serve a dual role. I am there to evaluate and to assess how I think that they would do post-transplant. But I also am there to advocate, to link them to these community resources, to refer them out if they need to be. You know, we see these patients about once a year, and so there are times where I have to follow up with them more than that if there are any concerns on my end. So we get to build a connection, a relationship throughout their listing, and it's great.

Dr. Campsen: But this dual role is interesting because not only are you an advocate for the transplant program and helping the transplant program select the right people to give organs to, you're also a member of the team of the patient. And how do you navigate that dual role?

Melissa: You know, my goal, my purpose is to make sure that patients are successfully transplanted in a safe way and that they have the resources and support that they need, making sure that they're linked to exactly what they need that will help them have successful results.

Dr. Campsen: Well, I know what advice you've given me. What advice would you actually give a patient that was coming in to clinic to see you?

Melissa: I think something really important that I like patients to know is that their mental health really affects their physical health. If they are depressed or have anxiety, all those things are going to exacerbate especially after transplant, and I want them to know that we have these resources, we have ourselves, and we're available to help them through any sort of difficulties that they might have from an emotional, psychosocial side. You know, I really like making these connections with patients. Sometimes I do wish that I had more interaction with them than just once a year. But just seeing how successful they are, see how different their lives can be, a lot of them go back to work after several months and, you know, they talk about how grateful they are for our team and really for this process and having gone through that.

Dr. Campsen: I know that I always like to say that basically, once a patient gets listed and they get an organ, they're always a member of our team and they always have medical resources. But they also have social resources, correct?

Melissa: Right. Yeah, so we're available to them post-transplant. You know, we usually say for about a year after but we're happy to meet with patients any point whether it's been years out or, you know, within a few months.

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Interviewer: Expanding the kidney donor pool with en bloc kidney transplantation. What is it? You'll find out next on The Scope.

Announcer: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You are listening to The Scope.

Interviewer: We're with Dr. Jeffery Campsen, he is a surgical director of kidney transplantation. We're going to talk about something called en bloc kidney transplantation. Is that how you pronounce it? En bloc or is it en bloc?

Dr. Campsen: Either way is fine, potato, potato. It's EN and then bloc. Some people call it lollipop kidneys. Basically what we're talking about is transplanting two kidneys from the same donor at the same time. In the United States, there are thousands of people on the waitlist for kidney transplants and there are not enough organs available. Dialysis keeps people alive, but ultimately they want a kidney transplant.

Interviewer: Nothing replaces a kidney.

Dr. Campsen: Nothing replaces a human filtering kidney. So many medical centers, high-volume transplant centers have started trying to expand the donor pool by using organs that we used to not. And one of the areas is an extremely young donor. Unfortunately, young children die and often their organs are not used because they're deemed too small to be used.

Interviewer: And how young are we talking?

Dr. Campsen: For this discussion we're going to talk about children that are less than a year old.

Interviewer: Okay.

Dr. Campsen: Really less than 15 kilograms or less than 10 kilograms. Very, very small children. And as you can imagine, just one of their kidneys is not enough to filter an adult who a normal adult's greater than 70 kilograms so it's a significant size mismatch.

But what we found is if we keep the kidneys together, meaning that they're en bloc, they're not separated at the time of donation and transplant them together into an adult that actually ends up being enough kidney volume to filter an adult. But then what we found that's really cool about this is that these kidneys grow, and over time over the next year, the kidneys will grow to almost adult size.

So at this point, a person who has kidney failure that gets the small kidneys will ultimately almost get two kidney transplants so they come off of dialysis and they do very well. And these are organs that were being wasted or discarded, not thought to be able to be used in the past.

Interviewer: Yeah, so normally a child can transplant to another child, but if you don't have another child then now they can be used in adults as well.

Dr. Campsen: That's exactly right. So what we talk about with transplantation is you have to have a blood supply and then you have to be able to produce urine for kidneys. And so the arteries and veins are the blood supply. And in the past, surgically, we thought that maybe these arteries and veins are a little small and are high risk to transplant.

But because we keep them together and use the great vessels to sew them in the aorta and vena cava, the vessels aren't as small. And then, what we can do is they stay open. They don't clot and the organs are successful. They are higher risk in the sense that they do have the predisposition to want to clot. So we use anticoagulation in these kidneys.

So the medicine and the surgery behind it is more complicated than a complicated transplant in the first place, but at a center that does these like the University Utah, and has done them successfully, our patients can benefit from these types of donors. We have a good relationship with Primary Children's Hospital and other children's hospitals in the country, which then allows us access to these organs so they're not wasted.

Interviewer: So I think where we are going with this message now at this point is that conversation that we all should have as adults, now we need to include our children as well if something was to happen, realizing that organ donation is a possibility and you could bring some good to a real bad situation.

Dr. Campsen: That's the perfect way of putting it. Unfortunately, people are going to die. And unfortunately, children are going to die. And what transplantation offers is something good coming out of that tragedy.

Interviewer: Is this something that parents that know that they have a child that might be high risk for other reasons that might die soon after birth, would those kidneys be able to be used, or are those still a little too young?

Dr. Campsen: That's a great question too. There are surgeons in the United States now experimenting with those very, very small kidneys. Talking about patients that are just being born or just after birth, that is something I think we're moving towards and those transplants that have been done have worked. And it's a high level of difficulty. You have to have it done at a center that does these and specializes in these types of en bloc pediatric donors. And that's what we're starting to provide here.

Interviewer: A very exciting time for you and for anybody that would need organs, especially in a time of shortage. Any final thoughts?

Dr. Campsen: I think when you come to your transplant center, you basically talk to them about your options. And if your transplant center offers you some unique ways of getting transplanted, whether it's very small donors, these en bloc kidneys or it's a live donor chain or anything else that that they offer you, keep an open mind because ultimately getting our patients off of dialysis is the goal. And it's complicated because there are just too many sick people and not enough organs.

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Dr. Campsen: I'm Dr. Jeffrey Campsen, surgical director of kidney transplant and pancreas transplant at the University of Utah. What're your options when you've been diagnosed with kidney failure? That's next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Dr. Campsen: If you've been diagnosed with kidney failure, there are three options we're going to talk about today. I'm Dr. Jeffrey Campsen and we're with Dr. Martin Gregory, nephrologist at the University of Utah, who is going to tell us more about those options today.
So, a patient comes in they've been diagnosed with kidney failure. What are their options?

Dr. Gregory: Basically there are three main options: kidney transplantation, dialysis, or conservative treatment.

Dr. Campsen: Okay, I do kidney transplants and I'm a big advocate of that, but there's an organ shortage so the other two obviously are the first-line therapies.

Dr. Gregory: Indeed, the majority of people will be treated by dialysis, either hemodialysis or peritoneal dialysis. And it's important we discuss both of those options because they are very different in terms of the impact of the patient and the family, in terms of where the treatment is carried out, how it's carried out, who does it, and what repercussions that has for the patient's lifestyle.

Dr. Campsen: So hemodialysis, "hem" means blood, so that's when they actually filter blood, where peritoneal dialysis, there's a catheter in the abdomen that the abdomen then acts as the body's filter, the kidney.

Dr. Gregory: That's exactly right. Most patients with kidney failure in the United States will have hemodialysis. But, peritoneal dialysis is an equally effective form of treatment and indeed offers many advantages for the patient in terms of convenience and particularly for patients who like to take command of their own treatment and be in control with what's happening, do the treatment themselves, or do it at home. Peritoneal dialysis is a pretty satisfactory form of treatment.

Dr. Campsen: And I think the other thing I'd like to point out is I think each of these therapies have a timeline on them. At some point, patients can get infected with their peritoneal dialysis catheter or it may not work anymore. The same way with hemodialysis where you have to have fistulas created so you have access to the blood and sometimes those burn out also. The same with a kidney transplant, where the kidney transplant may only last so long and there is only so many organs. And so, ultimately it seems like a combination of these therapies are what people with kidney failure need.

Dr. Gregory: You're absolutely right. Many patients will have experience all three of these types we are currently talking about: transplantation, hemodialysis, and peritoneal dialysis. And it's extremely important that patients learn about these at the outset so that they can make appropriate choices and express their preferences for which would work best for each individual.

Dr. Campsen: And so that's interesting, so there's three options. One is conservative management, one is dialysis, and one is transplantation. And what you're saying is some people will try to stay off of dialysis as long as possible, almost to their detriment, until they absolutely need it. And then other patients will really prefer dialysis and then other patients want to receive a transplant before they ever get on dialysis.

Dr. Gregory: All of those are true. Conservative management has a very valuable role particularly in elderly patients or those with multiple other illnesses, comorbidities we call them. These patients may have their life extended by dialysis, but perhaps only by a small amount at the expense of having to go through an awful lot of medical treatment, surgical operations, and time receiving the treatment.
Those patients may well elect not ever to get anywhere near transplantation or dialysis. The situation that you spoke about where people defer getting any treatment until its absolutely necessary is one that frequently leads to a lot of misery down the line. It does lead to bad outcomes and complications. And those are often the patients we see who have a miserable experience with their kidney failure and with dialysis.

Dr. Campsen: Well, I think what's interesting that I'm realizing in speaking to you is that, if you come in with kidney failure, you need very good education on these three options. But once, as a patient, you get educated, really the ball is your court to be proactive and decide what's right for you. No matter what you choose, there is still a lot of work to be done on the patients' part to make sure that the therapies are available and work for them.

Dr. Gregory: Yes, it's always a team approach. The most important part of the team in all circumstances is the patient and things work, as I've just heard you say, very very much better if the patient is pro-active, takes an active part in not only deciding about therapy but then making sure that the therapy is done in a first class way to get first class results.

Dr. Campsen: Kidney failure, it's a lot of work. Getting a fistula created for dialysis and then showing up for dialysis on a consistent basis every week that you need it or three times a week. Or a kidney transplant where you have to have a large surgery and then you have to get your immuno-suppressions and get your labs checked. Any of those things, it's a much bigger responsibility to keep yourself healthy than some other very common morbidities.

Dr. Gregory: It's a huge responsibility for the patient and it's a responsibility that may change and evolve as time goes by. Many patients would dearly like to get a transplant without the need for dialysis, but the majority of those in fact, because of the shortage of donor kidneys, are going to have to have dialysis for some period of time, maybe for many years. This makes it very important that the right form of dialysis is chosen, something that the patient can live with, can stick with, and can work with the remainder of the team to maintain good health until the time of transplantation.
Hemodialysis, for example, is most commonly done in a dialysis center. The patient comes three times a week, but it doesn't have to be that way. Patients can do hemodialysis at home and many patients who do dialysis at home find that's an excellent means. They can do it more frequently, which more naturally mimics what a patient's own kidneys would do, and gives better results. And, the time they spend at home is not nearly as much lost time, as time would be going to a dialysis center.

Dr. Campsen: But as a sidebar, in full disclosure, one of the nice reasons to have Dr. Gregory here is his area of interest in research at the University of Utah is dialysis and hemodialysis.

Dr. Gregory: Yes, we've been trying to arrange a method of hemodialysis, particularly for use in the third world, that would permit us to do hemodialysis without the need for electricity or any external form of energy. Been working on that for a number of years. Potentially it can work, but the devil is the details - actually getting it to be really practicable.

Dr. Campsen: The point is that medicine is evolving and so is treatment for kidney disease and that's why you need to come to an educated physicians, a nephrologist, who can really tailor your treatment specifically to the patient - one of the three options that we talked about, conservative management, dialysis, and transplant.

Dr. Gregory: Knowledge is power. The more you know about your options the more you decide how they would fit with your lifestyle, the better. Working with the team, making sure that what will work for you is part of their plan, is going to be crucial to the success of your therapy.

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Interviewer: You just had a surgery. You might be wondering when can you get back to your life, the things you enjoy doing, your activities? We're going to find out next on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: How long after surgery until you can kind of get back to your life the way it was before surgery? That's a question a lot of people have. We're with Dr. Jeff Campsen. He's a surgeon at the University of Utah Hospital. So, when can you get back to your life after surgery?

Dr. Jeff Campsen: Well, it depends on the type of surgery you have. Anytime you have some sort of incision that goes intra-abdominal, you have to heal that incision. Depending on your state of health, it can be shorter or longer. An average time length that a lot of people say with an abdominal incision is about one to two months or even just six weeks to where you really want to let it heal and you try not to put too much pressure on your abdomen during that time.

Interviewer: Is it the skin that's the issue, that that's going to break apart, or is there muscular things underneath that need to heal as well?

Dr. Jeff Campsen: That's exactly right. It's the deeper tissues, what's called the fascia. The fascia needs to heal, and that's what you would get a hernia through. The skin heals fairly quickly, but the deeper tissues take a little bit longer to heal. That's what takes one or two months. Those tissues are basically what make up your abdominal wall. They're sewn back together, but then the stitches that we use, the deep sutures, will only hold up so long. Most of the time over time they get absorbed, so it's really your body reforming that abdominal wall.

Interviewer: Oh, so after surgery there's multiple stitches. There's the stitches inside of me, and then the stitches I see on my skin.

Dr. Jeff Campsen: That's right. You can have internal sutures or external sutures on the skin, but it's the deep sutures that are really what's prohibitive to getting back to your normal daily activities. Basically, lifting anything greater than 10 pounds, putting any kind of stress on you abdomen.

Interviewer: Wow. That's not a lot of weight. I mean, you can't go grocery shopping without lifting something that's 10 pounds.

Dr. Jeff Campsen: You can't. Most children are greater than 10 pounds, which really puts a damper on a lot of people and just daily activities puts you in that position. But it's worthwhile waiting for it and letting yourself heal because then the end result is that you tear through those sutures or don't heal, and eventually you get an abdominal wall hernia, which then can be life-threatening and will need to be fixed at some point, adding another surgery onto what you've already had.

Interviewer: Wow. So it's very serious stuff.

Dr. Jeffrey Campsen: It can be.

Interviewer: Yeah.

Dr. Jeffrey Campsen: It can be extremely serious, and this is the one thing where it's a good idea to pay attention to your doctor.

Interviewer: All right. So what types of activities are OK and not OK?

Dr. Jeffrey Campsen: I think as you get further and further out, the activities open up more. In the first two weeks you have to be very conservative. You want to walk, because getting out of bed opens up your lungs and pumps blood back from your legs to your heart, so it keeps you from getting a pneumonia or blood clots. So you definitely want to get up, walk, and do activities around the house. You can still do desk work and different things like that. You need to be active to allow healing.

After about two weeks, at two to four weeks you can start doing a little bit more physical activities. What I tell my patients is there's a little voice in your head that's probably saying, "Eh, that's not a good idea," and if that pops up, you should back away from it. Then after a month, you should start to push it a little bit. If it feels bad, don't do it. Wait a couple days. Try it again. If it feels good, move forward, because I'm not there with you, and you're going to be, basically, living this every second and you need to sort of use a lot of common sense on what to do and not to do, and basically really listen to yourself. The mantra is, "If it doesn't feel right, maybe give it a few more days."

Interviewer: Got you. When you say feel bad, you're talking about pain? Is that what you mean by feel bad?

Dr. Jeffrey Campsen: Pain, pressure. You know, you don't want to hear somebody call in and say, "I lifted something and I didn't listen to you, and I heard a pop."

Interviewer: Oh.

Dr. Jeffrey Campsen: What you want to do is not get to that point, and so you're basically. . . If you're pushing yourself a little bit, you're starting to lift something heavy, you're starting to do some exercise, all the good things that we actually do want you to do, and you start to feel pressure on your belly, maybe back away and give it a little bit of a rest.

Interviewer: So, it sounds like if you just kind of pay attention to your body, you're going to have a fairly good idea of what is appropriate or not. Or should you do far less than what you feel is appropriate?

Dr. Jeffrey Campsen: No, I think if you pay attention to your body, you can pretty much do what's appropriate. It's just you really have to use some good common sense and listen to yourself and not push it too far.

Interviewer: Anything else that we should talk about? Anything that might surprise somebody about this topic? Anything that you feel like we forgot, or feel compelled to say?

Dr. Jeffrey Campsen: I think one whole different aspect is this also comes into the realm of when can I drive after surgery? I think driving comes back into your abdominal wall healing. It's not so much your ability to turn the steering wheel and press the gas pedal. It really comes down to: Is your abdominal wall healed enough to where you can stomp on the brake? You obviously need to be off your pain medications, because you can't drive on pain medications, but if you can stand straight up after surgery, whatever many days later, and take your brake foot and stomp on the ground really hard and it doesn't hurt your belly so bad that you are writhing in pain, then you can proceed to drive.

The reason that is, is that most people can drive around. They can push on the gas pedal. They can work the clutch, all that kind of stuff, but if they get into a situation where they've got to stomp on the brake to stop their car rapidly, and they can't because it's painful to them, then they're going to get into a wreck.

This kind of goes into when is your abdominal wall healed enough that you can handle that? Everybody heals a little bit differently, and so it kind of comes into common sense. So, if you can do that test before you ever get into the car, and you're successful, chances are you're going to be fine.

Interviewer: Should you avoid twisting, turning motions?

Dr. Jeffrey Campsen: This gets into. . . You know, it's springtime in Utah, and a lot of people are golfers. What we basically say to that is very similar to lifting and all the other things. You can turn and twist, but if it starts to put too much pressure on your belly, you need to wait. As you get two, four, six week out, you can do more and more.

The analogy with a golf club is maybe in the first two weeks just sort of use your putter, and in the two to four weeks, you can sort of use an iron and just do a half of a backswing. Then, maybe after six weeks to eight weeks, you can really do that full golf swing that you want to do. I think that sort of relates to, basically, what do you do with your abdominal wall, and any of that twisting and turning you can do more and more as you get further out from the sugary, but also the rule, again, is if I feel like it's painful, if it's putting too much stress on my abdominal wall, back off. Give it a couple days to rest, and then try it again in three or four days.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

updated: June 29, 2018
originally published: June 25, 2014

Interviewer: You've had a surgery now what do you eat afterwards? Does it matter? We're going to find out next on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: After you've had a surgery does your diet influence how well you'll heal? We're with Dr. Jeffrey Camden. He's a surgeon at the University of Utah Hospital. Does your diet matter after surgery?

Dr. Jeff Campsen: I think so. Let's start from the beginning, so you have some sort of inter-abdominal surgery, and you come out of the surgery, and at some point you're going to want to eat again. Some people take a couple days to feel hungry, some people want to eat right away, and it depends on what's going on. So we sit down as the managing team and really try to make sure that your intestines for lack of a better word wake back up and can accept food and basically allow you not to get sick after surgery. So the things that we look for are basically everybody hears their stomach rumble, we want to hear those sounds. So after surgery sometimes your intestines can shut down. It's called an ileus and it basically means that the intestines aren't actively moving food forward, and so if that's happening then you can't eat yet.

Interviewer: And that rumbling is that what's happening?

Dr. Jeff Campsen: That's your intestines basically waking back up. Basically being comfortable that no one's going to go in and touch them again and operate on them again.

It's interesting there's actually two things that help your intestines wake up and they've been proven. One is getting up out of bed and walking because that normalcy and the pumping of blood from the walking through the body helps, and then there is a good study out of the Mayo Clinic that said chewing bubble gum actually helps intestines come back quicker, and it's probably because you're not really creating any food but you're giving that sort of reflex of tasting something in your mouth and stimulating your stomach and your lower intestines to think that they need to be working, and so chewing gum and walking those two things are probably the best advice that you can get to moving along.

Interviewer: Got you, alright so what types of foods do you want to start eating at that point?

Dr. Jeff Campsen: So at that point when we start hearing bowel sounds, and we actually ask our patients, you know, "Are you passing gas?" This is a difficult question for some people because no one wants to admit that, but in this particular case that's a good thing and we want to hear that. What we don't want to hear from you is that you're burping. Burping's bad, that means that stuff's not going through and it's backing up in your stomach's getting distended. The reason that that's concerning is if your stomach gets too distended it can cause you to vomit, and if you vomit too much and you've just had surgery, and you're mildly sedated you can actually breathe that vomit in which is called aspiration, and it can give you a very bad pneumonia.

Interviewer: Does that have any chance at that point of rupturing those internal sutures?

Dr. Jeff Campsen: I think that it can. Your abdominal wall is going to spasm to do those violent vomiting episodes, and you probably can damage the repairs that we've made on you, and so we'd prefer that not to happen.

Interviewer: So at this point are you still under the care of a physician and a team?

Dr. Jeff Campsen: Yes.

Interviewer: Up until this point.

Dr. Jeff Campsen: Right, so you've come out of the operating room, we're in the first sort of 24 hours, 24, 72 hours, are you starting...Are you not burping, is your intestines making the rumbling sounds, and plus or minus are you passing some gas? At that point what we would start you on is basically some clear liquids. If you can see through it it's not thick, not milk which is very thick, we start you on that. If you can tolerate clear liquids then we, what we call it is advanced diet is tolerated, then you may go onto something soft, it's called a soft mechanical diet, that's not very spicy, not hot, not all these kind of things that may upset your stomach, that's very bland. Bread and sort of soup those kind of things and if you handle that then you can move along to what you would want to eat.

Interviewer: Alright and when you get discharged and you go home what should you be thinking about in your diet at that point?

Dr. Jeff Campsen: Well I think at that point you can basically go back and eat whatever you would normally want to eat. I do think it's an opportunity to really reevaluate what you are eating and basically try to eat healthy because if you've had inter-abdominal surgery you need the building blocks for healing, protein, sugars, different things that go into along your abdominal wall to heal, and if you're eating unhealthy during that time you're not going to give your body the kind of tools and building blocks that it's going to need to heal properly. So you want to look at your diet and try to eat as healthy as possible during that time. Now if you can parlay that into lifelong better dietary habits then that's great. You might as well; you've gone through the surgery you might as well benefit from it on that angle too.

Interviewer: Got you, so it sounds like if you ate healthy beforehand just continue your normal diet afterwards. If perhaps you didn't have the best diet beforehand that be a good time to reevaluate and maybe make some lifestyle changes.

Dr. Jeff Campsen: I think so; I think it's extremely important during the first month to eat healthy because again you have to have the right components in your diet to allow your body to then create a new abdominal wall, for lack of a better word. To heal that area that was, where the incision was made, and if you don't give your body that then you're not going to heal well, and then if you get an infection, a complication, a hernia it could be a result of that.

Interviewer: And what does it mean to eat well? I mean do you have to go all superstar diet, super clean foods, or...?

Dr. Jeff Campsen: No I don't think so. I think it comes down to you want to have a moderate amount of calories. So you want to look and see how tall you are and based on that how many calories you should have a day and try to stick within that, and then on top on that it needs to be balanced. You need to have the building blocks of protein and carbohydrates, but all sugars and no protein, and I think based on that and who you are going into the surgery your dietary requirements fluctuate a little bit, but again it's the basic food groups that go into it, and then moderation.

Interviewer: The stuff we've learned as kids.

Dr. Jeff Campsen: That's exactly right.

Interviewer: The stuff we all know but ignore when we go to the, you know, the fast food restaurants.

Dr. Jeff Campsen: Right. No I think the biggest thing is that everybody's intestines wake up at their own speed. It's whoever your body actually is at the time coupled with the type of surgery you have, and everybody's intestines will wake up, but if you move too quickly you can hurt yourself.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: September 25, 2018
originally published: June 12, 2014

Dr. Jeff Campsen: You've had kidney pain. You don't know what to do. You're at the end of your rope. There may be a procedure that can help you. We'll talk about that next on The Scope.

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Dr. Jeff Campsen: I'm Dr. Jeffrey Campsen, and I'm here today with Dr. Blake Hamilton. We're going to talk about kidney disease, kidney pain, and techniques to help kidney pain. It's a specific type of pain that we'll talk about today that may be helped by a procedure called autotransplantation of the kidney. So there's all types of kidney pain. Is there a specific type of pain or a scenario that a patient comes to you and ultimately gets to this point?

Dr. Hamilton: Yeah. Well, first let's make it clear. We're talking about very unusual, extreme pain after other things have failed. We're not talking about your basic first time kidney stone episode. Kidney stone pain is very severe. It's some of the worst pain you can have. Most of the time, this pain goes away. The kidney stone passes. You have surgery. It gets better. But sometimes people who have had previous episodes will end up with this recurrent, chronic, refractory pain that doesn't seem to respond to anything. We can take out all the stones. We can make sure the kidney's not obstructed. Everything looks fine, and the patient still has debilitating pain. And then the question is, "What do you do? How do you help them?"

Many things have been tried. Obviously, one of the things that people do is they simply take the kidney out. Well, that's a problem because you lose a kidney. So this idea of autotransplantation is an extension of kidney transplant, which is what you've built your career on and is an expert at. The typical transplant of a kidney is a kidney that's donated by somebody else and goes into the patient. Autotransplant means it's the patient's own kidney that's taken out and then transplanted into a different part of the body. In this case, it goes down into the pelvis, adjacent to the bladder. The idea of this is that when you take the kidney out, you sever the nerve supply from the kidney, and so you stop that pain. But by transplanting it, you preserve the function of the kidney.

Dr. Jeff Campsen: So from what you've said, I've got a couple of questions. At the beginning, when you're trying to diagnose this, is there a scenario or a type of pain that really moves you in the direction that this may help them?

Dr. Hamilton: The character of the pain may range from dull and aching to severe flank pain. So it's not the quality of the pain as much. The location has to be fairly typical, but it's really the duration, the chronic nature of it, and the fact that we tried everything else to make it go away and cannot. The next step is to say, "Can we predict if an autotransplant will work?" So we've been working with our radiology colleagues, and what we have them do is under radiology guidance, they'll put a needle right by the hilum of the kidney and they'll inject some anesthetic right where those nerves run. If that makes the pain go away, then we can predict that this operation is going to be helpful for them. We're early in our series, but so far, we've got a pretty good track record. We think this is an excellent technique for predicting success.

Dr. Jeff Campsen: Now, this is something that you've developed over your career to try to figure out whether or not this will work. It's not something that's written about a lot, and it's a procedure that you've had success with recently?

Dr. Hamilton: Yeah. Autotransplant has been around for a while. It was originally described for something called Loin Pain Hematuria Syndrome, which in Layman's term means, you've got flank and and you've got blood in your urine, and nobody knows why. This is more focused on the pain aspect of it. They may or may not have blood in the urine. The success rate is somewhere between 60 and 70 percent, but by comparison with other things like chronic pharmacologic management of the pain, which is not very good and leaves people somewhat functionally debilitated because of the medications, this is an excellent opportunity to improve people's quality of life.

Dr. Jeff Campsen: In your understanding of this, why do you think this works?

Dr. Hamilton: The nerves are sending a message to the brain that something's wrong when there is no longer something wrong. So what we're trying to do is interrupt that message by severing the nerves. These are sensory nerves to the kidney, so after you sever the nerves to the kidney, the kidney functions just fine. We know that, again, from the long history of kidney transplant experience. We also know that people with kidney transplants don't really experience pain in their kidney. For example, if they get a kidney stone, they don't get that same kind of pain. That's why we suspected that this would work.

Dr. Jeff Campsen: Importantly, I think, by the time they get to this point to where you're going to offer them this procedure, they're ready to literally get rid of their kidney?

Dr. Hamilton: Most people say, "Do anything you want. Take the kidney out. Stomp on it. Get rid of it. Throw it away." But that's a little short-sighted because we have two kidneys, and there is some reserve for sure. But if you're 30 years old and you've got another 50 or 60 years to live, that second kidney may prove to be very useful down the road. So we do everything we can to save kidneys, and this is yet one more way to do that without sacrificing a good functioning kidney.

Dr. Jeff Campsen: As people are listening to this and they say, "Well, I've got pain that I think is from my kidney," how should they go about seeing a urologist or a primary provider to start thinking about this?

Dr. Hamilton: The first step is to do an evaluation of the kidney. So imaging, like, a CAT scan, looking for stones, looking for common things. Often, there may be some little stones if they have a history of stones. So, we'll usually go in and do an endoscopic surgery where we remove all of the stone pieces, all of the fragments, really clean out the kidney, and then let a little time go by and reevaluate. If the pain goes away, that's great. If there's any blockage, if it's relieved by some kind of a drain, great. But if you do several things and the pain persists, then we start talking about what we might do next. Often, these patients have had all of this done by other physicians and they come to me looking grasping for straws, looking for any hope, any sliver of a chance that they might get better. At that point, they're ready to have their kidney removed. In fact, curiously, they often ask if they can donate their kidney. I have to tell them, "No, I don't think anyone wants your kidney."

Dr. Jeff Campsen: That's a good point. I think the piece to pull away from this is that this is not the first line therapy. This is way down the road after multiple attempts to take care of the pain and the primary disease have not necessarily been completely successful.

Dr. Hamilton: That's right. This is in-stage treatment. I mean, I would guess something, like, 1 out of 10 or 1 out of 20 patients in these extreme conditions actually progress to this point.

Dr. Jeff Campsen: So someone's at the end of their rope. They've had a lot of procedures with their urologist. What do they do?

Dr. Hamilton: Most of the time, these patients are referred by their urologist who send them to me because we're a University center, and I have some experience in this. The urologist often doesn't really know what more to do either. So that's where we get started. This is not the kind of thing that's done around the community. I mean, this is a very specialized procedure. Even among academic medical centers, not everybody is offering this to patients. So, I think it will grow in popularity as we and others demonstrate good success with this.

Dr. Jeff Campsen: I think the University of Utah really provides a multidisciplinary group that can handle the care of this difficult patient.

Dr. Hamilton: Right. This goes beyond my own expertise. I mean, I need people who are good at image-guided needle placement. I need somebody who can do the transplant surgery. We need post-op management. We need pre-op evaluations. So it really is a team approach here.

Dr. Jeff Campsen: So what do you think? Does it work?

Dr. Hamilton: Well, I think our success rate is around 75 percent. It's not perfect, but I think in this patient population where there are not a lot of options, this is a very good approach. I think it's showing great promise.

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Interviewer: Organ donors save lives, but for some reason it can be kind of scary checking the "Yes" box that you want to be an organ donor when you get your drivers license or ID. You might have some questions. Well, hopefully we'll answer some of those coming up next on The Scope.

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Interviewer: I think most people know that being an organ donor is a good thing, but for some reason there might be some questions or some concerns that you have that keep you from saying, "Yes. I want to be an organ donor," when you get your drivers license. We're going to talk about some of those right now with Dr. Jeffrey Campsen, transplant surgeon at the University of Utah Hospital. First of all, if something was to happen to me and I was an organ donor, what organs would be used to help other people?

Dr. Jeff Campsen: From a solid organ transplant, which is what I do, the heart is usable. Both lungs are usable. They can go to actually individual people. The liver is usable. The liver can actually be split and go to two individuals. Both kidneys are usual. The pancreas is usable. The intestines are usable. And then expanding out from there, corneas, tissues, bone are all on the table for donation and other parts of the body, if they're not available for transplant, can actually be used for research.

Interviewer: That sounds pretty awesome. All these different organs can go help 10 or 15 people potentially, it sounds like. Why aren't more people checking "Yes" do you think?

Dr. Jeff Campsen: I think there's a couple reasons. I think that there's always a fear of death, and who wants to think about their death? Some people do, but most people don't. So avoidance of that conversation is very easy. Once you start talking about it in a time that's not emotionally charged, rationally, it sounds very good in the sense that if you do die, you can help people. I think it also provides a lot of closure for your family members and your loved ones to know that even though there was this tragedy, something really great came out of it. It's almost, like, you've become a hero in your death. I think another reason that people are scared sometimes is misinformation that people are going to try to take their organs early. The Institute of Medicine, which is a formal body governed in the United States has made very strict rules about organ donation, it's highly regulated, and about brain death. No one can donate their organs unless they are brain-dead. There's tests that have to be confirmed then reviewed. I think when people realize that it's not waiting around to try to take organs, but it's the process of dying that then you can get something out of after you're death. Again, in a non-emotional setting you understand that it's very helpful. I think the final thing is that people have a lot of deep, personal beliefs in their faith and religion. The good news is that over many years, many of the different religions have come to think about this and embrace it and realize that it's something that's acceptable. I think you just check and talk to the people in your faith and see what they think.

Interviewer: If I choose to be an organ donor, can I have an open casket funeral?

Dr. Jeff Campsen: Absolutely. Absolutely. The incisions where the donations are made are hidden, and the organ procurement organizations which are called the OPOs actually work with the medical examiner's office as well as the funeral home directors about exactly how the family and the person themselves want themselves to be presented at time of funeral, and we respect those.

Interviewer: What is the process of organ donation?

Dr. Jeff Campsen: When someone comes to the hospital and they've had an injury that results in brain death, there's an organization called an organ procurement organization, the OPO, and each region has one. Utah has one, California has one, so forth and so on. These individuals are highly trained specifically to approach families about organ donations. They're not involved with the University of Utah. They're not involved with the transplant surgeons. They're a separate organization. They approach the families and say, "The physicians that are taking care of your loved one has an unsurvivable injury and is brain-dead. Would you like to proceed with donation?" If you say, "We'd like to talk about that," they come in and they talk to you about it, and then you talk about how you would like to proceed with the donation. The drivers license allows them to come and talk to you, but also if they have not done that and you say "Yes" to it, then you have a conversation. Just because you're talking to them doesn't mean you're going to proceed, and just because you're proceeding with that doesn't mean that they take over. We work with the families on a minute-by-minute basis to make sure that donation benefits both the families as well as the patients receiving the organs.

Interviewer: As an organ transplant surgeon, it must frustrate you when people say that they're not going to donate their organ.

Dr. Jeff Campsen: It does frustrate me. I'm an organ donor. The people in my family are organ donors. It's something that I support probably because I see the good that comes out of it. Literally, these are not only life-extending procedures improvement in quality of life but life-saving procedures where many of the patients, especially those receiving heart, lungs, and livers, are literally going to die in the next month are so, and then they go onto live decades. We cure diabetes with the pancreas transplant. We take people off of dialysis with kidney transplants. It changes people's lives. It saves them. So when I'm dipped in that and I see that on a day-to-day basis, it is frustrating to know that people don't want to be involved in that. However, that's their choice, and that's okay, but this is why we're trying to educate people on this, and then they can make a rational decision at a non-emotional time if they do want to proceed and help people.

Interviewer: Any final thoughts? Any take-aways?

Dr. Jeff Campsen: These tragedies are going to happen. They happen every day, and that's unfortunate. There's nothing that we can do about that, but if donation is able to help with closure of the tragedy, help do good from that, I think it's very important, and I think people realize that after donation that even though they've lost somebody, they've helped other people, and it helps people move on.

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Interviewer: A lot of people with Type 1 diabetes believe that the insulin shots and a pump is enough, but there might actually be a better option, a pancreas transplant. We're with Dr. Paul Campsen, Surgical Director of Pancreas Transplant Surgery with the University of Utah. That option is pancreatic surgery.

Dr. Paul Campsen: That's correct. Right now we do pancreas transplants for Type 1 diabetics. Type 1 diabetics can't survive without insulin, so they give themselves shots and they can administer this sometimes through am insulin pump which is a very good way to keep them alive. The control that they get from that is not a replacement for the human organ, the pancreas. That's where the pancreas transplant comes into play in the sense that you can help yourself stay alive just like dialysis helps with kidney transplant, or with failure. A pancreas transplant gives you back the human organ that you actually need.

Interviewer: Plus, also a better quality of life.

Dr. Paul Campsen: A much better quality of life. Over the long term the pancreas transplant itself is completely correcting the diabetes, so any of the sequelae of diabetes, whether it be peripheral vascular disease, damage to your eyes, damage to your nerves, damage to your coronary arteries, all of that stuff is stopped with a pancreas transplant.

Interviewer: Not with the insulin shots or the pump?

Dr. Paul Campsen: No, I think that the insulin helps a lot. It slows down the damage. Obviously it literally saves their lives by giving them insulin, but it doesn't stop the diabetes because you're still a diabetic. The pancreas produces a variety of different enzymes and secretes many things that actually help the body including insulin, also glucagon, which keeps the sugars from going too low which can be life threatening, and any of the pancreatic enzymes that help with digestion. None of that' s given with the insulin pump. When you replace the pump with a human pancreas you get all of those benefits.

Interviewer: It sounds like a great solution. Why aren't more people doing it? Is it a dangerous surgery or is it fairly safe?

Dr. Paul Campsen: The diabetics who come to us hate their diabetes so much and they're so scared by it, and their so scared by brittleness of their, meaning they go too high with their sugar or too low, that they would do almost anything not to have to use insulin anymore, but they're scared because surgery is a big deal. The vast majority do very well with this surgery. It's very safe. They stay in the hospital for about a week afterwards, but the moment that they leave surgery they're not a diabetic anymore.

Interviewer: That's pretty amazing, isn't it?

Dr. Paul Campsen: It is pretty amazing. Many of the patients that come to us, their diabetes has also ruined their kidneys, so they're on dialysis at the same time. We'll do a simultaneous pancreas and kidney transplant. The moment that they leave the surgery the next morning they're cured of their diabetes and they're cured of the their renal failure and they're not on dialysis. The other thing that's very interesting in these patients is if you just give them a kidney transplant their Type 1 diabetes will still attack the kidney transplant.

Interviewer: It just kills that organ.

Dr. Paul Campsen: That's exactly right. The pancreas transplant added on top, because it cures the diabetes, actually protects the kidney transplant. Then both organs survive much longer.

Interviewer: Who would be a good candidate for this type of surgery?

Dr. Paul Campsen: I think anybody who has Type 1 diabetes. We're talking about unfortunate people who were diagnosed with diabetes probably before they were 20. We'd like to see these patients well before they get into their 30's. The earlier we see them the better.

Interviewer: OK. What are your final thoughts for somebody that has Type 1 diabetes and is a little on the fence?

Dr. Paul Campsen: I think basically this is a safe surgery. Coming and seeing us doesn't mean we're going to trap you and give you the surgery, but it's something where we can talk about it and see if this is the right surgery for you. If it is, we can cure your diabetes. If you have kidney problems we'll take care of those too.

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