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Selena Gomez's kidney transplant is a reminder: kidney donation is a great way to save a life

Can’t keep my kidney to myself.

Dylan Matthews is a senior correspondent and head writer for Vox's Future Perfect section and has worked at Vox since 2014. He is particularly interested in global health and pandemic prevention, anti-poverty efforts, economic policy and theory, and conflicts about the right way to do philanthropy.

This summer, singer/actress Selena Gomez did something that too few Americans get to: She received a kidney transplant.

Gomez has been very public about her experience with lupus, an autoimmune disorder where the body’s immune system mistakenly begins attacking healthy tissue. In one common variation, lupus nephritis, those attacks hit the kidneys, whose function then deteriorates, sometimes to the point of total kidney failure.

When your kidneys fail, there are basically two options. Option one is dialysis, which uses a machine to partially replace your kidneys' waste-filtering functions. Dialysis is absolutely terrible. It's usually performed three times a week, for four hours at a time. That means no traveling of any real length, since you have to be close to the machine. You can’t hold down a regular work schedule at an office or workplace — you have to be home (if you’re lucky enough to have a home dialysis machine) or at the hospital too often. Even part-time work is difficult because dialysis is physically extremely draining, and the vast majority of people on it report being fatigued. The rate of depression among dialysis patients is more than double that in the general population.

Dialysis is terrible for just about everyone, and for someone with a busy touring schedule that necessitates frequent travel, like Gomez, it means abandoning your career entirely.

And dialysis doesn’t work nearly as well as a human kidney. Dialysis can only replace about 10 percent of normal kidney function. One in four people on dialysis don’t survive a year. Sixty-seven percent die within the first five. That’s a five-year survival rate comparable to that of brain cancer.

Option number two is donation. As kidney recipients go, Gomez was lucky: She had a good friend, actress Francia Raisa, who had a compatible blood type and no antibodies rendering donation impossible, and who was willing to donate her spare kidney to Gomez. These kinds of friend and family donations make up the vast majority of living kidney donations. Of the 5,629 living kidney donations performed in 2016, 4,598 or 81.7 percent were from a biological relative, spouse, life partner, or friend. Another 642 (11.4 percent) were paired donations, where a friend or family member who doesn't match with their intended recipient gives to another person needing a kidney, in exchange for their friend or loved one getting a kidney from someone else.

Donations like Raisa’s save lives. The recipient of a living kidney gains about 10 years of life, on average; deceased donor kidneys — which are much more common, making up 61.8 percent of kidney transplants in 2016 — last about half as long as living donor kidneys.

And the toll on living donors is tiny in comparison. The risk of death in surgery is 3.1 in 10,000, or 1.3 in 10,000 if you don't suffer from hypertension. For comparison, that’s a little higher and a little lower, respectively, than the risk of pregnancy-related death in the US. The risk isn’t zero (this is still major surgery), but death is extraordinarily rare.

Indeed, there’s no good evidence that donating reduces your life expectancy at all. The procedure does increase your risk of kidney failure — but the average donor still has only a 1 to 2 percent chance of that happening, compared to the about 3 percent of the general public who will experience kidney failure at one point in their lives. Because Medicare guarantees coverage for all dialysis and transplant costs in the US, donors pay little or nothing for the surgery.

The main problem is that there aren’t nearly enough kidneys going around to help everyone in Selena Gomez’s situation. As of this writing, there are 116,569 people on the kidney waitlist who need a transplant. Someone joins the waitlist every 10 minutes. By contrast, only 23,090 kidney transplants have been performed so far this year. People are coming onto the waitlist faster than they're getting transplants necessary to take them off; every day, about 20 people die while waiting for a transplant to come.

Even if you don’t have a friend or family member in need, the way Francia Raisa did, you can still help. You can sign up to be a nondirected kidney donor: someone donating to a total stranger. It might sound crazy, but I did it last year and it’s the best decision I ever made in my life. My recipient got to go off dialysis and live years longer, and because we did a paired exchange where one of his family members also donated, and the chain kept going after that, four people total wound up getting kidneys. That's about 40 more years of life people get to experience, due to a few medical procedures.

And here’s the thing: This is not that hard to do. Not really. Anyone with an understanding employer with paid medical leave and friends and family willing to support them in the recovery can do the same thing I did. There’s a simple form that takes, like, five minutes to fill out if you want to get started. Your recipient might not be Selena Gomez, but I promise it’ll be worth it.

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