Why seeing a therapist almost kept me from donating my kidney?

Mayra AlmendarezTransplant News

Written by Martha Gershun, Guest Blogger

When I reached out to the Mayo Clinic in 2017 to see if I could be a living donor for a kidney patient I had read about in the newspaper, I had no idea if I would qualify.  First, of course, I didn’t know if I would be a blood and HLA tissue type match.  I also wondered if I was too old (I had just turned 60) or overweight (I was about 30 pounds over my ideal weight).

But I filled out the online health questionnaire and offered to donate blood.  If it turned out I was qualified, I was eager to help.

About two weeks later I heard from the Nurse Transplant Coordinator at Mayo.  My blood type was a match!  Further blood tests would determine if I was an HLA tissue type match, but the odds were now definitely looking good.  The Transplant Coordinator reviewed each of my answers to the health questionnaire and detailed a long list of next steps if I wanted to pursue becoming an organ donor.  She was not concerned about my age; healthy people can donate kidneys well into their seventies.  And she was not concerned about my weight.  If I was a match they would schedule a three-day medical evaluation to determine if I was healthy enough to donate.

But they were concerned that I had answered “yes” on the initial survey to the question: “Have you ever seen a mental health professional?”   She asked if I would be willing to talk with one of their social workers before we proceeded – in other words, before they billed my potential recipient’s insurance for the more expensive bloodwork to see if we were an HLA match.

“Sure,” I said, unwilling to derail the process now that I knew my fairly rare blood type (B+) was a match for this woman in desperate need of a kidney.  “But this seems unneccesary.  I went to see a psychologist to think through my decision to retire last year.  And I go back now and then when I’m wrestling with something in my personal life.  What does that have to do with becoming a living organ donor?”

The Transplant Coordinator just said it was protocol to have everyone who answered yes to that question speak with a social worker.

Three weeks later the social worker called.  We had a nice chat, and I repeated my story about the relatively benign nature of my psychologist visits.  She asked if I would be willing to have all of my mental health records faxed up to the Transplant Clinic.  Again, I said “Sure.”  I really didn’t want to let any of this get in the way of saving someone else’s life.

But my psychologist disagreed.  She felt that my records were private and had nothing to do with my suitability as an organ donor.  She was concerned that the clinic would ask to have them faxed in their entirety.  Instead she wrote up a summary of our time together and her professional opinion that I was mentally competent to be making this decision, that my motivations were sound, and that she did not believe donating a kidney would cause me future psychological harm.

That must have done the trick, because nearly three months later, after more blood tests showed I was a near-perfect match; numerous medical tests, scans, and x-rays showed I was healthy enough to donate; and many more conversations with social workers and clinic staff showed I was emotionally and financially prepared for the procedure, I was approved to be a living kidney donor.  I was never questioned about my therapy sessions again.

My story has a happy ending – for me and the woman whose life I saved nearly six years ago.

But I have never been convinced that the Transplant Center’s stigmatizing view of mental health counseling was appropriate or useful.  Why was my decision to see a therapist a red flag?  Would it have been better if I had serious mental health problems, perhaps the kind that would have made me a bad donor candidate, but chosen never to seek professional help?

Even more concerning, what if the request to fax my mental health records to the clinic had scared me off?  At the time, I was the only identified potential donor for this particular kidney patient.  What if the clinic’s over-focus on this likely tangential issue meant no donor was ever found for this patient?   What if she died waiting for a transplant?

I have heard from more recent living organ donors that not every transplant center asks this question, but instead does their own assessment about the psychological readiness of the potential donor.  I hope that becomes best practice.  No one should ever be stigmatized for going to see a mental health professional.  And we should never put up unnecessary barriers for those trying to donate an organ to save a life.

Martha Gershun is a nonprofit consultant and writer living in Fairway, KS with her husband Don Goldman. Her most recent book, Kidney to Share (Cornell University Press, 2021), with co-author John Lantos, MD, details her experience donating a kidney at the Mayo Clinic to a woman she read about in the newspaper. Gershun serves on the Expert Advisory Panel for the Kidney Transplant Collaborative and serves on the Board of the National Kidney Foundation Serving Kansas, Oklahoma, and Western Missouri.