Dr. Uttam Reddy

Dr. Reddy shares his journey into the field of Transplantation including the mentors he met. He highlights his journey over the last 11 years to grow the Transplant team and the transplant program. His north star being patient care and educating his patients.

https://www.ucihealth.org/clinicians/uttam-reddy-1487846481

Please note this is not medical advice. It is meant for entertainment purposes only. 

Transcript

SPEAKER_01 0:02

All right, everyone. Welcome to another episode of Totally Transplant. This is your host, Dr. Manpreet Samra. A very special guest with us today, Dr. Utum Reddy, who is the medical director of the University of California Irvine Kidney Transplant Center. So Utum and I actually uh trained together. How many, how many years ago, Utum?

SPEAKER_00 0:25

Uh let's see. 14 years ago.

SPEAKER_01 0:28

14 years ago, um, during our transplant rotations at UCLA. And it's a pleasure to have you on today. If you could introduce yourself to the audience.

SPEAKER_00 0:37

Yeah, sure. Thank you, my preed, for the the offer to speak at your podcast. I commend you on taking this off the ground. So my name is Utam Reddy. I am the medical director and transplant nephrologist at UC Irvine. I joined UCI uh in 2015, coming from being a transplant nephrologist at UCLA, which is where I trained. I was there for two years and I had this opportunity to take over uh as medical director for a program that was quite literally in my backyard. And so it was a challenge. And um, yeah, and now it's 11 years later, and we're I'm very proud of where we've come and happy to talk to you today about it all.

SPEAKER_01 1:18

Right. Well, I'm looking forward to delving into that more. Before we do get into that, will you share with us how you got into the world of transplant?

unknown 1:28

Yeah.

SPEAKER_01 1:29

Your entry.

SPEAKER_00 1:30

So my older brother is a family physician, and I always enjoyed the idea of being someone's patient uh throughout the continuum of time. I wasn't one of those people that like wanted to do a procedure and never had to see anyone before. I wanted to know what this person was like, what his sports teams were, what his family was like. And so I was always drawn to primary care. And my brother, as a family physician, said, You have to do me one favor. You have to never do primary care. The realities in this country are difficult. And as my younger brother, I want you to specialize. And so I did internal medicine thinking, like, okay, I can find some specialty where I can find my niche and go from there. And so my first rotation at Harbor UCLA was um nephrology. And I had an attending uh Dr. Camero Countar, who was a mentor at the time, and he basically was like, Oh, you're doing this? You should do nephrology. And it was kind of like a joke, but it kind of settled some reality of it into my soul. And I ended up really liking the pathophysiology of neprology, and I really liked the continuity of care of nephrology. Um, oftentimes nephrologists are the primary care doctors of the patients. They're like, no, no, this is my primary care. And as much as we try to avoid that title, uh, the the reality is it's often true for many patients. And I think deep down a lot of us do enjoy that role. And so in my last year of residency, I actually had a medical illness that caused me to cut my residency short. And it kind of changed my perspective on being a physician, my own life path, what patients go through. And um, before starting my nephrology fellowship, my program said, you know, why don't you handle this stuff first and then you can take a year off? And thankfully, you know, after a big surgery, I wasn't sure if I had like a really, you know, poor prognosis or that I would be good. And it turned out everything was fine. I had an intra-abdominal mass that was 14 centimeters that turned out to just be a lipoma and it was not a liposarcoma. So I felt like I kind of got my life back. I kind of got a second chance at things, and I had this year off where I was a hospitalist. And at that time, you know, hospitalist was a new thing. And so my census was like 12. I had two NPs. I was living a good life. And so I had this free bill of health, I had another zero on my paycheck, and um, I really did enjoy being a hospitalist, but I didn't have that fulfillment that I knew that nephrology and subscription medicine had and that I sought for. So then I did nephrology and you know I took a big pay cut to do it. But I also realized that like as much as I love continuity of care, as much as I loved the pathophysiology and inpatient nephrology, my program assigned us to a dialysis unit, and we had to to round in that same dialysis shift for two years. That was our every Thursday, an afternoon shift, I had to go. And so I found that when I came home from dialysis rounds every Thursday afternoon, like something was lacking in my soul, like something was missing. There was like a pain there. And I just would see these patients connected to this machine and with like not so much hope and very monotonously get dialysis. And I monotonously adjusted the the ARNS dose and the phosphorus, and um, I felt a sense of panic that, like, oh, maybe I I joined the wrong field. And dialysis is a big part of nephrology. And you know, it was only the first or second month, and I called my brother and I was like, oh man, I I don't know what I've done. I'm not sure about this. And he's like, you know, just stick with it, it's still early. And I think my second month, towards the end of my second month, I was on call and we did a transplant for one of the patients that I actually met in the dialysis unit, and I saw he made two liters of urine. And I talked to my transplant attending, and I was like, Oh my god, this is incredible! Like he peed so much and his creatinine is coming down, and she was like, Yes, yes, this is what it's about. And so I kind of stumbled into transplant, but I immediately, as soon as I saw that, it was it vibed with everything that was important to me. It it offered a second chance, kind of like I felt like I was just given, you know, a year before. I always believed, like from human anatomy, that you know, we all focus us on our differences so much. But when you do human anatomy, you realize like all these bodies are the same. Like everybody is the same. And and we all just focus on our differences and and this was proof to me that you know we can help each other because we are all the same. All of us as human beings in death and in life can can donate organs and we can be the the shepherds of that and help patients and honor those that passed away so they don't pass away in vain. I just everything about it, it it like rocked my world. And I called my my big bro and I was like, hey, bro, I found it. And he's like, What happened? I'm like, it's kidney transplant. That's my calling. Like, I'm not sure about this dialysis stuff, but this transplant world, I can feel it. And then as I got, as I thought about it, I saw, you know, these patients and and what our transplant attending at Harbor, Dr. Barba, would mean to them. And so I slowly just started kind of following her. And then she said, you know, you're since you're interested in you have this rotation next year in your second year where you go to UCLA and you can learn more about it. And there I was, like a lost guy at UCLA, and I met a girl who was equally lost. Uh, and that was a Dr. Man Peter Samura. And I was gung-ho about transplant, and she was like, Are you sure, man? Like you need to calm down with all that enthusiasm. But that was our beginning.

SPEAKER_01 7:05

Yeah, that was really something. And also, I mean, I think it's really important to point out your attendings and who you work with. And we worked with Dr. Gabe Danovich. Yeah. And my gosh, is it possible to not go into transplant neprology after you've trained with him?

SPEAKER_00 7:23

Right. So Dr. uh Danovich probably doesn't love when I tell this story, but you know, his name at UCLA is very big. And, you know, when you're coming from Harbor and you're rotating there, you know, like, oh shoot, when Dr. Danovich is on, you gotta be on. And so he was our, you know, the my first attending when I was at UCLA for the weekend that was on call. And, you know, we were supposed to round at 10, and it was like 10.45. And um, every time I called him, we'll go straight to voicemail. And um, I'd be like, oh no, I'm gonna have to run this service. Where is he? And then he came like at 11 limping, and he had fallen, and he had sand in his ear, and I'm like, what happened, sir? And he was uh running along the beach and he got hit by a wave and he'd fallen and his phone like phone got wet and he was out. And I thought, like, man, a man of this stature actually is just a regular guy like me. And then he became this amazing mentor to me where I saw that he would treat, you know, the patient the same way he would treat the janitor, the same way he would treat a med student, the same way he'd treat an attending. And um, he became a father-like figure to me. And I I try to emulate, you know, at UCI everything that he taught me at UCLA, and and you know, just kind of live and pursue your career with your heart and passion and caringness and kindness. Yeah, so that first day really humbled him in my eyes, and then I kind of got over that like uh mystique of him, and and I just kind of learned from him as a as a fellow like human and a real man and uh you know an amazing mentor and pioneer in the field. So yeah, so having worked with Dr. Barba at first and then Dr. Danovich next, and Dr. Buna Pradus and all the amazing mentors at UCLA, um, it really solidified what I knew that first day at Harbor when I saw that patient is that that this was my calling. And and even now when med students like, you know, you're trying to figure out what you want to do, I'm like, man, it's like sometimes you just fall into it. And that's the beauty of medicine. It's not you sometimes you can game it out and you can make all the plans, but once you see it and you live in and you breathe it, you end up somewhere else.

SPEAKER_01 9:34

Yeah.

SPEAKER_00 9:34

And like all my med medical school friends are like, How are you the academic medicine guy? Like, I know you would be the private practice guy, and I'm like, I don't know, man. I fell in love with the field. And and and usually, you know, the jobs are in academic medicine, and so here I am. But yeah, it was an uh you know, been quite a run.

SPEAKER_01 9:54

So that's a great segue into now 11 years ago. You land at UCI and you take over the reins. Walk us through what the last 11 years have been like.

SPEAKER_00 10:05

Yeah. Last 11 years has been honestly been like a life honor to to to kind of work so earnestly and humbly and hard to try to get this transplant program to the status of like a UCLA or one of the major players. So coming from a UCLA, you see the importance of collegiality between nephrology and surgery. I think that's first and foremost uh a nice uh way of doing transplant medicine, especially kidney transplant medicine, because you know, we really have to work together. And Dr. Danovich and the amazing surgeons, Dr. Gritch and Dr. Veil over there, really have that kind of that bond and that closeness and that mutual respect that I think is very important to be successful. And so I I'd, you know, been joined, I joined UCI, which was mostly surgically run program. The nephrolog they didn't really have an in-house medical director, it was just a community nephrologist who was sitting in the selection committee, which, you know, as you you know, is probably not the best for long-term success. And so we were doing about 35 kidneys and they had, I think, three deaths, and so they were on um CMS probation. And part of the probation was to hire a like a true medical director that would be working there. And so I got to kind of create this role where there was no person predecessor before me, but there was a program. And so when I went there for an interview, I was struck by how amazing the staff that were there were. They were passionate, you know, though they were on probation, it was, you know, sometimes it's just bad luck, and sometimes, you know, that bad luck turns into good luck because you get more resources and you get more what you need to be successful. And so, you know, I knew that geographically Orange County was a gold mine. Southern California landscape is competitive. You have UCLA, which does close to 400 transplants, cedars, which is 350 Loma Lenda, 200 plus, USC, 150, 200. And so for programs like St. Joseph's and Harbor UCLA and UCI, we were all doing like 30 to 50, and it's competitive, right? We all fight for the same organs in this OPO. So to grow, I knew it would, you know, take a lot of work. But I also knew that because in Orange County there was no other like major medical center doing more than 100 transplants, that I had a golden opportunity. And I saw all the Orange County patients go to UCLA. So I knew they existed. They just didn't want to come into their local program. And so basically, we just redesigned how we looked at patients. We, you know, we we made pre-clinic before it was just like all kind of clinics into one. So we made, you know, specific pre-transplant clinics with goals to see, you know, X amount of patients per week. Then we put all the post-transplant patients, and because we're outcomes-based, we're really focused on the one-year outcomes. UCI is pretty much like a county hospital, even though it's not deemed a county hospital. So it's usually typically over two-thirds of the patient are Hispanic that are English is not their primary language. And so since I was fluent in Spanish, I felt like a calling to really help these patients. And so we really locked in on like post-transplant outcomes and we would make sure that we saw patients under one year. We basically saw them twice a week the first month, once a week the second month, every other week the third month, and then monthly for the first year. And just really, that's like if they're doing well. And if they weren't doing well, there was many patients we would see every week. We would we'd have some patients fill their pillbox for them just to make sure that they were gonna have good outcomes. And so after the first year, we did about, you know, 35 transplants, but we had no deaths or graph failures in the second year when we did 48. And so we just really kind of dialed in the nephrology piece that I think that program was missing. Because I think sometimes it's more than just the surgery itself. I mean, that's a very important piece. But for us to be successful with this patient population, we really got to see it through, make sure everything is being checked that you're being meticulous about viral screenings and levels and compliance. And the thing I like to do is really motivate the patient, spend time with them to build their confidence and teach them and you know, take pride in them. And and um, and I think that's what we do well. And so from there, you know, we went from one surgeon to two surgeons. My third year, we went from 48 transplants to 103, I believe. And then we just slowly and continually just started to build. And so eventually, local nephrologists were like, hey, we don't need to send patients to San Diego or UCLA or Cedars or farther that we can go right here. We always maintained that outlook that we were under probation. So we really didn't loosen like how frequent we saw patients or how we did post-transplant management. And for years we had the best outcome scores in in the country. In California, it's sometimes hard because uh our average wait time is eight to ten years. And and then you're having this patient population that comes from a lower socioeconomic group, English might not be their first language, and trying to get them through when they've been on dialysis eight years already, and diabetes is the number one cause of kidney failure and low living donor rates because you know of the significant you know incidence of diabetes in this population. So we have this like 85, 90 percent deceased donor pool. We have this you know lower socioeconomic pool, we have the longest wait times in the country pool, and then you know, we're trying to be successful, and then against growing with UCLA and Cedars and and Loma Linda, and you know, don't even get me started on the dual organs that we're missing on, right? All these people are in the best kidneys for the dual organs, and we're you know, just a kidney pancreas program. And so, you know, so slowly we started to become one of the more aggressive centers, and that's where we are now. So, like now in this last chapter, we're up to on pace for 250 transplants a year, and we have we work with OPOs around the country that can't place organs. And, you know, I think one thing, you know, I think we can highlight today in is the concept of geographic disparities. I think we make a lot about disparities in transplant that are racial or socioeconomic, but I think we forget to talk about the geographic disparities. And one of the biggest problems in transplant is access. But we kind of just say, oh, New York, San Francisco, LA, eight to ten years like sucks for you guys. But yeah, uh when you're here and you see the patient population that we have in, you know, when we have this patient population, they're not able to go to other states to kind of scoop up a kidney and come back home. And so I feel like, you know, it's our role as kind of representatives of them, once they're on their wait list, that we gotta hustle. You know, we gotta we gotta get these kidneys for them and try to decrease that eight to ten years to something lower. Right now, I think our wait time is closer to four to five years because we've been aggressive, but it's because of these geographic disparities that, you know, we have to push the envelope. And so those days of trying to pursue perfect outcomes, you know, that's not my goal anymore. Like if we're above expected or as expected with everything I just laid out, that's actually pretty remarkable. And so the real kind of pride I have now walking around clinic is just knowing, like, man, half these people, if they were listed somewhere else, probably would still be on dialysis. And, you know, they don't need to necessarily know that, but like I think it's important that, you know, we continue to advocate for them because the geographic disparities really are detrimental to kind of their their goal of getting a transplant. So that's kind of where we've we've come. I know I kind of vomited all that out quickly. Wow, but basically we went from a small program that was really focused on outcomes. And I always feel like volume is not something you seek. You put your head down, you work hard, and you look up after three months and said, Oh, damn, we did 90 transplants in three months. Amazing. You know, but it's not like, oh, we're only at 60, let's do three more this week. Like, that's not what we're about. We we we focus on outcomes, we focus on quality, and I think I think volume just it naturally follows.

SPEAKER_01 18:13

That is superb. I mean, what I heard you say is you came in there 11 years ago and you came in with this vision, this strategy. You knew you were gonna go to back for the patients, whatever it took. And you created this organization, you basically redesigned their whole transplant program and brought in these uh vital programs and separated out the pre-transplant clinics and the post-transplant clinics, and then you slowly build the team, you know, one after the next. And then I also heard you say that you build that relationship and the trust, not just with the patients, but with all the referring centers and the referring professionals as well. And all of that is so important, so bravo. I mean, that is phenomenal.

SPEAKER_00 19:06

And then yeah, that that's all very true. The only thing I would say is like, you know, this is really a team effort, right? And so, like, when you say you, it's like it's it's all of us. Like when I got to this team, I really felt like, man, these NPs are amazing. I don't think they really know it. There's no pride when you're in a program sometimes that's on probation. You've you question yourself, like, are we good enough? Are we not? But I wouldn't have gone there if I didn't see the talent around. And like what's really cool is like we don't lose anybody, like nobody leaves the other programs. We've just continued to build and gain and grow. And you know, we have this culture of like, yeah, like, you know, we have this underdog mentality, um, and we're not really underdogs anymore, but we like to kind of feel that way, you know. So it's it's like this whole kind of culture that you create where, you know, and the patients feel it. The patients are like, Dr. Reddy, this team is like, we really feel loved and cared for. And I love when they say that because it really reflects like what we are. So, yeah, we have like, you know, from the wait list team to the pre-team to the post-team and the living donor team, they all kind of got each other's back. And you see this beauty of how transplant all is this continuum. And then we just recently added this call team that really changed the game for us. So now we have these night night aggressive people, then and that's really helped us increase our volume. So, yeah, it's everything you said, but it also, you know, really takes a village in transplant. And and that's the complex part sometimes, but that's also the beautiful part when it works.

SPEAKER_01 20:41

I think that's wonderful. Yeah, and I want to acknowledge like the leadership too that it takes to do that. So, I mean, I've been here, I've been a witness to your journey, and um, yeah, I'm so proud. And so you can hear like the pride in your voice that you take too for the program and your team. So I mean, congratulations. There's so many things you talked about, and I want to touch upon a few of them. So, one thing you said is, you know, keeping on top of things like viruses, levels, compliance. Could you elaborate on those for patients that are listening?

SPEAKER_00 21:16

Yeah. So, you know, when you get a kidney transplant, I think it's important to acknowledge that, you know, this is really a gift. And the way I kind of frame it sometimes is, you know, I sometimes we don't know so much about the donor, but we know that there was a donor. And I and I say this person's loved one accepted that we were gonna give this kidney, and it's on us to try to maximize this. It's not to just roll the dice and see if it works, is to really have the program that believes that this patient's gonna do well, and then a program that works with that patient to do well. And so we have this it's not pressure, but it's just the understanding that it's like more than just a kidney coming out of the sky, that there's this kind of Responsibility that we have to really do our best. And often, you know, we're not, we know that we're not a hundred percent successful field, but I think when we have a mentality of like responsibility, but also positivity, you know, sometimes patients make mistakes and we don't beat them up about it. We acknowledge that a mistake happened, that you know, they didn't get to the med in time for the pharmacy, and then we talk about if this happens again, you know, how to do differently. And so I think a large part of what we do is really stay to motivate patients to really like kind of figure out like what their challenges are, but then motivate them to do better. And some sometimes we see patients three times a week until they get there. And then with viral screamings and stuff like that, we check a lot of labs, right? And so initially, because some of these viral screamings take a couple days to come back, so many of them were not being addressed until the next visit, which is often, you know, too late. And so we worked with the lab to now give us a report every week on all the positive CMVs and all the positive BKs. And then I work with the coordinator, and then we can really keep an eye on which ones and then adjust medications appropriately. And so when you have a large program and there's a bunch of negative ones, you know, you don't have to worry as much about those. But for the positive ones, we now have like a way to kind of go through it. And we do that similar um with the Alishers that we order or the um cell-free DNA from Prospera, um, either one. So I think surveillance is very important and then compliance. Like, so compliance is something that comes up at every visit, right? We're not the type to say, Oh, we called a pharmacy and we know that what I ask patients instead of saying, Are you taking your meds? I ask them, How many times did you miss your meds this week? And you get a much more honest answer. If you're taking your meds, it's just like asking your kid, like, you know, if they had a good day at school. But when you say, How many times did you miss your meds, you actually get a a much more honest answer and you can see them look at you and they're like, oh shit, okay, yeah. Uh twice. And then you now you have something to work on, right? And so just kind of, you know, so I think sometimes I feel like when you make this a responsibility on the patient, they don't want you to let you down. And that's sometimes good, but sometimes I feel bad because they come in clinic and they they feel like, oh, Dr. Reddy, we let you down. And then I'm like, no, no, you're fine, like we're gonna do this together, and you kind of build them back up again. But I think it's important to have that seriousness about it because if we're just like, oh, this is on autopilot, you can come back in three months and check your labs. I think you lose a lot. And and when you see them often in clinic, you catch that, you know, hey, there's edema here. Oh, we notice your breathing a little bit tougher, you know, and you can make so many changes that I think really results in having better outcomes in the end.

SPEAKER_01 24:46

Yeah, absolutely. The compliance, the adherence, the education, the relationship and rapport you're building. I feel like you just beautifully described that. Going into, you know, practicing transplant medicine now. Can you talk a little bit about IOTA and if your program is participating in it?

SPEAKER_00 25:05

Yeah, so all of Southern California's uh programs are mandatorily participating in it. We, you know, are firm believers in iota. Well what's interesting for us is we did all of the stuff on growth the year before IOTA started. So we went from a program of 140 a year to uh 221. So we went up 87 transplants that year. And in America, I think we only went up 453. So like net, we were like 20, we weren't really 20% because some go up, some go down. But in terms of, you know, as a program, this single program went up 2087, and as a country, we went up 400, some 50. And we did that the year before IOTA. So we we thought that it was like it's fine, you know, like we were doing everything that IOTA was asking for. So one is organ acceptance. You know, we have the highest organ acceptance ratio in California and one of the top ones in the country because we're you know been more aggressive about kidneys that we take. In terms of outcomes, our outcomes have been pretty good. We've always been focusing on that, but growth, right? We went up 87. And so at first, we were when we were asking about iota metrics, we're like, is this gonna hurt us? Because we did it one year for and so I'm sure there's a lot of programs in the country that felt that. Luckily, it's over like a you know, three-year period, and then they take the average. So the other two years were definitely not as high, and so we still look okay. But when IOTA came, it was we kind of were chuckling because we were like, this is exactly what we organically did on our own to increase growth and maintain quality, and these are the ways we did it. We felt like we were really prepared for it. And if anything, yeah, maybe like you know, our reward was less because we did it the year before, so our volume was higher to start off with. But um, we definitely commended kind of uh I think it's clear that because transplant is so strictly regulated, there's a lot of conservative behavior. And I understand it. I came from a program that was on probation. I I know how that mentality works. I know it's not fun when you feel like you might get shut down. And in reality, that really rarely happens. But um, because of the conservative behavior, you know, there's a lot of kidneys that do get discarded. And having programs like that and incentivizing people and making them feel less regulated, you know, I think will lead to more kidneys being used. And maybe we won't have the perfect outcomes like we used to, but I sometimes think when we're too outcome driven and we're like, oh, we got a five out of five, then maybe you're not being aggressive enough. And, you know, and I'm I say that as a program that, you know, I used to tell administration, oh, we got five out of five, two years in a row, and now we're at threes and fours, and they're like, what's happening? And I'm like, oh no. You know, I think we were looking at it wrong because we weren't really achieving the volumes we should because we're just kind of wanting to be too perfect. And when ESRD is as bad as it is, when dialysis is what it is, you can't be totally perfect on the other end. And I think iOTA is important in kind of bridging that gap and increasing volume and not expecting, you know, the most perfect outcome. So we we really did a lot of that before it started. And so when it started, we kind of just maintained that and continued to build off of that.

SPEAKER_01 28:15

Got it. And for those not familiar, IOTA stands for increasing organ transplant access. And it's a new CMS model where about 50% of the programs in the country are participating. And the goal, as Dr. Reddy described, is to increase access and increase the total number of kidney transplants in the country so that this list of patients waiting for a kidney transplant that ranges anywhere between 90 to 100,000 a year goes down so that we have less patients on dialysis and more patients with a transplant. So that's great. I'm very glad to hear that. So we've learned about your journey into transplant. We've learned about what is what it's been like to create this new platform of advocacy for patients. Where do you think the future of transplant is going? Where do you think we're headed?

SPEAKER_00 29:14

If I knew that answer, I think I would be working at a different place. But I think we're headed in the right direction, at least. I think um certainly xenotransplantation is closer to reality than you know most of us in the field ever thought we would be. I still firmly believe because the way I look at transplantation is, you know, there's 330 million people in America and we did 6,000 living donors. And before we talk about, you know, using this pig kidney and getting off dialysis, I think there's more conversations that we should have as human beings that what we can do to incentivize living donation to do more deceased donor kidneys. I feel like the answer to me is amongst humans. Because as much as I see xenotransmantation is amazing, and I just think like biologically, you know, you're gonna get rejection at some point. And if you don't, the amount of medications you're gonna need to kind of you know comes with a price. But back to Human Anatomy Lab, like we are the same, and we know that these this we already know we have proof of all these transplant programs in the country doing this, but 6,000 living donors to 330 million Americans, I really think the answer is there. And I would like to believe that that's where the future of transplant is, like amongst ourselves. You know, certainly the people that are researching Xeno, that's also a great possibility. But I think if I want to have a kidney that doesn't just last like two years or three years, one to get me through the next 20, right? Transplant's not just a word, right? Like, oh, you get a transplant and that means automatic good. Like if it fails in two years, then you're back on that. Like, did we how much did we help? I I don't know. But you know, transplant is this beautiful transformation, you know, that's supposed to last 10, 20, 30 years. And I think amongst humans, we do have that capability. And so how do we motivate more donation? How do we get hospitals to do more deceased donors? How do we incentivize this? I think the answers are there. I just think it's complex because you have recipient size, donor size, and now you know there's sometimes negative publicity that's associated with that that kind of holds us aback a little bit. But I think those that are true and working in the field every day and and see it from the inside, I think there's a lot that can be done with within us to take that number that you just described, 90,000, 100,000 down significantly. I mean, I don't know what the number of 6,000 to 330 million is, but it's it's not that difficult of a thing where it needs to be that low of a percentage. It it is the most honorable thing and the most amazing thing. But I do think that I do see a a future where that number is could be 10x.

SPEAKER_01 32:06

Yeah. How do you think we could get to that 10x number? How do you think we could increase the number of living donations happening in the country?

SPEAKER_00 32:16

I think by continuing to like work to get the message out, one fear that I have is like if we let everyone be a living donor and you start having issues, that'll hurt us. So like we still have to keep the standards very high, that we are certain that this is a very low risk. And we have to not just worry about volume, but really keep quality in mind, you know, not like make this exception, that exception, that maybe one, two times is fine. But when you try to do that 10x, you you're gonna run into problems. So I think keeping it strict is still very important so that we know that these people are gonna do well, getting the word out. And I don't know. I mean, I think if I had the answer to that, I would have done it already. But I do think there is some sort of incentivization that can be done, whether it's you know, a tax credit, an education credit, a credit for a future family member. Like, I think you know, it's I'm not a guy that's like that's where my brain is good at, but I feel like there's some things that we can do to make it more palatable. And certainly NKR has things that they do to try to with donor shield and stuff to make that a little bit better. But even like, you know, at any hospital, like, you know, I have to remind nurses like this donor is not a patient, it's a person that's like, you know, they're like patient. I'm like, I don't even like that word around, you know, and like we're like, this is a hero that came to the hospital and that it's not just like the standard, like sick patient that's coming in, right? And so like I always tell donors, like, if you could come to UCI, I'll just like have this ever-flowing red carpet in front of you that just everywhere you go, it's there. It's an honorable thing. And when you talk to donors, they often say, like, that's the best thing I've ever done. Yeah, you know, but but the stories aren't loud. I think there's so many barriers, even yourself, right? Like when you get a living donor, I always joked with them. I was like, it's gonna feel like we don't want your kidney. Like, we're gonna do so many tests on you, or you're gonna be like, Do they want my kidney? And I say that up front so that they understand that. And then they're like, okay, this is just their process. And in this process, I'm gonna get the best medical workup I've ever gotten, right? And so, yeah, I mean, I think to 10x it, and there has to be a different way in which the barriers are reduced and maybe incentivizations are increased. And I know that's a complicated topic, but that's where I would see the numbers go up.

SPEAKER_01 34:37

And for patients that are listening right now, there's of course so many messages that you have already given them. But if you could leave them with a message within the field, what would that be?

SPEAKER_00 34:50

I think the strongest medicine that we have is hope. And I think that's the beauty of transplant because I know even as a doctor, I'm not even a patient, but going into that dialysis room, I had a visceral feeling and it wasn't fun. Like it was like something I didn't enjoy, and so I was searching for something else. And I certainly understand, you know, whether you're facing that or living through that, that there is hope of transplant and that we as humans have this beautiful ability to help each other. It doesn't matter if the donor was this race or that race, as long as that kidney is pink, right? And so, you know, when you're in a country where we're we have all these programs just working very hard 24 hours a day to try and facilitate these gifts that come through tragedies and through debts. And so we can relieve your suffering and hopefully give you health with transplant, but we can also honor another life through your life so that their passing is not in vain. And so the main message is to have hope and to remain as positive as we can be during, you know, difficult times. And I look at dialysis as a bridge, it's not a determination of life, it's a bridge to your transplant. And our goal should be to keep that bridge as short as we can. I would say that's my main message to anyone that's like in those shoes and and find a program that's gonna go to bat for you and and be the best advocate you can be yourself too.

SPEAKER_01 36:14

Thank you, Dr. Reddy. I think that's a great note to end on. I really appreciate you being here today.

SPEAKER_00 36:20

Thanks, Dr. Samura, and congratulations on starting a podcast and more power to you. I think we don't have enough voices that are getting these stories out there. We kind of all work in our silos and we're all competitive with each other. But you always see a bigger picture, and these kind of forums, I think, will do service to the greater community at large. So appreciate your work and pushing our field forward as well.

SPEAKER_01 36:43

Thank you.