What "Justified" Got Wrong (And Right) About Kidney Transplants


Tonight's episode of Justified featured a creepy doctor bad guy taking both kidneys from loveable bad guy Dewey Crowe. To get his kidneys back, Dewey needed to find $20,000 in four hours - presumably the time it takes to die from a lack of kidneys.

I don't want to be a pompous snot - and I don't expect total medical accuracy from my favorite TV show - but the specifics of kidney transplants are kind of my "thing." I got one in 2010, so I want to highlight what the show portrayed as accurate and not so accurate. I do this because there is a lot of misinformation out there that could affect whether someone becomes a donor.

What It Got Wrong

* Although it turns out Dewey never had his kidneys removed in the first place, he would most likely not die in four hours. It'd take weeks or months - maybe even years - for toxins to build up to lethal amounts. Poisons and their side effects would torch other critical organs. It's a gradual process. Heck, my two bum kidneys operated at less than 10% for most of my life. And I didn't even know it.

* It's mentioned twice (once by the creepy doctor, once by the strippers) that kidney transplants occur in sets of two. This isn't true. You only need one kidney. That's all that's ever donated. The creepy doctor was selling himself short by claiming to have one recipient in Chicago for two kidneys.

* Cutting a kidney out and selling it on the black market in a matter of hours won't work. Aside from blood types, there are all kinds of factors to match a donor to a recipient. An example is PRA (panel reactive antibody). The PRA measures what tissue attributes, called Human Leukocyte Antigens (HLA), a recipient's immune system will attack compared to the donor. My PRA was a 6% compared to my donor, which is well below the threshold of 25% needed to get in the clear. Sound confusing? You're right. Which is why a quick turnaround on a black market kidney isn't going to work.

* A character (I forget which one) mentions a kidney taken out of a drowning victim. This is extremely rare. As my doctors told me, "Most people don't die correctly." Most cadaver kidneys come from people who died in controlled settings, such as on life support. With car wrecks, drownings and any sort of unexpected death, the kidneys usually die from lack of oxygen unless promptly removed.

* Although the creepy doctor never took Dewey's kidneys, the incisions he made were totally off. You'd need some nimble fingers to reach the kidneys after cutting on either side of the abdominal muscles. Incisions are made closer to the waist.

What It Got Right

* As Raylan said, "Kidneys are for pissin'."

* Also as Raylan said, dying of kidney failure usually involves nodding off and not waking up.

* Justified is still the best crime drama on TV.

10 Other Things You May Not Know About Kidney Transplants

1) The kidney count goes from 2 to 3, not 2 to 1. Surgeons add kidneys to bowel rosters, they don't subtract. They don’t remove the bad kidneys. These are absorbed into the body after they completely shut down.


2) Blood type is not the most important factor for determining donor candidacy. Whenever I’d tell someone I needed a kidney, a typical response (and I don’t mean this in a negative way) was, “What blood type are you?” While blood type is important, it’s not the most important. That’s because EVERYTHING is the most important. Medical history, tissue type, kidney function and countless other variables are extremely important. Thankfully, there are doctors who can decode everything and match donor to recipient.


3) Recipients aren’t put on “the list” right away. The list I’m referring to is that one your grandpa went on before getting a kidney from a motorcycle wreck. Or the great aunt who got another 20 years from a cadaver. Recipients are only put on this list (which is a very complex list in and of itself) after willing donors are ruled out.


4) Receiving a transplanted kidney isn’t a fast process. This isn’t like going in for a physical. Expect to wait months, even years, for a new kidney. Everything depends on how fast willing donors are matched, and how lucky (or not) recipients are on “the list.”


5) Most transplanted kidneys last an average of 20 years. This means a strapping young lad such as myself will need another kidney at age 45. Although some kidneys can last up to 40+ years, this is not common.


6) People with kidney disease may not even know it. I had it most of my life and didn't have a clue. The symptoms were never enough for me to worry. These include random bouts of fatigue (who doesn’t?), bad breath (name someone who hasn’t had it), twitching during sleep (hey, it beats other bodily functions) and others. Since chronic kidney disease takes place over many years, bodies sometimes get used to it.


7) There are five stages of kidney disease. Unsurprisingly, those stages are: 1, 2, 3, 4 and 5. This is because the doctor who came up with this system ran out of fingers on his right hand. (I hope I’m kidding) The fifth stage is also called “end stage.”


8 ) Not everyone with end stage kidney disease needs dialysis. While someone waits for a kidney, he/she must need dialysis, right? Nope. Some people can continue to function while waiting for a kidney. It depends on the severity of the situation.


9) The cause of kidney disease is sometimes unknown. This is my case. My kidneys have been so messed up for so long that they couldn’t be tested for causation.


10) Kidney recipients need to go to the dentist. If you don't take off your shoes in the entryway, the whole house gets dirty. Same concept here.

BSP: Maynard Soloman, a crusty and profane private detective, is a product of my frustrating road to recovery. Check him out in 4 Funny Detective Stories - Starring Maynard Soloman.

Diagram of kidney transplant via Wikipedia here.

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Comment by Benjamin Sobieck on February 17, 2012 at 6:22am

Kidneys filter what ends up in the bladder, so it's conceivable that his bladder was full. Not too likely, though, since the bladder has to be empty to successfully remove the kidneys.

On the other point, yeah, it'd be too late. They'd take the organs first.

None of this ruins "Justified" for me. I more thought it could be a moment to draw attention to my pet cause.

Comment by Dana King on February 17, 2012 at 1:07am

Thanks, Ben. Good stuff. I would have commented yesterday, but we DVR JUSTIFIED and watch it over dinner on Wednesdays.

Two questions came to mind:

1. True, kidneys are for pissing, but would Dewey's bladder have to be empty? Even given the cuts are in the wrong place, can we assume they didn't take his kidneys? The nurse is sure ready to take Raylan's, and she and the prison nurse act as though they have Dewey's.

2. Art talked about a funeral director in New jersey waiting until after the service, then harvesting the organs and cremating what was left. Given the time frames involved for this, wouldn't the organs be ruined by then?

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