Saturday, November 6, 2010

Kidney Transplants: Not a Cure

Rick Tuel: water worker, cartoonist, end stage renal disease patient, modern medical miracle. Photo by Mary

The first thing the Northwest Kidney Center tells you about having a kidney transplant is that it is not a cure; however, it is the most effective treatment for kidney failure we have at present.
The major obstacle to successful kidney transplants is the recipient's body's rejection of the new kidney as a foreign object. People who have kidney transplants must take anti-rejection drugs for the rest of their lives. That is why a transplant is not a cure.
When transplant surgery was new, it was only done from living donors, and between close matches such as identical twins. The development of anti-rejection protocols made it possible for kidneys to be taken from cadavers for transplantation, so now transplanted kidneys come from both living and deceased donors.
Kidneys from living donors tend to last longer than kidneys from deceased donors, but how long a kidney will last is an unknown. Kidneys from cadavers tend to last 15 to 20 years; kidneys from living donors tend to last longer, and there are people who have been going with a transplanted kidney for thirty and forty-plus years, but some kidneys fail immediately, or within a few years. You never know.
Sometimes living donors donate in a “chain.” Say your best friend Ralph needs a kidney, and you'd like to donate, but your blood and tissue don't match Ralph's. So you donate your kidney to someone who is your match, and a friend or relative of theirs donates a kidney to someone else who is their match, and so on, until some friend or relative of a kidney recipient is a match for Ralph, who finally gets a kidney.
Experience seems to indicate that the majority of kidney donors do fine with only one kidney, and both donors and recipients are required to go through rigorous testing and screening. It costs donors money to donate, by the way. That doesn't seem fair, but there it is.
Potential kidney recipients can be turned down for a variety of reasons. From what we heard at the Kidney Center, you have to be in the pink of health, except of course for your non-functioning kidneys. The committees that decide who will get a transplant do not want to “waste” a kidney when there are so many more people who need kidneys than there are kidneys to transplant. Many people who get on the waiting list for a kidney wait for years. Some don't live long enough to get a kidney.
The immune suppressant drugs recipients must take cause problems of their own: infections because the drugs suppress the immune system; sepsis; a form of post-transplant lymphoma (cancer); and side effects such as unwanted hair growth OR loss; obesity; acne; type 2 diabetes; etc.
A major problem with the immune suppressant drugs is that they are expensive. Not having adequate insurance to pay for immune suppressant drugs is a reason for being turned down for a kidney transplant in the United States. This will not seem important to you until you or someone you love needs a kidney.
My husband was diagnosed with end stage renal disease on October 5, 2009. In the last year he has had multiple surgeries and continual tweaking of drugs to keep him going, and he is now on peritoneal dialysis. Because he had cancer last year, he will not be considered for a kidney transplant until he has been cancer-free for two or more years.
It has been a hard year, friends, but we have been carried through it by you and other people as we adjusted to the new normal. Rick is starting to work again, gradually, just a little bit. If you see him out there spraying paint on the road to mark the location of an underground utility, give him a smile and a wave. He and everyone living with kidney disease is a modern medical miracle.

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