Saturday, August 18, 2007

Donating a Kidney: Part I

If you do yet not know I am donating a kidney. The surgery is this Friday.

This decision was borne from the brain-child of one Maryanna Ramirez (Maryanna, consequently, is the type of friend one thanks their lucky stars for: beside her infinite ability to forgive she has impeccable taste and a long history of promising and datable roommates). Maryanna almost a year ago mentioned that in the medical field there are ethical debates surrounding the permissibility of organ markets. She mentioned that genesis of such medical ethics came from a book by Richard Titmuss entitled, "The Gift Relationship." She also mentioned Sally Satel who currently write for the American Enterprise Institute and has written in favor of organ markets – specifically (if not exclusively) kidney markets.

Thus was my introduction to the world of kidneys. Now, Maryanna knew such an issue would fascinate me for three reasons: 1) it involved economics 2) it involved ethics 3) it was a generally contentious subject.

In the following weeks I read not only the Titmuss and Satel pieces, but everything else on living laparoscopic nephrectomies, which is the medical operation kidney donors undergo. After my initial foray into the world of organ donation two things became abundantly clear: there was a shortage of kidneys and I could relatively safely donate one of my kidneys.

First, lets talk about the shortage of kidneys. End-Stage Renal Disease (ESRD) is a catch-all medical condition for kidneys that are failing or not functioning to such an extant that dialysis or transplantation are necessary. Though cadaveric donation and living relative donations meet much of the demand for kidney transplantations about 4,000 kidneys annually are still needed. Dialysis is the only option for those waiting on the list or who have no option of being a recipient. Further, dialysis – though a wonderful medical invention – marketedly decreases life expectancy, quality of life, and in the long run costs more, on average, than transplantation. The number of ESRD patients who annually die waiting for a kidney is nearly the same as the number of US military deaths in Iraq in the past four years – around 3,600.

Second, a living laparoscopic nephrectomy is a relatively safe procedure. Besides the chance of death being effectively 0%, complications are exceedingly rare. The two hour long procedure consists of two half-inch incisions (for laparoscope and surgical tool) and one four to five inch incision (for kidney removal). Most post-operative pain is not due to the incision, but rather the carbon-dioxide gas used during the operation to literally inflate the chest cavity. A donor stays over night and discharged the next day. In one to two weeks of rest donors can return to work (required it involves no heavy-lifting) and in four to five weeks donors can return to rigorous exercise.

For these two reasons I decided a year ago that I would donate my kidney. On Friday that promised decision will become a reality. Per a friend’s request that I blog the process I am going to do just that. Thus, I will be updating the process throughout the week, and would love to take questions you may have.

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