Sunday, August 26, 2007

Selling Kidneys: Part II - Living Kidney Tx

We should agree that cadaveric donations cannot fully satiate the demand for kidneys (see Part I).

In a desire to explore all viable medical and ethical options to increase the number of kidney transplantation one should then turn to living kidney transplantations.

Surprisingly living transplantations came before cadaveric transplantations, usually between twins when immunosuppressant drugs were still only marginally effective or inexistent. For a while cadaveric donation (CD) became much more common then living donations (LD), but through the 1990's LD become an accepted medical procedure between family members or related living donors (RLD). Following this, emotionally-related living donations become acceptable. Thus, between 2001-2003 there were more LD than CD txs (See OPTN database). Though now there is an almost equal number between living and cadaveric donations.

Moreover, LD are usually preferable to CD txs because LD can be done preemptively, before a patient begins to undergo dialysis. This noticeably decreases the morbidity and mortality rates of the recipients who were pre-emptive. Further, the longer a patient is on dialysis the less effective the kidney transplantation will be in improving the quality and quantity of life.

Of course, during this time the LD operation (nephrectomy) became much safer, less invasive, and offered a quicker and less painful recovery time for the patient. Two reasons for this: 1) growing experience in the field from doctors who began to specialize in the procedure and 2) laparoscopic technology that bypassed the need for opening the abdominal cavity of the donating patient.

The procedure has become so safe that most hospitals now allow for non-direct donations or sometimes called 'good-Samaritan' donations. This is when the donor does not know the recipient. This is the type of donation I went through (see Donating a Kidney).

To say anecdotally that the procedure is safe does not likely reassure the modernist mind. So, cautiously and pessimistically the surgical mortality (death) rate is around <.005% or death in 1 in 20,000 cases. The chance of complication during surgery or the morbidity rate is a little higher, around <.007% (See OPTN).

It seems that this 'minor major' surgery is a relatively safe procedure. Living transplantations then might be a viable means to procuring more kidneys. The next post will then begin to look at the ethics surrounding living kidney procurement options – most specifically at direct financial incentive options.

Post Script
I want to thank my friend and blog-resident surgeon Jessica Clevenger for making sure I am not spoofing on any medical facts or jargon. Thank you.

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