Browsing through SRTR stats the other day, I ran across this data regarding kidney graft (transplanted organ) survival rates for those 65+ at the time of transplant.
Note: I really would like to see this broken down further by age so it would be possible to know how the graft survival is affected by each subsequent year. I’m also notating the year(s) when the info was compiled because they vary a bit. I’m guessing SRTR wanted as recent data as possible due to advances in anti-rejection meds and the like.
This applies to those receiving a living donor kidney:
3 months (2005-2006): 96.9%
1 year (2005-2006): 94.4%
5 years (2001-2006): 73.1%
10 years (1996-2006): 36.3%
If asked, a transplant professional will claim a living donor kidney lasts, on average, 15 years. Clearly that is not the case for this demographic.
With the knowledge that kidney transplants are not cures, and that a person can survive on dialysis (so the lack of a transplant is not condemning someone to die as popular opinion might think), should our transplant system reexamine the notion of giving living donor kidneys to those 65 and older?
The usual immediate reaction to this sort of proposal is a hearty “No!”, bringing to mind so-called death panels, or as I like to call it, ‘putting grandma on the ice floe’. But as I just stated, no one is being denied treatment. The national waiting list with deceased donor kidneys, dialysis, plus relevant medications and other therapies, are available.
There’s still a lot of cringing and that’s okay. No decent person really wants to see anyone die, even if we all intrinsically know that death is inevitable. In the U.S. we’re all brainwashed into believing that modern medicine should be employed until all avenues are exhausted, no matter the cost. A suggestion such as this would require a paradigm shift.
All transplant professionals acknowledge a severe kidney shortage, and living donor kidneys are seen as most valuable. So, does it makes sense for two-thirds of this precious resource to be destroyed in less than ten years on those 65 and over when 60-plus% of living donor kidneys given to receipients 64 and younger are still kicking at the ten year mark?
Let me put it another way – The transplant industry has lulled itself into believing that living donation is ‘ethical’ because the ‘benefit’ to the recipient outweighs the ‘risk’ to the living donor. But not all living kidney donors go on to have happy endings, and the more years spent as a one-kidneyed person, the higher the risk and incident of hypertension, cardiac issues and kidney disease/failure.
A. 1-2 living donors die per year, within 90 days of surgery. How many years should the recipient ‘get’ out of that kidney in exchange for their donor’s life?
B. Was condemning Daniel Huffman, 17, to sixty years with one kidney, not to mention the relinquishment of his dreams as a football player, worth the ‘benefit’ his 60-something-year-old, diabetic grandmother received from his kidney? Does it matter that her diabetes will eventually destroy the transplanted kidney too, if a pancreas transplant is not done? Or that Daniel committed suicide eight years later?
C. In the U of Minnesota study the media-types like to quote, the reported incident of end-stage renal disease (ie. in need dialysis/transplant) in living kidney donors was 180 per million in comparison to 268 per million in the general population. How many years should a transplanted kidney survive to compensate for putting another, previously healthy, person in dire straits with their own renal health?
Transplant recipients will never be free of their kidney disease, and living donors will never regain their pre-donation health and life. If we are to continue using living people for their kidneys, we must start examining each transplant in a greater context than what can be gained by the recipient. As Dr. Murray would say, it is our moral duty.