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Bad Art Friend Kerfluffle

A group of writers decided to behave like terrible human beings to another writer, who also happened to participate in kidney chain as a non-directed living kidney donor, which resulted in a very popular article in The New York Times Book Review.

No, I’m not going to link to it; Google is your friend.

I did whip off a Twitter thread the night this article went viral, because (naturally) no one seemed to understand that Dorland had to pass a psychological evaluation to donate, and despite her obvious vulnerabilities, was permitted to do so.

The conversation about this situation continues unabated as, seemingly, every writer *everywhere* is penning and publishing their perspective on it.

I have not. Nor will I.

Firstly, because I tried that when I was in the thick of LD101 and this blog, and not a single editor anywhere wanted to hear anything except rainbows and puppy dogs in reference in living donation. It didn’t matter that I had myriad academic articles and other assorted evidence. Hell, a particular reporter at the NY Times, who had composed multiple pro-donation articles, even accused my cohort of “conspiracy theories” (Pretty hilarious given this country’s recent history and current situation on that particular topic).

Anyway, I’ve had to listen to the same bullshit discourse regarding transplants recently as I did in 2008 and the ~7 years following:

  • Living donation is safe (A quick search of this site will reveal that to be untrue)
  • The mythological “spare” kidney (Do you have a spare arm/leg? I don’t think so)
  • “Life-saving” kidney transplant (Transplants are treatments, not cures. Most recipients will need multiple transplants to achieve an average life span. Many folks with end-stage renal disease are not good candidates for transplants. And there are other treatments; namely, dialysis)
  • And of course: I really hope this (depiction of the aforementioned living kidney donor’s behavior) doesn’t discourse people from donating (insert eye roll emoji here)

All of this has provoked two – wait, three – consequences for me:

  1. It’s made me talk about shit I stopped talking about years ago, because I’m tired of being branded a liar, conspiracy theorist (see above) or any number of random insults.
  2. It’s really, really pissed me off, which is not great.
  3. It’s triggered the hell out of the PTSD I obtained as a result of being a living kidney donor, which is really fucking bad.

So, if you end up here, don’t come at me with “the site hasn’t been updated in X number of years”. No shit Sherlock. Unlocking the history of the transplant industry’s shenanigans while poring over every published academic article I could find *and* conversing with potential and current living donors who were wounded and trying to find their way through the labyrinth; plus commenting on the media’s perpetuation of misinformation and one-sidedness (thanks google alerts) was a FULL TIME FUCKING JOB FOR WHICH I DID NOT GET PAID.

Use the search function. Look up the source material (which is *always* noted/linked). Everything is in these pages and posts. If you’re too lazy to read, then do us both a favor: STFU and go away.

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Status as of June 2020

You might notice that things look at little different around here. In an effort to reduce costs, I switched webhosts, which meant completely deconstructing Living Donor 101 (built back in the dark pages of css by yours truly) and consolidating it and Living Donors Are People Too into one site.

There are, undoubtedly, broken links and other issues; I will attempt to fix them when I can.

Living Donor related shirts and stickers are available at the following links:

https://www.zazzle.com/store/conspicuouschick

https://www.zazzle.com/store/livingdonor101

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It’s Time

I officially turned off the auto-renewal on this domain name. So, sometime in December of 2017, this blog will disappear. For the sake of all current and future living donors, I sincerely hope someone will build upon what I’ve begun and maintained. Take care of yourselves.

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Incompatible Kidneys Are Twice As Expensive, Half as Good

Desensitization protocols and the unimportance of tissue matching are all the rage in the transplant world these days. They’re heralded as a solution to the so-called organ shortage (no matter that the ‘active’ kidney transplant list has been flat, if not declining, for many years now), and a plethora of propaganda-type media articles have followed. In fact, according to these authors, the propaganda has filtered into academic articles as well.

To be blunt:

This analysis by Axelrod et al concludes that transplanting across the ABO blood barrier “appears clinically and economically appropriate.” We think this conclusion is not justified by the analysis.

 

Specifically:

“The authors estimated Medicare spending for all covered services for 270 ABO-incompatible (ABOi) and 27 000 ABO-compatible (ABOc) transplants for the period 30 days before transplant through 3 years after transplant and found that costs for ABOi transplants were 74% higher than those for ABOc transplants.

“The authors also estimated adjusted hazard ratios (AHRs) for both graft failure and all-cause mortality…showed that ABOi-transplanted patients had 1.9 times the risk of both death and graft failure compared with ABOc patients.”

 

in short:

“These estimates indicate that ABOi transplantation costs more and has a large negative impact on the health of recipients compared, with ABOc transplantation.”

Whoops.

 

Here’s an important point:

“The authors provide some evidence of a trend toward ABOi transplants being performed more frequently in patients with private insurance than in patients with Medicare insurance. This would be consistent with transplant centers being able to pass on the higher cost of ABOi transplants to private insurance companies but not to Medicare, which generally has a fixed price per transplant procedure”

 

Not coincidentally, the more transplants performed, the larger a surgeon’s and hospital’s revenue stream. It shouldn’t be surprising they’d promote ABO-incompatible transplants over dialysis to those with private insurance. After all, surgeons and hospitals don’t profit from dialysis. Besides, the federal government (Dept of Health and Human Services via CMS) only measure a hospital’s one-year graft and patient survival rate. What happens after that isn’t the surgeon’s or the hospital’s responsibility. So why not take the money and run?

 

 
Held, P., & McCormick, F. (2016). ABO-Incompatible Kidney Transplants: Twice as Expensive, Half as Good American Journal of Transplantation, 16 (5), 1343-1344 DOI: 10.1111/ajt.13638

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Kidney Donors’ Cholesterol Linked To Kidney Disease

The authors examined 292 living kidney donors a median 14 months post-donation and found that renal function (GFR) was associated with Total Cholesterol and Low-Density Lipoprotein levels.

 

“The likelihood of CKD [chronic kidney disease, as defined by a glomerular filtration rate < 60 mL/min/1.73 m2] at last follow-up was greater in [living kidney] donors with elevated [total cholesterol] and [Low Density Lipoprotein] levels”

 

By the way, Dyslipidema can be caused by chronic kidney disease, and is prevalent in kidney transplant recipients.

 

Yoon, Y., Choi, K., Kim, K., Yang, S., & Han, W. (2015). Clinical Assessment of Lipid Profiles in Live Kidney Donors Transplantation Proceedings, 47 (3), 584-587 DOI: 10.1016/j.transproceed.2014.12.035