Magazine article Nutrition Health Review

Should Kidneys Be Sold for Transplantation? an Interview with Sally Satel, M.D

Magazine article Nutrition Health Review

Should Kidneys Be Sold for Transplantation? an Interview with Sally Satel, M.D

Article excerpt

Q: Are transplanted kidneys from a living donor associated with better outcomes than kidneys from a deceased donor?

A: Yes, because the organ spends less time on ice. It goes directly into the person who needs it, and it doesn't usually have to be shipped across the country in a cooler.

Q: What are the risks of a kidney transplant to a living donor?

A: Any kind of surgery, in terms of infection and bleeding and anesthesia, carries risks. Afterward, recuperation for the donor is like that of any other surgery. There have been a number of long-term follow-up studies of organ donors. A recent article basically said mortality rates aren't very different among people who have donated a kidney compared with the population at large. You have to be very healthy to give a kidney.

Q: What is dialysis, and how is it performed?

A: Dialysis is a process that essentially removes water and toxins from the blood that the kidney would normally do. The old name for dialysis was "artificial kidney." The procedure also helps to balance electrolytes. It is usually done three times a week for four hours at a time (clinic-based hemodialysis); that is what most people do, or they can perform it at home. Dialysis is usually done daily. It can be performed at night when the patient is sleeping, but a family member or nurse must be on hand to make sure that all of the equipment stays plugged in.

Q: Why is transplantation a better solution than life-long dialysis?

A: Going into a clinic and getting the blood cleaned three times a week is very unnatural, since naturally the kidneys are working every minute of every day. It is not an adequate replacement, and death is guaranteed sooner. With a transplant, you are gaining a working kidney again. Many people mind the dialysis; they often feel miserable and very tired afterward. Estimates are that one in five people who cannot anticipate receiving a transplant in the future just don't go back to the clinic. If they don't go back, they die in two weeks.

Q: Can you describe the organ-donation process?

A: There are basically two kinds of donors. There are deceased donors; a person signs an organ donor card and discusses this decision with the family as well. If the person is in the hospital in a brain-dead state, the organ will be retrieved there. Living donors are usually volunteering to donate an organ for a close friend or family member. Approximately 90 people each year walk in to a hospital and offer to donate a kidney for anyone who needs it.

Q: How are donors matched with patients in need?

A: Living donations are usually directed. People come in and say, "I want to give my kidney to a person here who needs it."

Q: How has the growing shortage of donor kidneys affected patients in need of a kidney transplant?

A: The death rates have climbed every year because there aren't enough organs. A shortage has existed since 1987, when the list was created.

Q: What has been done to help increase the supply of donated kidneys?

A: There have been efforts, but they have been kind of flatlined. All of our educational efforts haven't been enough, and we are taking organs from less healthy people. There's a debate now regarding taking HIV-positive organs and giving them to HIV-positive patients in need of an organ transplant. There are also paired kidney donations. This occurs when two pairs of people are not compatible with the people they want to give their kidney to but they are compatible with someone else, so they trade with each other. …

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