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Kidney donation: why it's well worth considering

Yesterday the transplant surgeon, Gabriel Oniscu, said he or one of his colleagues plan to take out my left kidney very soon.  It makes the scheduled operation a bit more 'real' in my mind, knowing which kidney is going be handed on to someone else (with a greater need for it than me). It's another step on the donation journey I've been travelling for some months now.  Most blog posts on this website are primarily written for fellow health professionals & others interested in evidence-based approaches to stress, health & wellbeing.  This post (and I hope later several others) are different in that they are written mainly for other potential kidney donors and their friends & families.  A personal story about a fellow donor's experience will, I hope, be helpful.  The fact that I'm also a medical doctor and a psychotherapist colours my observations in ways that may add further useful information.  In this post I want to write a bit about the benefits of kidney donation.  In later posts I hope to write about the risks, who donates, what we can do as donors to make the whole process more successful, the operation, first weeks of recovery, and the longer term experience.

So what are the benefits of kidney donation?  As an intending kidney donor, I'm lucky to be based in Edinburgh. The first successful kidney transplant operation in the United Kingdom was performed here in 1960.  The Edinburgh Renal Unit has an excellent website and their page giving information about transplantation states "Kidney transplants have revolutionised life for many people with kidney failure. Dialysis only keeps you OK - a successful transplant restores your health."  They go on to comment "Most patients receive a kidney from someone who has died in hospital, usually on a life support machine.  However the best transplants come from living people - who must be a close relative, or in certain cases, a partner or close friend (or unrelated 'altruistic donor').  Live donor transplants can be carefully planned, instead of coming as a surprise at any time, and the kidney is proved in advance to be very healthy."  They also point out that unfortunately "The number of kidneys required greatly exceeds the number available, and you may have to wait a long time (sometimes years) before a kidney suited to your blood group and tissue type is found.  Some patients, however, are lucky and get a kidney transplant within a few months ... the time you wait depends entirely on availability and suitability of the organ available."  

OK, these seem good reasons to consider kidney donation.  What about the numbers?  The US National Kidney Register provides helpful information.  They state "People facing kidney failure who are medically qualified for transplant surgery have two basic options: stay on dialysis or get a transplant. Transplantation is far superior to long-term dialysis. Transplant recipients generally live twice as long as those who stay on dialysis and transplant recipients are not restricted by the challenging routine of dialysis therapy."  They also point out that living donor transplants are much better than deceased donor transplants - the figures they quote from the American Journal of Transplantation show that 50% of deceased donor transplants are still functioning after 14.7 years, while for living donor transplants 50% are still functioning after 26.6 years. And not only does kidney donation very significantly improve the duration & quality of the recipient's life, it can also save the NHS a good deal of money.  The UK National Kidney Federation has an interesting page on transplantation cost effectiveness.  At 2010 rates, a kidney transplant saves the NHS about £25,000 annually in dialysis costs - so a living donor transplant, which functions for 26 years, theoretically saves the NHS about £650,000 (although in actual practice people receiving dialysis are very unlikely to survive as long as those receiving a transplant ... and these earlier cost estimates are currently being updated).  All figures can be multiplied severalfold when an altruistic/Good Samaritan donor initiates a chain of transplants - see, for example, this illustrative diagram.

The Edinburgh Renal Unit give information on local transplant surgery.  Their report for 2013-14 shows (p.87) that they provided 87 deceased donor and 35 living donor transplants (including 5 altruistic and 6 paired/pooled).  If we look at the bigger picture, it's pretty daunting.  Today's figures for the United States show 119,847 people are waiting for an organ transplant (of whom over 100,000 want a kidney) and the gap between supply and demand has grown steadily.  In the US, on average 22 people die every day waiting for a transplant.  Figures for the UK are a bit more encouraging than this (see correspondence below), but the bottom line is that over here too nearly 4 people every day either die hoping in vain for a transplant or are removed from the waiting list, typically as a result of their health deteriorating so badly that they are no longer eligible for an operation.

What more can be done to help?  Well for starters, do consider going on an organ donation register so that when you die there's a possibility that your organs can save someone else's life.  It just takes a couple of minutes to sign up, for example with Organ Donation Scotland or the NHS Organ Donation site.  As the latter very logically points out "If you needed an organ transplant would you have one?  If so please help those in need of a transplant by opting to donate organs and tissue."  The International Registry in Organ Donation and Transplantation provides more widespread information.  There is also active current debate here in the UK over whether we should move from an "opt-in" system for organ donation after death to an "opt-out" system.  The great majority of us support organ donation, but only a minority have actually signed up as organ donors.  The British Medical Association would like to see current legislation changed to what is called a "soft opt-out" system. This happened in Wales at the end of 2015 and already people who would have died without the law change are having their lives saved.  Every day that legislators in the rest of the UK delay on this, people are dying unnecessarily.  If you agree that this is a stupid situation, do also add your voice to help change legislation more quickly - see for example the last paragraph on this British Humanist Society campaign page with it's easy-to-complete email to your MP.

There are plenty of useful internet sources of information about kidney transplants.  Besides the organ donation sites mentioned in the last paragraph, there's our local Edinburgh site, the UK National Kidney Federation charity, the more 'altruistic donor' targeted UK Give a Kidney charity, the helpful clinically-orientated NHS Organ Donation & Transplantation site (with encouraging details of a strategic plan to take organ donation forward in the next few years), and too the fine US National Kidney Register.  Facts and figures are great, but sometimes real life stories can touch us more deeply.  As Thomas Newman, a professor of biostatistics, pointed out "The brains of human beings seem built to process stories better than other forms of input."  If you have 3 or 4 minutes, do take a look at this film clip on the National Kidney Register site - "Kidney donation leads to unexpected kindness".   

For the next post in this sequence, see "Kidney donation: what are the risks?".

 

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UK figures

This is a very helpful account from a unique perspective.

Up-to-date UK figures are found in the relevant pages of the Organ Donation and Transplantation site:
http://www.odt.nhs.uk/pdf/activity-report/summary_of_transplant_activity...

On March 31 2016 there were 6,476 people active on UK transplant lists ( all organs), with a further 3,452 suspended.

Most of these - 5275 - awaited kidneys. This figure has actually fallen by 411 compared with previous year.

I look forward to reading future blogs.

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