Theses are some ways to increase life expectancy in people with ESRD:
In no specific order...
1. Increase AV fistula use.
2. More frequent hemodialysis
3. Increase pool of organs available for transplantation
a. Expand usage of expanded criteria donor (ECD) organs. Many kidneys currently not being used for transplantation may not be ideal but they will increase ESRD patients life expectancies compared to remaining on dialysis so it is a no brainer from a humanistic perspective or from a utilitarian perspective or from a rational decision making model based on probability. So why are so many kidneys being thrown away?
b. increase live donor pool
i. increase live donation from family and community
ii. incentivizing live donors with monetary and other means (repeal parts of the killer legislation AKA National Organ Transplant Act.) I don't like complimenting Iran, but they have a real functioning market for kidney sales where buyers and sellers can transact business and a kidney can be bought and sold for a government mandated price of approximately $2,000 (as of a few years ago that was the price.)
4. Medicare should cover anti-rejection meds for life after transplantation. This will elongate the survival of the transplanted graft which will keep people healthier and alive. Currently, anti-rejection meds are only covered for 3 years after transplantation so if a person cannot afford the anti-rejection meds, some transplant centers won't even allow the person to receive the transplant! In some other circumstances, the person undergoes transplantation, then after they can no longer afford the meds, their bodies eventually reject the graft and then the person ends back on dialysis and Medicare will pay for that for life.....which is much more expensive and is only a treatment and not a cure which the transplanted kidneys (actually) are for as long as they do continue to function.
To be continued...
Showing posts with label NOTA. Show all posts
Showing posts with label NOTA. Show all posts
Thursday, July 26, 2012
Monday, January 16, 2012
Scarcity of Kidneys: A Physician Making a Child Ineligible for A Kidney Transplant because of "Mental Retardation"
Read this mother's heart wrenching story here of how a transplant physician at the Nephrology Department at Children’s Hospital of Philadelphia has reportedly denied a little 3 YO girl with a rare genetic disorder the chance of getting a kidney transplant because she is "mentally retarded."
Here is a partial transcript of the emotionally charged conversation according to the mother's account:
(Start Transcript)
[Mom]“So you mean to tell me that as a doctor, you are not recommending the transplant, and when her kidneys fail in six months to a year, you want me to let her die because she is mentally retarded? There is no other medical reason for her not to have this transplant other than she is MENTALLY RETARDED!”
[Transcript Surgeon] “Yes. This is hard for me, you know.”
(End Transcript)
Nobody should pretend to be omniscient, or to "play God", and certainly, nobody should revel in "playing God."
While I certainly understand the mother's position, I can see the physician's position although I vehemently disagree with it. I hope to write an extensive post on why I feel this way.
But, the mother reports she offers to find a live donor.
[Mom]“Oh, that’s ok! We plan on donating. If we aren’t a match, we come from a large family and someone will donate. We don’t want to be on the list. We will find our own donor.”
[Doctor] “Noooo. She—is—not—eligible –because—of—her—quality– of –life—Because—of—her—mental—delays”
If the family finds a live donor match from their family, surgeons are able to implant even an adult kidney into a child's body by implanting the kidney into a different part of the child's abdomen. (See here to read about cutting edge research being done at Stanford's Lucile Packard Children's Hospital where they have pioneered a method to keep adult kidneys alive even in small children where blood tends to pool and clot in the relatively large kidney causing the organ to stop functioning.)
Assuming the family is able to obtain its own donor, the transplant surgeon should keep his opinion completely to himself... the family is not getting involved with the transplant waiting list so he should not "play God" and pretend to be omniscient...he should allow the parents of this little girl to do everything they want to keep their child alive.
Here is a partial transcript of the emotionally charged conversation according to the mother's account:
(Start Transcript)
[Mom]“So you mean to tell me that as a doctor, you are not recommending the transplant, and when her kidneys fail in six months to a year, you want me to let her die because she is mentally retarded? There is no other medical reason for her not to have this transplant other than she is MENTALLY RETARDED!”
[Transcript Surgeon] “Yes. This is hard for me, you know.”
(End Transcript)
Nobody should pretend to be omniscient, or to "play God", and certainly, nobody should revel in "playing God."
While I certainly understand the mother's position, I can see the physician's position although I vehemently disagree with it. I hope to write an extensive post on why I feel this way.
But, the mother reports she offers to find a live donor.
[Mom]“Oh, that’s ok! We plan on donating. If we aren’t a match, we come from a large family and someone will donate. We don’t want to be on the list. We will find our own donor.”
[Doctor] “Noooo. She—is—not—eligible –because—of—her—quality– of –life—Because—of—her—mental—delays”
If the family finds a live donor match from their family, surgeons are able to implant even an adult kidney into a child's body by implanting the kidney into a different part of the child's abdomen. (See here to read about cutting edge research being done at Stanford's Lucile Packard Children's Hospital where they have pioneered a method to keep adult kidneys alive even in small children where blood tends to pool and clot in the relatively large kidney causing the organ to stop functioning.)
Assuming the family is able to obtain its own donor, the transplant surgeon should keep his opinion completely to himself... the family is not getting involved with the transplant waiting list so he should not "play God" and pretend to be omniscient...he should allow the parents of this little girl to do everything they want to keep their child alive.
Thursday, January 12, 2012
Morality: Is it Moral to Outlaw the Exchange of Money to Obtain a Kidney Transplant?
The bottom line is this: While some may argue it is immoral to buy and sell organs, I argue it is much more immoral to cause people who would otherwise be alive to be dead because less organs are available to the market. Let's keep more people living and reform the market for organs. A well regulated market will allow people to buy and sell organs and thus increase the supply of organs available and help everyone....because for every organ that a richer person bought, a poorer person will now have access to one more organ that is now available to the market.
Sometimes, the most moral decision is made not because it is not without any moral ambiguity or taint, but rather because it is the best option among many bad options.
Case and Point: The U.S. and the U.K.'s treating the evil Stalin as an ally in order to defeat an even greater evil, Hitler, in order to save Europe (and possibly the world) and defeat Nazi Germany.
But, clearly, to destroy Hitler, morality dictated we cut a deal with Stalin to carve up post-war Europe in order to saving the world from Hitler's ambitions of a 1,000 year rule where he would purify the world from everyone except those of the Aryan-race.
When Al Gore and Orrin Hatch promoted the passage of the National Organ Transplant Act of 1984 (NOTA), its purpose was "[t]o address the nation's critical organ donation shortage and improve the organ matching and placement process." See here.
It also outlawed the buying and selling of organs for transplantation.
This piece of legislation constantly causes the death of people who are unable to receive an organ for transplantation before they die.
The are not a finite number of organs available for transplantation in the U.S. that we have already reached. Putting aside deceased donor donations, there is plenty of room for live donors to supply many kidneys to people on the waiting list and thus alleviate the shortage to some extent. If we rely on altruism alone, a certain quantity of kidneys will be supplied to the market. If live donors could be compensated for their very valuable donation (dialysis for people with kidney failure can easily cost $70,000 per year and Medicare [AKA the taxpayers] covers all people with ESRD regardless of age) then the quantity of kidneys supplied to the market would increase and the shortage can be decreased or possibly even be wiped out. See an old post here where I discuss a possible government policy where live donors are given a $50,000 tax refund for their kidney.
NOTA must be reformed to save lives!!!
Sometimes, the most moral decision is made not because it is not without any moral ambiguity or taint, but rather because it is the best option among many bad options.
Case and Point: The U.S. and the U.K.'s treating the evil Stalin as an ally in order to defeat an even greater evil, Hitler, in order to save Europe (and possibly the world) and defeat Nazi Germany.
But, clearly, to destroy Hitler, morality dictated we cut a deal with Stalin to carve up post-war Europe in order to saving the world from Hitler's ambitions of a 1,000 year rule where he would purify the world from everyone except those of the Aryan-race.
When Al Gore and Orrin Hatch promoted the passage of the National Organ Transplant Act of 1984 (NOTA), its purpose was "[t]o address the nation's critical organ donation shortage and improve the organ matching and placement process." See here.
It also outlawed the buying and selling of organs for transplantation.
This piece of legislation constantly causes the death of people who are unable to receive an organ for transplantation before they die.
The are not a finite number of organs available for transplantation in the U.S. that we have already reached. Putting aside deceased donor donations, there is plenty of room for live donors to supply many kidneys to people on the waiting list and thus alleviate the shortage to some extent. If we rely on altruism alone, a certain quantity of kidneys will be supplied to the market. If live donors could be compensated for their very valuable donation (dialysis for people with kidney failure can easily cost $70,000 per year and Medicare [AKA the taxpayers] covers all people with ESRD regardless of age) then the quantity of kidneys supplied to the market would increase and the shortage can be decreased or possibly even be wiped out. See an old post here where I discuss a possible government policy where live donors are given a $50,000 tax refund for their kidney.
NOTA must be reformed to save lives!!!
Subscribe to:
Posts (Atom)