Saturday, November 14, 2009

Donating an organ is not like fixing an appliance

A couple weeks ago the washing machine died.  A repairman looked at it and noted that he could fix it, however, it would cost as much as replacing the machine with a lesser model.  We chose a new machine with a warranty.  The new washer was installed on a Sunday afternoon.  The next morning, the dishwasher wasn't working properly, nor was it draining.  That appliance, fortunately, is still under warranty (for about a month!).  Another repairman came to the house, looked at it, made a mess of my kitchen, and has ordered a part, a drain pump.  Hopefully within a week or two that machine will be operational again. 

Meanwhile, I can't help but think that my kidney is not an appliance.  It doesn't have a warranty.  I can't just go to Sears and pick out a new model and schedule a delivery time.  If I donate my kidney, that's it, that's goodbye forever.  If the recipient doesn't take to it, he's back to where he is now and I'm out a kidney.  I realize his body will reject it and he'll need to take drugs for the rest of life to fight his body fighting the new organ.  It's amazing this is even possible, however, I'm not sure I'm amazed enough myself to fork over my kidney.  I want to help my friend, but all the stats and data I've read is just a huge jumbled mess. 

For living donors "...some studies have shown a slightly higher risk of high blood pressure and proteinuria. These risks can be monitored through regular physical exams, blood tests, and urine tests. Interestingly, Switzerland established a living donor registry in 1993 to track living donors and to ensure they are regularly examined by their personal physician for blood pressure and renal functions. No such registry or post-operative protocols exist in the U.S. or other countries. Some transplant centers will follow up with you after a couple of months, but such follow up is not mandatory and the results are not used in constructive ways (e.g., research). The UNOS Living Donor Committee has proposed a standard medical and psychosocial follow-up protocol, but UNOS has yet to adopt the suggestions."

A slightly higher risk of high blood pressure and proteinuria? How much is "slightly"?  2%, 7%, 45%?  Switzerland is tracking blood pressure and renal functions... anything else?  What about donors who experience depression, PSTD, and a host of other issues after donating?  And the US, what are we tracking?  Oh right, the recipients.  I'm all for tracking the recipients, but what about the living donors?  Donors aren't appliances where you takes the parts from one to fix up another.  Even if Switzerland has an adequate track record of its living donors and their health, how does that translate to American donors?  Would an American donor receive comparable care and as often? 

Studies have shown that up to 40% of living donors do not have health insurance. Consequently, they skip out on follow-up care, and will not see a physician when they experience a complication or problem due to the transplant.


But wait, there's more!  If I donate an organ it's then considered a pre-existing condition.  Insurance companies do not like pre-existing conditions.  Amazing how when I'd need insurance the most (after donating an organ) that's when insurance companies want to turn me away, I'm too much of a risk for them.  Insurance companies are in business to make money.  Pre-existing conditions, care, treatment, follow-up, etc. is expensive.  Do the math.  I currently have health and insurance and as long as I'm employed in my current job I'll maintain that insurance... but if I get laid off or fired, ugh, I don't even want to think about it.

Well, it's time to take the car in for a check-up.  It's been leaking... something.  I'm not a mechanic so I don't know what exactly is wrong, but it's likely it can be fixed.  If that's not a viable option, the car is replaceable.  People, not so much.

Interesting how if an appliance or vehicle isn't working properly I'll do something about it.  However, when it comes to my body I tend to neglect it, I figure it sucks getting older.  Oh those headaches?  Stress.  Not sleeping, it's due to stress.  My period being five days late, stress again.  Wait a minute... if I'm experiencing all of these fabulous side-effects thanks to the stress of considering donating a kidney, what the hell will my body do if I get testing and go through with the donation (assuming I'm a match)?  I can't even begin to imagine. 

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