Monday, September 16, 2013

Searching for Organs.....

A friend sent me this link with a note attached:


I do love it. It's a tale of unselfish devotion and the unimaginable kindness of strangers.

But it disturbs me more than I can say.

The donor is a 41 year old woman.  Kudos to her for helping a stranger.

The recipient is a 77 year old woman (I think.  The husband is 77 and they've been married for 57 years, so give or take a couple of years...). 

Transplanted kidneys can be expected to survive about 15 years.  That means that this woman will be 92 when the 41 year old kidney fails.  Or she'll be dead.  Her life expectancy (absent her known diagnosis of kidney failure) is roughly 85, statistically speaking.  So they are giving a young kidney to someone who could reasonably be expected to die of natural causes long before the kidney would normally be expected to fail.  The odds are that she was never placed on a public transplant list because she simply didn't qualify.

So they are deliberately 'wasting' half the life of the transplant.

And then there is the cost.  Medicare (yes, really)  paid for ONE HUNDRED people to be tested as donors for this elderly woman at a minimum of $500 per person for those who were immediately proven not to match, and $10,000 for those who were close.  Figure at least $50,000 - maybe closer to $100,000.  Then there's the surgery and hospital stay.  $10,000/year in medication costs.  Specialist medical visits for $500/week for a year. 

We were told that we could expect that Babygirl's first year with a transplant would run about $100,000.  They underestimated.  Re-admissions for complications are the expected norm for transplant patients.  She was in the hospital four (?five) times in less than one year, and was desperately ill twice - sick enough to die, actually.

Babygirl was 12.  Thirteen.  Fourteen.  An age where the body can, given enough support, recover from nearly any insult.

Not so true with a 77 year old.  Statistically speaking, not many teens die of pneumonia, or strep throat, or influenza - or surgical complications.  LOTS of 77 year olds do, even in the absence of immunosuppressive medications.  Once again I find myself asking, "In a world of limited medical resources, where should our money be going?" 

This isn't just about 'rationing' care.  It's about understanding a basic fact:  We are all going to die.  None of us is going to live forever.  The statistics surrounding medical care in the last year of life are appalling:  Nearly 20% of Medicare recipients have some form of surgery in the 6 months before they die.  WHY?

It's a touching story - an old man, still deeply in love with his wife, begging for a kidney.  Who wouldn't be moved? 

And I hope it goes well for them, I do.  But I suspect that they may be stunned, as many are, as WE were,  to learn that transplantation is not the cure for kidney disease, but a treatment that has many, many risks.  And no matter what anyone tells you about those risks, there is no way to truly prepare yourself for the degree of difficulty involved in the years after transplantation.  It may turn out that the transplant hastened her end rather than prolonged it.  And more likely, transplant may have worsened her quality of life in her last year because no one will want to give up and 'waste' that kidney.


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