One in every 10 people you see on the street has kidney problems

One in every 10 people you see on the street has kidney problems

19 June 2011, Sunday / GÜLİZAR BAKİ, İSTANBUL

Surgeon Alper Demirbaş is someone who has helped turn Antalya into a center for kidney transplants. In fact, having transplanted 516 kidneys last year, he was the doctor who transplanted the most kidneys in 2010 in the world.

Demirbaş notes that one in every 10 people you see on the street has kidney problems. We asked him why there has been such an increase in kidney problems in recent years.

Research done by the Nephrology Association in Turkey has revealed that one out in every 10 people in Turkey has kidney problems, which means that there are 60,000 people with diagnosed kidney problems in this country. Every year, another 10,000 people are diagnosed with kidney failure, which means that if things continue this way, by the year 2015, Turkey will have more than 100,000 people with kidney problems. These are kidney patients who have to get dialysis two to three days a week just to live. Or, they get a kidney transplant in order to become better altogether. Last year in Turkey, there were 2,300 kidney transplants that took place. Despite the fact that Turkey has the world’s best surgeons in this field, as well as the largest kidney transplant center, the number of kidney transplants done in Turkey is below world averages. The world’s largest kidney transplant center is at the Medical Park Hospital in Antalya. This center is headed by Dr. Demirbaş, the world’s foremost kidney transplant surgeon. Demirbaş worked in America for years on transplants of kidneys, livers and pancreases. In 2000, he returned to Turkey and began to head up the Akdeniz University’s Kidney Transplant Center. The fact that he returned to Antalya in Turkey at what was the height of his career elicited many reactions. Now his name is recognized more and more in terms of the records he is breaking. I caught up with Dr. Demibaş to talk to him about what he knows best.

Kidney problems have increased surprisingly in recent years. Why?

Because access to health care has become easier. People are getting diagnosed more easily. It used to be that diabetics would die because their illness was not diagnosed properly. We were losing people with chronic high blood pressure to brain aneurysms before their kidneys could malfunction. But now, with precautions taken by the Health Ministry, we are keeping our patients alive.

In other words, the problem is long-standing...

Yes, but not really known. People were dying. But now, thanks to dialysis, they are living. We add another 10,000 kidney patients to the numbers every year. And this is a very serious health problem. Each year, $3 billion is set aside in the Health Ministry’s budget for dialysis. And this is actually a large black hole for the budget because the costs of dialysis are around eight times that of transplants. The Health Ministry is currently working on solving this problem. One of their best moves recently was this: This is a private hospital, but there are no extra fees taken from patients who come here. It is completely shouldered by the state. It is very good from the perspective of both the patient and us. There is no dialogue concerning economy between doctor and patient. As it is, organ transplants need to be state policy that rises above politicians.

Does a kidney transplant mean no more dialysis?

Here is what dialysis is as a therapy: There are two large needles placed into the patient’s arm. There is a machine to which they are connected and all of the blood of the patient is cleaned in that machine for four hours. This process is repeated three times a week. And the dialysis machine is only able to carry out 5 percent of what a person’s kidney can do. In other words, dialysis is a method that seems to allow people to hold on to their lives. But people who receive kidney transplants only have to take medicine afterwards to make sure their bodies don’t reject the new kidneys. And over time, the dosage of this medication is reduced. After the operation, these people return to work, give birth to children, etc. And in fact, people who have had kidney transplants tend to live 3.5 times as long as those receiving regular dialysis.

We look at this all from the patient’s perspective. What about kidney donors specifically?

Before the final decision is made regarding the kidney transplant, the entire body of the donor is examined from head to toe. Doctors examine carefully what the volume of the kidneys are, how many veins they have, how well each one functions. … It is very interesting and surprising -- some donors come in and in turns out they themselves actually have only one kidney. Do you know how many kidneys you have? People can live with just one kidney. Even more interesting than this is the situation with liver transplants. We can remove 65 percent of the liver of a donor, and transplant it into a patient who needs it. In other words, the donor has only 35 percent of his or her original liver left. But two to three months later, the liver in both the donor and the recipient has grown to the size and volume the body needs. Not one gram less or more. I believe people’s bodies are machines with spare parts. I wish we could take all of our donated organs from patients who were brain dead because in the end, each transplant is an operation for the live donors. And every operation has its own risks, not that these risks are any greater than, say, an operation for a slipped disc.

What does brain dead mean really? If someone’s heart is still working, how can they be seen as dead?

[A person is brain dead] when they have taken their final breath. Their heart may be beating, but there is no longer activity in their brain. Medically speaking, a brain dead person is dead.

Are there not people who wake up and start moving later?

No, no... You are thinking of people in vegetative states. In other words, people whose respiratory systems have not been affected. Like plants. If you take good care of such a patient, he or she will live. Since brain death destroys the respiratory system, these are patients who can be kept alive just 24 to 48 hours by being attached to a breathing machine. After that the other systems begin to shut down. It is not the organ transplant team who decides whether someone is brain dead. The team who makes the decision on brain death includes a brain surgeon, a cardiologist and an anesthesiologist. In the beginning, this seemed like a very unacceptable thing to me. You say to a mother: “Your child is brain dead. Will you please donate his or her organs?” If the mother has never heard of this before, there is no way she will accept the question. Our coordinators have done some serious work on ways to explain all of this to people. Dr. Levent Yücetin from our team has gone all over Antalya to talk about this, which is why the levels of organ donors in Antalya are higher than anywhere else in Turkey. In fact, the Health Ministry has been working on this topic for the past six to seven years throughout Turkey.

Why are donor levels so low despite all this work?

There is a lack of correct information, as well as sociocultural reasons. Leading religious leaders have talked about this, and there is even a fatwa from the Directorate of Religious Affairs to help people transcend their hesitations. They are pointing to the Surah al-Maida from the Quran that says, “Saving just one person is like saving all of humanity.”

I was thinking of becoming a deputy; there was a lot of pressure on me

“I don’t really have any hobbies. This is the only area that interests me in life. Let’s say that today, for example, we operated on six people. The responsibility for the lives of those six people is now on my shoulders, which is why you can’t make even the slightest mistake. It is perhaps a bit pathological, but... As you might know, there was the issue of me becoming a candidate for parliamentary deputy. It was only through tough efforts on my part that I saved myself. There was some very serious pressure on me. The operating room is a dark place, with no windows. You feel like a coal miner there. It is cold, and you dress like an astronaut. I have worked like this for 20 years or so. It does make feeling empathy for people harder. When I was thinking about becoming a candidate, I felt through what I saw in their eyes that we were all in different places in life. The mother of a 1-year-old child called me and said, ‘Now that you’re going to be a deputy, tell me, will my child die?’ That is when I realized that those people were placing their lives in my hands. I would be responsible for them. So I did some inner accounting, and I decided that this job [kidney transplant surgeon] was the only one I would do.”

Too much salt bad for kidneys

There is a team of people who have worked with Dr. Alper Demirbaş for a decade. One of these is nephrologist Dr. Murat Tuncer. He prepares patients for operations and follows up on their health status afterwards. Tuncer talked a bit about the reasons why kidneys malfunction and ways to protect the kidneys. One of the most commonly seen reasons for poor kidney function is diabetes. Following diabetes, it is high blood pressure, urological problems and kidney infection.

Here are some quick notes about your kidneys

Cut down on salt. Make sure you accustom your children to food with less salt. Bread has 2 grams of salt in it, so when a family eats a loaf of bread, they have fulfilled their daily salt needs.

Drink at least 1.5-2 liters of water per day.

When a girl has a second urinary tract infection or a boy has a first, she and he must definitely go to the doctor for a kidney reflux screening.

If a patient passes a gall bladder stone, he or she must definitely go to the doctor to make sure the kidney was not damaged in the process of passing the stone.

Diabetic patients should have their kidneys checked on a regular basis.

Children need to be prevented from becoming overweight -- which can happen from eating too much fast food -- as many diabetes cases are connected to excessive weight gain.

People with high blood pressure need to understand taking medication is not enough. What are ideal blood pressure levels? The high number should be under 13, and the low under 8. If your numbers are 15 and 10, even with medicine, this is not ideal. If you continue this way, you will have kidney disease in 10 years. Try to aim for the ideal.

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