Organ Failure

[Rerun]

Kidney failure is only our disease and only ours to carry?  Ask your family if that is true.  Ask them if they get a little sad when you can't go hiking running with them anymore.  NO, kidney disease and dialysis affects everyone in your family and your friends, and co-workers.  They talk behind your back and say "I wish he'd get a kidney soon so things would get back to normal."  Not that a transplant is normal, but it is as close as you'll ever get. 

Believe me you do not carry this burden ALONE!   

[stauffenberg]

But I would counter Hemodoc's point by saying that a Christian society would give priority to sharing and giving, not to private selfishness and possession, and so would perhaps institute a kidney draft to ensure that the overall health of the population was maximized by ensuring that each person had at least one functioning kidney.  We all know the horrors that arose from the artificial construction of property rights and the sanctity of private interests as primary forces in social organization during the era of 19th century extremist capitalism, when the poor were allowed to die in the gutter with no social support networks so that the 'individuality,' 'freedom,' and 'insular autonomy' of the wealthy would not be limited in the least by progressive taxation.  What we have now in renal medicine public policy is that same type of brutality as occurred in 19th century economic policy: renal patients are allowed to suffer and die with no kidneys because the extra kidney in those people 'wealthy' from perfect health is regarded as their private property, untouchable for any public interest.

In a military draft we impose on civilians made into soldiers a risk of injury or death which is infinitely greater than that that would be imposed on people drafted to give a kidney.  If healthy people were forced to donate a kidney, perhaps 300,000 people on dialysis in the US could be saved from extreme suffering and gradually increasing morbidity, followed by premature death.  How many wars for which people have been drafted into military service have saved so many American lives, have reduced so much suffering among Americans, at so little comparative cost to those conscripted as would be incurred in a kidney draft? 

[Rerun]

A "kidney draft" is not even on the realm of possibility.  Buying a kidney for a fair price is.  A kidney draft is an interesting idea, but again not a possibility.  A born again Christian should realize that our bodies are only temporary and to give a fallen brother one of your healthy kidneys is a very benevolent thing to do.  And if that brother wants to send that donor to Hawaii for a week so be it.  It should not be illegal to compensate a nice gesture with a gift in return.

[Hemodoc]

Wow,

A renal draft, even if I could get a hundred kidneys out of a renal draft, I would not take a single one in such a coercive society.  Once again, that is the end of the slippery slope that NKF has correctly stood against in the payment for renal donation.  Renal donation and the ethics behind them are not in an isolated vacuum.  What becomes of the definitions of death and making human beings commodities should be stood against by the test of societal experimentation in these avenues many times over.

Your views are exactly why those that fight against payment for renal donation so state that altruistic giving would dry up.  Quite a scary world you would like to implement.  A renal draft!!!

Unreal.  Once again, my disease is my responsibility.  If out of a loving heart, someone donates a kidney to me, that is a gift, not a right.  Wow, get real folks, sickness and illness  are a blight of this world, but you do not have a right to my children' kidneys.  It is their life to lead and their own flesh and blood that is theirs to keep or to give.  You my friend have no right to their flesh and blood as you wrongly assert.  You are truly setting a scary situation and this is exactly why those that oppose payment for renal donation rightly state that it will cheapen the gift and further cheapen our concepts and ideals on the value of life.  Your are a great testament to why I will continue to oppose this as best I can.

Simply an unreal conclusion.   What was that book?  1984?  Simply off by a few years that is all.

[Zach]

But I would counter Hemodoc's point by saying that a Christian society would give priority to sharing and giving, not to private selfishness and possession, and so would perhaps institute a kidney draft to ensure that the overall health of the population was maximized by ensuring that each person had at least one functioning kidney.

You seem to be confused between altruism and coercion.

[pelagia]

Kidney failure is only our disease and only ours to carry?  Ask your family if that is true.  Ask them if they get a little sad when you can't go hiking running with them anymore.  NO, kidney disease and dialysis affects everyone in your family and your friends, and co-workers.  They talk behind your back and say "I wish he'd get a kidney soon so things would get back to normal."  Not that a transplant is normal, but it is as close as you'll ever get. 

Believe me you do not carry this burden ALONE!   

Read some of the IHD threads posted by the spouses/caregivers for perspectives on this issue.  We are most certainly significantly affected by ESRF, dialysis and transplant.  How could we not be?

[monrein]

The fact that I feel and get support from friends and family helps me tremendously to cope with my illness and so I feel that I'm NOT bearing it alone.  I'm very aware of exactly how it impacts my various family members and the impact is quite significant indeed.
That  being said, I don't expect anyone to have to give me a kidney and I'd be more than a little appalled if ever  they were forced to donate one or even feel coerced.  Those who do offer to donate, and I'm totally overwhelmed by the offers I've had, are generous, caring and altruistic in the extreme.  They do not OWE me this gift.  I will always be grateful to those who offer so freely to try to help me and if a potential donor were to change their mind at any stage and decide they can't go through with donation I'll still never forget that they wanted to help in the first place.   

[stauffenberg]

The Christian argues most loudly for putting personal selfishness ahead of the ability of suffering humanity to rescue themselves from premature death, but the atheist argues against him!  Now I've seen everything!

Try addressing the question: Why does the need to defend the entire society against a military threat justify the state in seizing whole bodies against the individual's will, exposing unwilling draftees to a much higher risk to life and limb than renal transplant ever would, while protecting the vulnerable minority of renal patients against lethal medical threats is somehow to be trumped by the 'higher principle' of personal selfishness?

In Iran the initiation of a paid kidney donation program for living donors did not reduce the amount of altruistic donation, so since that is the only empirical evidence we have for comparing the two options, we have to assume that paid donation would not cause the collapse of voluntary donation.  Even if it would mean the complete end of voluntary donation, since it has been calculated that if the government in the U.S. paid donors $100,000 each for offering a kidney for transplant the entire dialysis and transplant system would still save money, I am sure all the loss of volunteer donors could be made up and more, while the existing voluntary system still proves lethally inadequate, after having been in place more than 40 years.  Altruistic provision of a kidney and paid sale of a kidney motivate completely different types of person for completely different reasons, so there is no logical reason why one should conflict with the other.

[Rerun]

I'm going to go sit with Chris and Flip~

[Chris]

I'm going to go sit with Chris and Flip~

[MIbarra]

I do not see anything wrong with some financial reimbursement for a kidney donation. After all, chances are the person who is donating a kidney is taking off of work for the tests before the transplant, the transplant itself, and recuperating afterwards. Who is reimbursing them for this? Then there's the possibility of having transportation costs. And of course, anything could go wrong medically eventually down the line. The person donating is not only taking a big medical risk, but also taking a big financial risk in their life. Anyway, if it's left up to medicare or insurance to reimburse living donors, I doubt sincerely that they will be receiving a huge reimbursement -- not enough to retire on! So who would really donate for the sole reason of getting the financial reimbursement? Very few members of our country.

[okarol]

I just thought of something. The doctors and drug companies could kick in some cash for donor reimbursements. That way they could do more transplants, charge more surgical and prescription fees, and make more money. 

[Wallyz]

Look- the data is in.  With the Iranian model, the wait list went to zero. It is a more efficient system. End of story.  Hemodoc- I read your piece on SEOTN, and I have to say that I don't buy your logic, your ethics, or your theology.   

The idea that our illness is ours alone to bear would ask us to give up insurance, Medicare, and refuse charity of all kinds.  You have made transplant  a special class of treatment has different moral imperatives.  In this country we share the cost of care. We pay people who are providing care, and we charge people who receive care, and we share the cost between people who are able to pay, through insurance and taxpayer funded programs.
As far as I can tell, organ donation is the only case in our system where the provider of a good or service is not able to be compensated.
As far as your Jesus took up his own cross and told us to do the same,  interesting eisegesitc exercise there, but the burden he was referring to was the burden of the Kingdom, that is, caring for the poor, the sick, the widowed and the orphaned.

If we have it in our power to help these people with an improved organ donation system, and we refuse to do it so that our religio/moral aesthetics can remain unruffled, we have failed in the test of compassion.  If we have it in our power to correct the basic problem of our organ donation system, and we fail because we do not want to have to look at our past practices and admit how wrong they were, we fail the test of pride.
If we have  a proven solution, and refuse to use it simply because it wasn't ours, we fail the test of intelligence.

[Hemodoc]

Dear Wallyz,

You sound an awful lot like Stauffenberg and Somerville.  I will have to wait on a formal response to your incorrect accusations against me since I am off to visit Vermont this weekend.

Mark Newman, the editor in chief of Nephron disagrees greatly with your point of view on my article and placed it and my quote of the day on his web page.

http://www.nephronline.com/nephnews/

You are completely wrong about the experience of Iran, over 80% of Iranian vendors would not donate again if they had the choice.  Iran excludes woman and those over 50.  If that is the system you want, I hope you are not over 50(I am) or a woman.  You would not be on the list, and you would not get a kidney.  That is a real solution to the problem don't you think!!!

As far as my theology, Stauffenberg brought up the absurd out of context dig against my reply.  I guess, if you don't have a good retort, then just go to bashing the writer.  Great way to go.  You have gone beyond Stauffenberg and called me stupid as well.  Thank you for your quite unkind responses.

[Wallyz]

First, I am not attacking you, I am attacking your position, It is a debate.

Second, You will have to cite the 80% wouldn't do it again statistic.

In the main article about the Iranian model the only mention of the issue is here:

Unfortunately, the financial incentives to kidney donors in the Iranian Model neither has enough life changing potential nor has enough long-term compensatory effect, resulting in long term dissastisfaction among some donors.

The issue for many donors, some of my family members included, is not that they are unwilling to give a kidney, but that economically, they cannot take the time off of work.

The altruistic donor would never go away,  they would just be able to donate without their financial lives collapsing.

Enjoy your time in Vermont.

[stauffenberg]

Dr. Larijani, who, being an Iranian doctor, might be in a position to know the details of the Iranian system better than the rest of us, says that the renal transplant waiting list went to zero within two years of the initiation of the paid living kidney donor program. (B. Larijani, et al, "Rewarded Gift for Living Renal Donors, Transplantation Proceedings, vol 36 (2004) 2539 at 2540).  Obviously, if the number of donors does not go up to cover everyone on the waiting list, all you have to do is increase the price to the point where you recruit enough people to offer their services (economists call this 'the law of supply and demand'). Since it has already been calculated that the American renal medicine program could cost-effectively pay up to $100,000 per live kidney donor, there is a lot of room to expand the supply beyond that generated by the miniscule $1200 statutory compensation offered in the Iranian program (usually topped up by about $3400 contributed by charities which exist for this purpose.)  So the flaw is not with paid donation not meeting the need, just with paying an inadequate amount.

It seems that Hemodoc's concept of Christianity is based on the assumption that the only proper role for the Christian is to act as an individual to help fellow humans, but never to support general social policies to construct the basic logic of such legal concepts as 'personal property' and 'legal duty' so as to make the overall design of society Christian in its generosity and care for the sick and dying.  I don't see any theological reason why the role has to be limited in this way.  Other societies require by law that people step forward to rescue fellow citizens in danger or face the full sanctions of the criminal law for failing to give assistance.  But the more selfish design of common law rather than civil law systems assumes that there is no duty to help other people in mortal danger, so if you are an Olympic swimming champion and you come by an infant drowning in a very shallow pool of water, you can stand there, laugh, take pictures, and make bets on how long it will take the baby to die, but this is perfectly legal.  In this I think most civil law systems which impose a legal duty on everyone to assist represent a more Christian design of society.  The same is true if we were to impose on healthy people with two kidneys a legal duty to assist those suffering and dying because they have no kidneys.  How can that case be distinguished from the civil law code's duty to give help?  How can it be distinguished from Christian charity?

With respect to compensating living donors for their costs in providing a kidney for transplant, British Columbia has already taken that step and offers payment of up to $5000 to cover expenses for anyone donating a kidney.  But since many such systems which offer donor compensation, which some international agencies have argued should be a basic right of the donor to demand, also pay for donor 'work' in preparing for surgery and undergoing the operation, as well as pain and suffering, they have already crossed the line to paying people for giving a kidney, since there is no objective measure which can accurately distinguish what is payment in compensation of actual loss for this work and pain as opposed to what is payment for donor profit, or for the kidney rather than the work in delivering it.  So without realizing it, society has already accepted donor payment as legitimate.

[Wallyz]

Coercive live donation is a non- starter for me and for most people, Stauffenberg.  It's also not the issue on the table right now.  The Iranian model, and the proposed model is all about voluntary donations, and compensation for the same.

The frightening thing about  Dr Laird's opinion is that he seems to have rejected the ethical basis of live kidney donation in almost all circumstances. I absolutely respect his personal decision that live donation is not right for him, but the extrapolation to others in rejecting the idea of compensated kidney donation as  a policy stance is frightening.

Moreover, when I became aware of the alternative treatment option of daily dialysis which would not impact the health of any other person known or unknown to me, I felt a moral responsibility to truly put into practice the adage: “physician, heal thyself” and not look to another frail, mortal man to jeopardize their own life for mine. Daily dialysis gives me the same gift of life that a cadaveric renal transplant can give.  It is a treatment option that will be my responsibility to oversee and manage and It will not have any adverse health potential to any other person.

He has placed an either/or condition on the question of Home Hemo vs. compensated transplant, when it obviously is a both/ and situation.  Furthermore, he has denied the positive ethical value   of another person to choose to give sacrificially of themselves, which is the highest Christian ideal of love.  His refusal to allow it is more along the lines of Obejectivism than Agape.

He is rejecting live donation  in favor of Home hemo not just for himself, but for everyone.   The assumption that:

When American medicine simply climbs to the same level as the rest of the developed nations in providing optimal dialysis, the current renal transplant lists will fall much more dramatically than any payment for renal donation program ever could provide.

has no basis in any study ,and goes against the basic concept of medicine as healing arts, rather than disease management.  When a member of the medical community promotes long term, capital intensive disease management over healing, they unfortunately open themselves up to the conflict of financial interest charge.

Also- does anybody have a cite on the no women and over 50 aspect of the Iranian plan? I can't find anything about that.

I think that is a non argument for this debate,  because we don't exclude either group.  We do however, only give older kidneys to older people, and I know that there is an age cut off in the US, along with a host of health exclusions, but I don't know what the cut off is.

PS. if we had a truly Christian society, there would be no wait list now, but we don't.  We have a capitalistic society.

[stauffenberg]

I agree.  I find it highly ironic that after a system of altruistic kidney donation has proved lethally inadequate for decades, people are still arguing that we must never allow paid organ donation since that would somehow impeach the supreme moral value of altruistic donation.  Well if altruistic donation were ADEQUATE that would eliminate the demand for a payment system, so we are not comparing the supreme ideal of altruisism with compensated donation, but the profoundly, lethally flawed ideal of inadequate altruism with compensated donation.  And even if altruistic donation is a high moral value of our society with respect to kidneys, is it so high it is worth letting thousands of people to die every year unnecessarily to defend?

I am only arguing in this thread the extreme position of a kidney draft, which I fully appreciate is an unrealisic proposal given the entrenched character of human selfishness, just because Hemodoc and I have already debated the more realistic option of paid kidney donation on another thread.

[Hemodoc]

The Bible tells us that we are to love our neighbor as ourselves.  A lawyer, made the snide remark after Jesus taught on this: “and who is my neighbor.”  Jesus answered with the story of the good Samaritan.  (Luke 10:25-37)  I would highly recommend that you learn more of the real truth of the Bible before you incorrectly assign false accusations against it.  Further, you are the one my friend that has thrown the framework of Christianity into this discussion and not me.  I am only responding to your false discussion on so many different points in this matter.  In my post on DFTSEOTN, my arguments were not made from a religious perspective at all, even though you have inferred that they were.

Further, you continue to make false attributes to me in IHD on this subject.  I would ask you to refrain from denigrating my religion by your false statements that you say I have stated when in fact I have not.  You, are in great error on so many issues, but I dare say that this never does hinder you from creating your own false dialogues that no one can really respond to, so they just drop the issues.  Unfortunately, this leaves many false impressions hanging.

Nevertheless, instead of going through all of your false statements one by one, let us start with the beginning of our discussion which I will frame for the first time in a religious context.
Jesus commands to go and show mercy and to love our neighbor as ourself.  My perspective of my wife and my daughter is that they need their kidneys quite well for themselves and in such, out of love of them as myself, I will not accept their offer and instead wish only that they enjoy the good health that their TWO kidneys will offer them.

On the other hand, the love that my wife and my daughter showed to me is to be likewise recognized from a Christian perspective of loving me as themselves as well.  If there was not another alternative to renal transplantation that offers an equal chance of survival, which we do have, daily dialysis, would I have accepted the mercy and sacrifice extended to me by them? Perhaps, but there is an alternative and in such there is an obligation to “heal thyself” first before embarking on a course of action that could bring potential medical harm to another individual.  This is my personal choice and opinion.  Others are free to choose for themselves, but I would simply remind all to note that there is an alternative to renal transplantation with the same survival as renal transplantation and that renal donation is NOT without risk. 

Thus, it is my personal obligation and duty to do all that I can for myself without jeopardizing another individual FIRST before allowing them to be at risk for me.  This is my own personal view on this that others may disagree with.  Yet, indeed, if my daughter or my wife or any other that donated had an adverse outcome, could I justify to myself that I had no other alternative than to take one of their kidneys?  The answer that I honestly come to is, no, I could not justify that outcome when I could have chosen to take responsibility for my own disease and not imposed upon the health of another by opting for daily home dialysis treatments that I maintain the responsibility of completing.  This is the heart of my article that you have so completely misrepresented.

Lastly, I am not in the least against altruistic donation as has been stated.  In fact, if the only manner in which I could continue to be a contributing part of my family, I would indeed consider and accept a kidney from my wife, my daughter or another member of society that out of the love of a fellow man, would give that gift of life.  Thus, if I cannot dialyze with PD or HD, then yes, I would consider and perhaps accept that gift so that I can continue to be a husband, father and son to the rest of my family.

In fact, there are many that could enjoy and consider daily dialysis as their first renal replacement option that never have that opportunity in this country because it is not given enough importance in America.  We have only 1% of the potential 30% that could utilize this option.  I would state that there is an ethical obligation for those that consider renal transplant to consider this option in light of the vast number on the waiting list for renal donation. Looking at the numbers, if we had 30% on home hemo programs, how many of the nearly 100,000 on the renal transplant list could be taken care of this way with good outcomes and quality of life and reduce dramatically the wait time for all of those that either cannot or choose not to go the daily dialysis route.

You are free to disagree with me, but I see a duty and an obligation to consider this option before placing my wife or daughter or a complete stranger at risk of 1/3000 chances of dying from the harvesting of their kidney.  This is my personal opinion and my current choice.  Please feel free to disagree, that is your prerogative.

However, you do not have the right to attribute false statements to me on this or any subject and I will respectfully ask you to refrain from doing so in the future.

[Hemodoc]

Dear Wallyz,

The Iranian system has no central oversight that is published.  We thus, do NOT know what their numbers really are and whether the wait list exists or does not. 

Renal transplantation in Iran

Ahad J. Ghods

Unfortunately there is no national transplant registry in Iran to report the short- and long-term results of all renal transplants carried out in the country.

http://ndt.oxfordjournals.org/cgi/content/full/17/2/222

Is the list gone?

"But not everyone agrees that the claim is true. "It depends on how you define waiting list," Behrooz Broumand, a past president of the Iranian Society of Nephrology, told the BMJ. Javaad
Zargooshi, a urologist at the Kermanshah University of Medical Sciences, goes further. "The elimination of the waiting list has never occurred in Iran. It is merely a Goebblesian lie repeated over and over by the commercial programme's spin doctors," he said."

Further, most Iranian vendors would not donate again if they could go back in time:

Most Iranian paid donors would not donate again

http://www.billpeckham.com/from_the_sharp_end_of_the/2008/08/most-iranian-pa.html

In addition, we do not have access to all of the data for the Iranian system so you would advocate buying into a system without knowing all about the system such as exclusion criteria for the list.  Being over 50 and a woman is an exclusion criteria for this system.  Since most renal failure is age related, they already have an artificially smaller list to begin with. 

http://www.bmj.com/cgi/content/full/334/7592/502

Further, there are several studies published looking retrospectively at the adverse health effects of paid donation in the countries at question.  For those in these countries at the lowest end of financial resources, they are also the most at risk of adverse health even without donating a kidney.

Economic and Health Consequences of Selling a Kidney in India

http://jama.ama-assn.org/cgi/content/full/288/13/1589

So, you have not shown any data to prove your contentions that the Iranian system is a "proven" system as you claim, but do not back up with studies.  In fact, you will not be able to prove your statement since no such tracking system exists in Iran.  It is time to take a skeptical look at the claims of this country that wishes only to project a positive image of itself when so often it cannot.

[Hemodoc]

Dear Wallyz, your assertion that I am taking my own personal position and advocating an all encompassing "policy" is ludicrous.  First, I am only using my own decision process as a counterpoint to the Satel article.  Second, I have no policy making authority.

Please stick to the facts and stop making false attributes of my statements to me.  In fact, you have a writing style and thought process that makes me ask how closely are you related to Stauffenberg?  If the name wasn't different, I would conclude that your posts was Stauffenberg. It must be a rare situation to find two people that think and write exactly with the same style and false attributes to their opponents.

[paris]

Because of our amazing admins and mods, I feel sure Wallyz and Stauffenberg are not the same.  Stauffenberg has been a member for quite some time and has a very unique style of writing.  We love you Stauffenberg, even if we don't always agree.   

Now I am going to sit with Chris, Rerun and Flip      Epoman would have enjoyed this discussion!  He loved a good debate and stong opiinions.

[Wallyz]

Dr Laird:
Please stop making ad hominem attacks. It demeans the level of civility in this forum.  I'm not stauffenberg, I'm Brian W Steele-Sierk. I live in Lake Stevens WA.  I'd be happy to PM you my phone number if you need further demonstration of proof.

The issue at hand is a policy recommendation from the NKF, attacked by Dr Satel, and supported by you.

Your support of the NKF position is based in your personal decision about live donor transplant, which as I said,I fully respect.  If the article was not in favor of the NKF policy position, I am confused as to its point.



I like the Story of A Man was Traveling from Jerusalem to Jericho, for many reasons, not the least of which is that it demonstrates the kind of sacrificial giving we are discussing here.

But a Samaritan, as he traveled, came where the man was; and when he saw him, he took pity on him. He went to him and bandaged his wounds, pouring on oil and wine. Then he put the man on his own donkey, took him to an inn and took care of him. The next day he took out two silver coins and gave them to the innkeeper. 'Look after him,' he said, 'and when I return, I will reimburse you for any extra expense you may have.' "Which of these three do you think was a neighbor to the man who fell into the hands of robbers?" The expert in the law replied, "The one who had mercy on him." Jesus told him, "Go and do likewise."  (Luke 10 33ff)

Caring for his own needs, giving of his own wealth and  reimbursing the people who care for and heal the injured man.

I read in your essay that the moral decision is that the injured or sick man should rather work to take care of himself, if he is able.   One of the truths of the parable is that we are not able, and we are dependent upon others.  Jesus also said  "No one has greater love than this, to lay down one's life for one's friends. You are my friends if you do what I command you."

Our cultural concept of heroism is a person that risks their own life to save another.  To tell a fireman not to run into a burning building because it might be dangerous is offensive to the calling of their service.

You wanna sling scripture, I'm cool with that. an MDiv should be good for something.

As to the transplant numbers in Iran:
from your BMJ cite:

The waiting list for kidney transplantation in Iran has improved more than in any other country in the world,

The improvement may not have completely eliminated it, but it has improved it more than any other country in the world.   

The cite about most (65%, not 80%)donor would not donate again:
Yes, but the issue again is the insufficiency of the funds, and failure to follow up medically.  Those are both fixable, and not salient to the basic validity of the issue.




The India cite is on unregulated  sale of kidneys, and I am not asking for that,nor is anyone else.  Let's cut out the straw men and discuss the issue at hand.

To make something clear here, I disagree with your position on this issue.  I have no problem with you or what you do.  I would hope that you could return to the issue and instead of attacking the people who disagree with you, you could defend your position.  I think it's important that this issue is discussed, but I think its more important that it's done civilly.

[stauffenberg]

Whatever the results of the Iranian program -- and no one can cite these as a conclusive debating point since the actual data are in dispute and poorly recorded in the first place -- there can be no question that if a system of paid donation were properly run by a society with an advanced medical system and a highly-organized administrative apparatus the transplant waiting list, and the many thousands of preventable deaths it causes every year, could be eliminated.  I cannot conceive of any social or moral value -- whether altruistic donation, non-commodification of the body, non-coercion of the poor by economic temptation, respect for the insular selfishness of all members of society and their implicit right to fail so dramatically to cooperate with each other that they kill people, etc. -- which can possibly even come close to the absolutely supreme moral duty of saving human life.

Hemodoc knows that his blanket statement that there is a form of dialysis with outcomes equal to those of transplant is untrue, because on other fora even he restricts this claim to the comparison of short daily home hemodialysis with CADAVER transplant, which is very much inferior in patient morbidity and mortality to LIVE DONOR transplant.  Also, if you take a close look at the studies showing the benefits of short daily hemodialysis, they are totally flawed by the fact that they were conducted over such an extremely short time span and yet boldly project those highly limited implications over decades of expected health outcomes for the patients.  But since 15% of patients ultimately die from lack of vascular access for dialysis, a problem which should only be made worse by the additional needling involved in short daily dialysis, and since this elevated death rate only occurs after many years of dialysis, the positive results for short daily dialysis don't even measure this problem, so they are wildly off in their estimates of the life expectancy that dialysis modality will achieve.  Hemodoc always claims that those with failing vascular access would not be eligibile for translant anyway, but not only is this medically incorrect, as the clinical example cited by Beauchamp and Childress, Principles of Biomedical Ethics (Oxford: Oxford University Press, 1994) p. 514 proves, but it also misses the point, since those with a transplant would not even remain on dialysis long enough to develop lack of vascular access.  On the contrary, early transplant, which could be achieved with paid living organ donation, would postpone return to dialysis so that when patients eventually become medically ineligible for transplant, their vascular access would not have been lethally exhausted.  There is also the study recently posted in the News section of this website showing premature dementia results from continuing high creatinine levels even slightly outside the physiologic range, such as would continue with short daily dialysis, but which could be avoided with some well-functioning transplants.  Finally there is the fact we all well know, that it can be a living death to spend every day for the rest of your life dependent on a machine, and nothing can match the restoration of freedom and spontaneity, essential to the kind of life humans naturally need, which comes only with a transplant.

Anyway, I thought you said you were going to Vermont for the weekend and we wouldn't be hearing from you for a while.  I hope you didn't cancel your trip just for us.

[Rerun]

I needed to step out of "time out" for just one comment.

If you work for the US Government like United States Department of Agriculture..... you get 30 days off with pay for donating a kidney.  That is other than your usual Annual or Sick leave.  That was implemented about 10 years ago.  Not too many people know that.

OK back in the corner.