Organ Failure

[Hemodoc]

Dear Wallyz,

First of all, I did not accuse you of being the same person as Stauffenberg, I did remark on how rare it would be to find two people that make the same false accusations against me at the same time.  Read my post again before making another false assertion of my statements as you have already done several times.

Further, if you believe me comparing you to Stauffenberg is an ad hominem attack, then that is your assessment of Stauffenberg and not mine.  I suggest you may owe Stauffenberg an apology for that comment.

In addition, my analogy with the good samaritan was in response to Stauffenbergs inaccurate portrayal of Christian social behavior.  It was not in response to the Satel argument that I made this example directly from the Bible.

You further state that you disagree with my theology on my post disagreeing with Satel.  Please point out what theological state if any that I made in that post.  You state that you want to debate the issues, yet both you and Stauffenberg continually take my comments out of context, make false assertions of what I have stated and confuse the very simple elements that we started with.    Any references to theology was only to clear the misstatements starting with Stauffenberg’s attack against my Christian ideals.    Why was this even brought up at all in a discussion on renal donation when it was not in the least a part of my argument with the Satel article?

Further, you state I am advocating for policy to be applied universally when all I am doing is agreeing with the NKF position and disagreeing with Satel.  It was your incorrect statement that I am advocating for no living transplants at all.  I have never in any manner so stated.  Once again, if you wish to “debate” then please do not make false statements or assertions that you attribute to me.

I will on the other hand challenge all CKD-5 patients that are contemplating their treatment options to so note that a living donor transplant places absolute risks upon another person.  If you go back and read my original post on DFTSEOFN, you will see that I am advocating a personal responsibility to not cause harm to another person as the preferred choice of renal replacement therapy without considering your own responsibilities.  Noting that I can have the same quality of life and longevity without placing my family or a complete stranger at any medical risk is a responsibility that ALL seeking such treatments need to seriously consider.

If more CKD-5 patients took upon themselves to consider daily dialysis at home, we would save $10,000 - $39,000 per patient per year, we would equal transplant mortality reduction in the range of 70% and we would significantly lower the waiting time on those that choose the transplant route.  I stand by that statement and that was the sole intent of my article on the Satel post.  Any conjectures by you or Stauffenberg apart from these statements or intentions on my part are not an accurate portrayal of my views.

Thus, if you look at what I have stated, it is you that has made an inaccurate extrapolation of my views.

Lastly, even though I gave you the article directly, you have likewise misquoted from it.  The numbers are 85% not 65% as you have incorrectly noted.  Here is the quote and the link once again.

"Several donors said they had attempted suicide and spoke of donors who had killed themselves.278 70% of donors said that they felt worthless after the operation and 85% stated that if given the chance to go back in time, they would not donate their kidney and would also advise others against donating or selling their kidneys or any other organs whilst still alive."

http://www.flonnet.com/fl1907/19070730.htm

So, if you truly wish to debate the issues with me, that is fine, but do not make false extrapolations and attributions to me that I have not made, nor do I agree with.  Further, if we are to debate the issues, then please keep the facts correct as well.

Lastly, I would likewise appreciate the avoidance of as hominem attacks such as stating Dr Laird’s views are “dangerous” simply because I have stated that I am taking responsibility for my disease and not placing a burden medically upon another person with healthy kidneys?  That is dangerous!!  Further, you went on to imply that I had left my intelligence behind in my comments.  Sorry, but the only ad hominem attacks in the so called debate have been blatantly one sided on your part.

[Hemodoc]

Dear Stauffenberg,

Thank you for confirming my point on the data from Iran, we don't have it, it is not collected and the studies that we do have are not accurate.  It is you that stated the Iran model is "proven" when if fact by your admission it is not.  I stand by my recommendation to look carefully at the claims of the Iran system as I do not believe that it will hold up to the light of day if we could examine all of its components.

Further, the short daily dialysis is as good as cadaveric transplant is an amazing statement especially since nocturnal daily dialysis has much improved data form the short daily.  No, I do not back down form the facts of decades of usage in other countries.

Lastlly, I did greatly enjoy my weekend in Vermont and they actually have internet access even up there.

[Sunny]

This thread has really got me thinking.
I can see rationality in both sides of the coin regarding  whether we should buy kidneys or not.

[okarol]

Thank you for confirming my point on the data from Iran, we don't have it, it is not collected and the studies that we do have are not accurate. 

Iran? We don't even have data here in the US regarding living donors.   

[okarol]

I will on the other hand challenge all CKD-5 patients that are contemplating their treatment options to so note that a living donor transplant places absolute risks upon another person.  If you go back and read my original post on DFTSEOFN, you will see that I am advocating a personal responsibility to not cause harm to another person as the preferred choice of renal replacement therapy without considering your own responsibilities.  Noting that I can have the same quality of life and longevity without placing my family or a complete stranger at any medical risk is a responsibility that ALL seeking such treatments need to seriously consider.

It is the responsibility of the donor to decide about what risk they are willing to take vs the good it does for another person.

If more CKD-5 patients took upon themselves to consider daily dialysis at home, we would save $10,000 - $39,000 per patient per year, we would equal transplant mortality reduction in the range of 70% and we would significantly lower the waiting time on those that choose the transplant route.

Sadly, this is an option available to only about 10% of the dialysis population at the present time (stat per NxStage rep at RSN meeting today)

[Hemodoc]

Thank you okarol for you kind responses.  Yes, it is indeed the donor that must weigh the risks of donating, but is it not even more important for those in need of renal replacement therapy to think of this as well especially in light of the fact that we do have an alternative with equal mortality?

[Chris]

One thing I will say is that you can't compare apples to oranges, meaning comparing what they do in Iran and how we would do it in the US, or even what happens in Thialand. We may not be perfect, but w would do things better. If someone is willing to donate a live organ, in my gut I would hate for them to loose any finances by them missing any income and would want to compensate them somehow. People who donate deserve this for their efforts and risk. Cut all the crap and get down to the nitty gritty. This should be about what is the right thing to do for someone who is willing to donate (as long as they pass health screenings).

[Wallyz]

Dr Laird, you did imply that we were the same person.  You were accusing Stauffenberg (or me)of being a multi account user. Other posters noticed the same thing, Don't try to weasel out of it.   Apologize and move on.

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.

The theology was started in this thread before I posted.  To clarify, that was the theology I was referring to in my first post.

IF you agree with the NKF position on policy (not paying donors) and you speak out publicly, then you are an advocate for that position.  Why try to

The argumentation used stated that the moral value of self care (i.e. In home daily dialysis) is greater than live donor transplant because live donor puts another at risk.

You advocate selfcare int he home instead of compensated live donor, urging patients to take the burden  upon themselves rather than place another at risk.  You have rejected both compensated and altruistic donorship in your own situation.

If more CKD-5 patients took upon themselves to consider daily dialysis at home, we would save $10,000 - $39,000 per patient per year, we would equal transplant mortality reduction in the range of 70% and we would significantly lower the waiting time on those that choose the transplant route.  I stand by that statement and that was the sole intent of my article on the Satel post.  Any conjectures by you or Stauffenberg apart from these statements or intentions on my part are not an accurate portrayal of my views.

We agree that selfcare in the home needs to be more widely used, better funded and better supported.

However, the argument is placed against the negative of transplant, that is, risk to another person. (.03% Mortality, in your estimation)  If people are willing to take this risk to cure a disease, rather than manage it, what is the moral imperative against it?  Transplant pays for itself in 3 years (4-5 if the dd at home savings you claim are correct) has better mortality rates  for the type of dialysis 90% of the patients get, and improves quality of life.  Moreover- it is  cure (temporary) for the disease, rather than management of the disease.

What is it with the bias against healing and towards disease management? It's everywhere in the medical field today.

All your arguments are about Live donorship, not compensated donorship.  You have rejected altruistic donorship under the auspices of the patient has a responsibility to deal with their own disease.  You are now saying that you support altruistic donorship, but I honestly don't see where it fits into your moral reasoning on this issue.  You haven't offered a scenario or guideline where altruistic donation works better than at home daily, and your argument that kidney patients don't have a claim on another's kidney, even offered freely, seems to preclude it.

but is it not even more important for those in need of renal replacement therapy to think of this as well especially in light of the fact that we do have an alternative with equal mortality?

The equation falls down when at home daily is not available, or with the issues of dementia from elevated creatinine levels.  Similar mortality does not equal similar quality of life.

Another issue for our society of limited resources-

Is it in the societies financial interest to have more people on dialysis, or more people transplanted?  For years, it has been accepted that healthy transplant recipients are cheaper long term than even healthy, stable dialysis patients, and when you figure in illness and complication rates, the math becomes much clearer.

[Hemodoc]

Dear Wallyz,

I will not rehash many of the issues that I have already discussed in prior posts and on Bill's page.  I believe that you should go back to my Satel response and see that I have personally called Dr. Satel and the proponents of payment for renal donation to take an equal stand to bring about the option of daily dialysis for all those in this nation that should choose to do so.  Once again, you continue to make assumptions about my positions from a speculative standpoint when I have not so stated many of the issues that you state I have stated.  That makes for a very difficult and confusing "debate."

Now, I have taken an issue with Dr. Satel stating she would seek a kidney anywhere and even if she had to pay for it which at this time means she would have considered the illegal marketplace commonly called transplant tourism.  That is a quite interesting standpoint for a doctor who has otherwise condemned this practice.  I used my own personal walk through the same issues to show that there are others that don't wish to go so far as Dr. Satel was willing to do.  It appears that she had an altruistic donor come forth which is a benefit to her and I have no problem with that.  For an informed donor, that is their choice.

I likewise have family members willing to do the same for me, but I have looked at the issue from their standpoint and decided against that for myself as I do not believe that they should encumber the potential health burdens that can and do occur with renal donors since I am an excellent candidate for daily dialysis.  That does not mean that I have condemned that option for others, I simply decline it for myself out of my love for those in my family and the potential risk to their health.  From other threads here on IHD, I do not stand alone in this.  There are many that will accept a cadaveric transplant, but will not seek or accept a living donor transplant for this same reaon.  This is not a policy making statement, it is instead an example of someone who is not willing to take a chance on harming one of my family members.  The statements stand alone.

I continue to advocate that if we are going to make informed choices, then the issue of daily dialysis needs to be part of the renal transplant informed consent process.  I do not recall that when going through the renal transplant evaluation that my wife and I participated in that it was presented as an equal option which it is.

Once again, go look at my post and look at the last two paragraphs. 

"Sally Satel, my colleague, my fellow survivor of renal disease, I call upon you and your colleagues to open the dialogue for optimal dialysis here in America first before falling to place selfish burdens upon any person who would be motivated by financial incentives to “give” you or me of his own flesh, blood and organs.

I applaud the National Kidney Foundation’s courage to stand forth for ethical behavior and moral fortitude in the coming days of a full fledged frontal attack against turning man’s flesh and blood and organs into cheap commodities for sale.  I urge the NKF to continue as a leader in the ethical and compassionate care of renal patients that they already are.  I call upon all of my colleagues whether for or against payment for organ donation to overcome the mediocre treatment offered here in America and implement cost saving and life saving optimal dialysis."

After listing my own personal thoughts on the donation process and considering the best for the donor as well as my own options, I then called upon the people that put forth the option of payment for renal donation to stand for optimal dialysis here in America which has a much greater chance of reducing suffering than doubling or tripling the 14,000 or so renal transplants.  That still leaves 90% of CKD patients with suboptimal dialysis. 

Your posts on my article as well as Staufenberg's have ventured into completely foreign arguments to my rebuttal of the Satel article.   If you wish to "debate" these issues, then lets agree to keep the discussion limited in scope to Satel's article and my rebuttal and I will gladly correspond on these points alone.  If you choose to "extrapolate" my comments and turn them into issues that I have not commented upon, then there is no point whatsoever in continuing this debate at all.  It is a great waste of my time to go back and dispute point for point false statements attributed to me.  So, it is your choice.

Finally, I do support the NKF opposition to payment for renal donation not because I disagree with altruistic donation as you and Staufenberg have falsely alleged, but because it creates a climate of making man's organs a cheap commodity.  In this, I am not alone in opposing it, nor is the NKF.  If you oppose my views, fair enough, all I ask is that you put forth your own arguments and refrain from attributing words that I have not spoken, nor really care to debate with you or anyone else.  If you don't like my theology, first don't take my quotes out of context and attribute them to different issues, and second, I don't care to discuss theology issues here at IHD.  If you wish to discuss theology issues, then please take it to a religious issues blog.  I am here to advocate for optimal dialysis.  I am not here to discuss, argue or persuade you on issues of theology, but I will defend false statements attributed to me.

[Hemodoc]

Dear okaral,

You are completely correct that we do not even have the data on the renal donors here in America, so how can we even argue from an evidence based approach for expanding renal donation by payment.  We simply do not have prospective and long term data on the real impact of renal donation. 

Further, I once again challenge all that are seeking a kidney to consider whether you have optimized your own renal replacement treatments as your own responsibility before placing the burden of your disease upon another person's own health.  Not everyone is a candidate for daily dialysis.  Likewise, not everyone is a candidate for renal transplant.  Not everyone is a candidate for peritoneal dialysis.  Yet, if more people were informed and knew and understood the true data on daily dialysis, would they still be as eager to place another person in peril and jeopardy of their health as well?

As a licensed physician, it is my job to make these considerations for my patients.  As a husband with the knowledge of an MD, it is my duty to protect my partner from undo risk.  As a father with the knowledge of an MD, I have a duty and an obligation to utilize all treatment options available to me BEFORE placing her or future children at any risk.

When I looked over all of the risks, benefits and alternatives, I saw that my disease is my responsibility to manage with the resources available to me and not to place undo risk upon another person if I can achieve the same results with an alternative treatment option that places no medical risks at all to my family members or a complete stranger.  I challenge all looking into renal transplantation from a living donor to so consider this as well.

[Hemodoc]

Dear okaral,

One last comment for now, there are many like myself that simply are not willing to accept the well documented side effects of the anti-rejection medications.  These include a 9-20% increased risk of cancer of which most have a higher associated mortality than those occurring in patients with a normal immune system.  I find no peace whatsoever when it comes to the transplant medications in part due to the number of patients that I have seen with multiple side effects from these medications.  in such, I may indeed have a negative bias against transplant because this.

On the other hand, if people facing transplant do not get a complete informed consent on this procedure and the alternative options, then the process of renal transplant will be chosen by some patients who would not have chosen to do so if they had known all of the risks.  I find it interesting that the informed consent procedures for so many other treatment options are incredibly detailed, yet with renal transplant, many of the known risks are glossed over "since renal transplant is the only option for a long life" or so many MDs incorrectly believe and present this view.  Renal transplant reduces mortality by about 70% over conventional dialysis 3 days a week.  So does daily dialysis.  Renal transplant improves quality of life.  So does daily dialysis.  Renal transplant reduces dietary restrictions.  So does daily dialysis.

I have no problem with people choosing renal transplantation, but I do have an objection to the current informed consent procedures here in America which minimize the risk assessment for transplantation.  Was anyone out there warned of BK virus?  PTLD? Zoster? etc.  If you were, then you had a better experience in informed consent than many renal transplant patients who never knew of these risks until AFTER they developed them.

[Zach]

Dear okaral,

You are completely correct that we do not even have the data on the renal donors here in America, so how can we even argue from an evidence based approach for expanding renal donation by payment.  We simply do not have prospective and long term data on the real impact of renal donation.

Yes we do.  stauffenberg says it's so.

Given that studies have shown that renal donors in the West actually live LONGER than the average lifespan, I see no rational reason to excuse this slaughter of renal patients. 

[pelagia]

UKTransplant has a fact sheet comparing the costs of transplantation with the cost of dialysis.  According to their analysis, which is dated January 2007,  "The cost benefit of kidney transplantation compared to dialysis over a period of ten years (the median graft survival time) is £241,000 or £24,100 per year for each year that the patient has a functioning transplanted kidney."  

Using a currency converter that equals $446k US for a ten year period or $44,600 per year.  This is assuming the US costs are comparable (I wasn't able to find those numbers).

At the end of 2007 there were approximately 74,000 people waiting for kidney transplants in this country.  If we got them all a transplant tomorrow, by 2018 we should have saved at least $34 billion dollars.  That's assuming healthcare costs don't skyrocket over those 10 years.  Yes, I know some folks aren't truly eligible, but this is just a back of the envelope calculation.

Now what could we be doing with the billions of dollars of savings each year that would be realized if we could get all of those who want transplants off the wait list with a treatment that offers relatively little risk for a healthy donor and better health and well-being for the recipient?  

I can think of a few things... healthcare for children, fight poverty, research to find cures for kidney disease.  The ever increasing dollars we are spending on our burgeoning healthcare costs in the US are going to have major impacts on our sustainability.  Have you seen the size of the US deficit lately?

We need options, not dinosaurs.  I'm all for exploring as many options as possible.  

Sources:
http://www.uktransplant.org.uk/ukt/newsroom/fact_sheets/cost_effectiveness_of_transplantation.jsp
http://kidney.niddk.nih.gov/kudiseases/pubs/kustats/

[pelagia]

One last comment for now, there are many like myself that simply are not willing to accept the well documented side effects of the anti-rejection medications.  These include a 9-20% increased risk of cancer of which most have a higher associated mortality than those occurring in patients with a normal immune system. 

Whenever you are giving statistics such as this, please cite your sources.

[Joe Paul]

These include a 9-20% increased risk of cancer of which most have a higher associated mortality than those occurring in patients with a normal immune system.  I find no peace whatsoever when it comes to the transplant medications in part due to the number of patients that I have seen with multiple side effects from these medications.  in such, I may indeed have a negative bias against transplant because this.

pelagia, Seems to me, these stats are first hand.

[Wallyz]

Let's frame it this way:
Assuming equal morbidity rates for transplant and long term home hemo self care, under what circumstances is transplant morally equivalent to, or preferable to, self care?

From your essay, and from your posts, it appears you have excluded that instance. This is why I went on to make the assumption that in the view presented, home care is always preferable to live donor transplant, due to the risk of donor mortality and health risks.

I understand the problem with trafficking, et al. but the original essay was not about those issues.  It was about Home hemo being a better option than live donation.
I would love to have another debate about how a regulated compensation system can lower the demand for organ trafficking.

I absolutely agree with he informed consent problems in the US system, with renal transplant and with other procedures.   The overall bias against transplant, particularly live transplant, just isn't going to fly at a place called i hate dialysis.

[Wallyz]

The other issue is that the potential upside for transplant is much higher.  My father got a kidney and pancreas in 1995, and his health and quality of life have improved much more dramatically than even daily home hemo could have done.  I do extended home self care, and I don't have as much energy, And Iam much sicker than he is. I expereince the down side and the up side of Home hemo, and I can see thatthe upside is much higher,, wheras the down side to transplant seems an awful lot like the downside to dialyssis, that is, infection risk, lowered immune response, and possibly more dialysis.

[Hemodoc]

Dear pelagia and Joe Paul,

Here are some articles that I pulled up today.

http://www.entrepreneur.com/tradejournals/article/176793705.html

http://www.sciencedaily.com/releases/2005/09/050926074404.htm

http://www3.interscience.wiley.com/journal/118938682/abstract?CRETRY=1&SRETRY=0

http://www.nature.com/ki/journal/v66/n1/full/4494597a.html

http://jama.ama-assn.org/cgi/content/abstract/296/23/2823

Here is a post I did for Bill several months ago.

http://www.billpeckham.com/from_the_sharp_end_of_the/2008/05/deadly-skin-can.html

“Our findings confirmed that the majority of transplant patients surveyed did not know they were at risk of developing skin cancer, and many of the reasons they gave for not practicing proper sun protection or seeing a dermatologist could be remedied by developing an intensive educational approach that raises awareness of the prevalence of this real health threat,”

http://www.renalandurologynews.com/Post-Transplant-Skin-Cancer/article/108863/

Lastly, I spoke of where part of my bias against transplant came from not where the data came from.

I am only giving people some information on renal transplantation that most people on the transplant list never learn until after transplant.  That is a sad situation.

[Hemodoc]

dear Wallyz,

thank you for your comments.  Home Hemo is not for everyone, but there are many that would do very well on home hemo that do not have the opportunity to do so.  That is not right.

As far as renal transplant, most people that get transplants have little understanding of the real risks.  I would like to correct that situation.

[stauffenberg]

Golly, Hemodoc, no matter how much data I cite in my arguments, you just go breezing past, constantly spreading your medical misinformation as though you hadn't even read my posts.  As obsessed as you are with what you imagine to be the massive, overwhelming dangers of being a kidney donor, so great as to justify society in denying potential donors the right to exercise their rational autonomy to sell a kidney, the facts don't bear out that assumption.  As demonstrated by the two huge statistical studies with 31-year follow-up by Ingela Fehrman-Ekholm, et al, "No Evidence of Accelerated Loss of Kidney Function in Living Kidney Donors," Transplantation, vol. 72 (2001) 444 and "Kidney Donors Live Longer" Transplantation, vol. 64 (1997)976, donating a kidney is so medically harmless that kidney donors even live 29% longer than the general population.  Even with the much more primitive technology of nearly 40 years ago, such as might be found in the Third World today, kidney donors had the same life expectancy as non-donors (see E. S. Santiago, et al, "Life Insurance Perspectives for the Living Kidney Donor," Transplantation, vol. 19 (1972) 131.

But even making the generous concession to your inaccurate beliefs that renal donation is such a great danger, why should people for that reason not be allowed to decide to undertake it as an exercise of their own autonomy?  The death rate from cigarette smoking is 36 per 10,000, from frequent air travel is 30 per 10,000, and for other trivial pursuits, such as mountain climbing or motorcycle racing, is very much higher, yet all of these activities are perfectly legal choices that society concedes to the free choice of adults, so what is the difference with renal donation for payment?

Both dialysis (in any modality) and renal transplant have their medical complications, but you cite only the medical complications of the latter option as though they constituted a decisive argument against it.  But of course you have to balance the risks of the one choice against the other to decide.  In doing so, you have to appreciate that it is conceded on all sides that the quality of life among renal transplant patients is much higher than among those on dialysis, and this difference has even been calculated by the Nobel Prize winning economists Gary Becker and Julio Elias in "Introducing Incentives in the Market for Live and Cadaveric Organ Donation" Journal of Economic Perspectives, vol. 21 (2007) 3.

But the one figure which rolls into one easy basis of comparison between dialysis and transplant is the life expectancy, since that combines the net effects of all the complications of each therapy into one common basis for comparison.  For endstage renal failure patients in the 20 to 39 year old age group who are not diabetic, the life expectancy on dialysis is 14 additional years after life after diagnosis, but with a transplant is 31 additional years of life.  For diabetics in the same age group (about 40% of the renal failure population), the life expectancies are 8 years on dialysis and 25 years with transplant.  (R. Wolfe, et al, "Comparison of Mortality in All Patients on Dialysis" New England Journal of Medicine, vol. 341 (1999) 1725.  The latest data from the U.S. Center for Disease Control says that for patients in the 40 to 44 year old age group, remaining life expectancy if they were healthy would be 39.9 years, with a renal transplant is 23.1 years, and with dialysis is 8.1 years. 

You may complain that these figures represent the result for ordinary dialysis rather than for short daily dialysis, but live donor source renal transplant, which even you admit is superior to cadaveric transplant, has a graft half-life more than three times longer (for a two-haplotype match) than that of cadaveric transplant, although for you the fact that short daily dialysis is imagined to produce equal life expectancy
with cadaveric transplant suffices. (D. Hricik, Kidney Transplantation, London: Remedica, 2003, p. 3)

Even your theological reasoning seems difficult to defend.  If the central injunction of Christianity is to "love thy neighbor as thyself," then obviously those with two kidneys should give one to people having only one, since if each person is recognized by all as having equal value with everyone else, since we all love each other as we love ourselves, we would want the available stock of kidneys in the human race to be distributed so as to produce the maximum health and happiness. Obviously this is maximized by having one kidney in each person pair, since their total average quality of life and lifespan is greater if each has one, rather than if one has two and the other none.

But if Christians were in charge of designing society and they found that people were not willing to act on the basis of the Christian injunction of loving their neighbors as they loved themselves, should they fall back on the current elevation of autonomous selfishness to the level of a supreme value, as modern capitalist societies do, and let each person keep whatever he has, even to the lethal disadvantage of his neighbor?  Given that "a rich man shall pass into the Kingdom of Heaven as easily as a camel shall pass through the eye of a needle," I would think that the Christians designing society would require that the 'medically rich' individuals with two kidneys be made to act as if they truly loved their neighbors, and there would be a kidney draft, so that kidneys would be redistributed until each person had at least one.  What is the point of constantly going around repeating that you should love your neighbor as you love yourself if we don't care whether or not people act that way, and if we design society as if it didn't matter whether the outcomes for people were as if people loved their neighbors equally with themselves or not?  You seem to be confusing the central dogma of selfish, capitalist states, "Every man for himself," with Christianity, which is quite a leap of faith indeed.

[Zach]

Golly, Hemodoc, no matter how much data I cite in my arguments, you just go breezing past, constantly spreading your medical misinformation as though you hadn't even read my posts.  As obsessed as you are ...

Now who is really obsessed?

 

[pelagia]

One of the first things our clinic director said to our group when we went in to learn about kidney transplant was, "Never forget that this is a treatment, not a cure."  They reviewed the drug regimes and the risks.  It was not to the breadth and depth of what I have learned through IHD, but they did bring up the risk/benefit issues.  If I fault our clinic for anything, it's that they don't make enough resource materials available.  I've been meaning to tell them that.  

Every potential recipient should know about the patient and graft survival rate information at http://www.ustransplant.org, the vast amount of information available through the US Renal Data System at http://www.usrds.org/ and the National Kidney and Urologic Disease Information Clearinghouse (NKUDIC) at http://kidney.niddk.nih.gov/.  I learned about the ustransplant site on my own through a web search, but did not know about the others until in joined IHD.  I have also become a much stronger proponent of open access for the medical literature as I have been frustrated many times by not being able to access a journal article, especially the more recent ones.  

I wonder if the IHD administration has ever considered creating a reference page on this site that gives the links to some of the key sites for information about dialysis and transplantation.

When I read about risks, I generally try to evaluate them through the lens of my own experiences.  So, I am curious how the skin cancer risks for kidney transplant recipients compare with the risks for those whose jobs put them out in the sun on a regular basis. It seems as if every other person on my floor at work who is over 50 (we are field ecologists at a marine lab) has had one or more skin cancers removed from lips, nose, ears, chest, etc.  Many of us loved the outdoors as kids and spent a lot of time in the sun when we were young.  This was before effective sunscreen products were available and so all we had was zinc oxide.  I haven't had a problem yet, which is remarkable because I am blue-eyed and fair-skinned and worked as a lifeguard for 7 summers as a teenager.  Perhaps I can attribute my good fortune to all the broccoli I eat and the fact that I have been using sunscreen lavishly since it was invented.  Behaviors can effectively modify risks for individuals.

[stauffenberg]

Another thing that confuses the discussion about paid renal donation is all the scare stories, worthy of a Sax Rohmer story, that the opponents of the organ trade or that urban legends create out of whole cloth regarding babies being adopted and then chopped up for organ sales, people being kidnapped in the street and waking up the next morning with no kidneys, white young virgins being lured by Fu Man Chu into the fleshpots of the Orient and having their kidneys stolen, etc.  Most of these stories can be dismissed as utter nonsense, given that they are based on ignorance regarding the technical difficulties of harvesting organs for transplant and the maximim warm ischemia time kidneys can endure before they are no longer usable for transplant.

But I think the best counter-evidence to the theory that the paid donors of kidneys from the Third Wolrd are exploited or have their life or psyche destroyed by their service is provided, ironically, by perhaps the world's greatest enemy of paid kidney donation, Nancy Sheper-Hughes, Director of Organ Watch, who prowls the world trying to murder as many desperate and dying renal patients as she can by preventing them from  buying a life-saving kidney.  When she reported on her extensive field work in the Philippines on this trade, she said (N. Sheper-Hughes, "Rotten Trade" Journal of Human Rights, vol. 2 (2002) 197 at 202): "In the extensive shanty town of Banion Lupa, Manila ... the majority of young men are willing, even anxious, to sell a kidney and they express few regrets afterwards."

[Hemodoc]

Dear Stauffenberg,  from my very first interaction with you on IHD until our last interaction, the conclusion I have come to each and every time is that it is impossible to have a rational discussion with you.  The only reason I even reply to the majority of your posts is for those that would not be confused by your misinformation.  Otherwise, it is a really big waste of time.

Next, please keep your completely incorrect assumptions on what my religious point is or is not.  You most especially state false conclusions over and over again.  If you wish to debate religion, go to another site.  In the future, please stick to the limited discussions at hand.  This is a renal discussion board, not a theology discussion board.  Stick to the facts if you don't mind.

Lastly, it is you  my friend that keeps ignoring the data no matter how many times I post it. I find little sense to even engage in discussion of the facts when you so blatantly and willfully ignore them.  Sorry, but it is not profitable to discuss these issues with you any further. 

I am signing off this post once again since all that you are doing is wasting my time and that of the other people here.  I hope that the lies and misinformation that Stauffenberg will certainly spread on this issue and many others will be noted for the source it comes from.

[Zach]

I hope that the lies and misinformation that Stauffenberg will certainly spread on this issue and many others will be noted for the source it comes from.