Organ Failure

[Wallyz]

So- you are advocating against live Kidney donation in many cases, and against transplant as therapy for many patients.  That's exactly the difficulty I have with your stance.  I think more transplant, better dialysis, and more prevention are going to be needed in the next 40-50 years to address the flood of kidney patients, and advocating against any of these approaches is harmful to ESRD patients. 

Live donor donation is here to stay (until we can grow kidneys from stem cells, I'll go suck on my pipe now). Since it is here, we need to increase the population of voluntary donors.  I still believe that the Iranian Model, in spite of its problems, shows us that it can be done.

 

[Zach]

So- you are advocating against live Kidney donation in many cases, and against transplant as therapy for many patients.

Let's get the terminology correct, so not to confuse the issue.

There is live Kidney donation and there is live Kidney selling.
One can be in favor of the former, and be against the latter.

[Meinuk]

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.

Due to the sudden loss of Epoman, I believe that the Administration has certain limitations.  (which I believe Sluff & co are working on remedying)
Until then, Bill has an excellent CKD links page

http://www.billpeckham.com/from_the_sharp_end_of_the/ckd-links-and-resources.html

[Wallyz]

So- you are advocating against live Kidney donation in many cases, and against transplant as therapy for many patients.

Let's get the terminology correct, so not to confuse the issue.

There is live Kidney donation and there is live Kidney selling.
One can be in favor of the former, and be against the latter.

I agree, but Dr Lairds Argument is that Live donation in general puts donors at risk while providing no extra benefit to self care dialysis patients.  I wish the discussion was about Compensation vs uncompensated live donation,  but he has made the claim that live donation is too unsafe for both parties, and that home hemo is what should be pursued instead of increased donation rates.


Addressing the issue of donation vs selling, what is the qualitative difference between blood, plasma, kidney and/ or ova donation that makes some acceptably compensated and some not?

[Zach]

Addressing the issue of donation vs selling, what is the qualitative difference between blood, plasma, kidney and/ or ova donation that makes some acceptably compensated and some not?

Just a quick stab at it:

Blood -- virtually unlimited over time for the individual.  Many hospitals ban paid blood.
Plasma -- virtually unlimited over time for the individual.  Many hospitals ban paid plasma.
Hair -- virtually unlimited over time for the individual (unless they go bald).
Sperm -- virtually unlimited over time for the individual (unless they can't find a dirty magazine).
Ova -- limited number per woman over a lifetime.
Kidney -- only one in a lifetime, unless you've been born with three or four (from the twin you never knew).
Liver --  a partial lobe can regenerate.  I like mine smothered in onions.

The last three have greater risk due to the use of full anesthesia and surgery in the abdominopelvic cavity.

[stauffenberg]

Hey Zach and Hemodoc: I presented a whole series of data fully backed by well-recognized sources in medical science, extensively cited.  Then the two of you fire back (violating the rules of this message board which state that no negative personal comments are permitted against people posting messages) by simply calling me a liar, stating that everything I say can be discounted "because of the source it comes from," as though I am to be regarded as an inveterate liar, and then offering not one shred of scientific data, sourced or not, to criticize the arguments I have developed!  You have to recognize that that is not a rationally valid way of making argumentative points.

I stand by absolutely everything I wrote and I stand ready now and in the future to debate this issue with anyone and back every single thing I write by extensive scientific proof in the form of references to recognized sources in the medical and scientific literature, as I have repeatedly done in this debate in the past, even though no one has yet offered a shred of counter-evidence.  I expect those who care to debate this point with me to do the same, or to confine their comments to pure logical inference if they depart from discussing the empirical data.

[Zach]

Hey Zach and Hemodoc: I presented a whole series of data fully backed by well-recognized sources in medical science, extensively cited.  Then the two of you fire back (violating the rules of this message board which state that no negative personal comments are permitted against people posting messages) by simply calling me a liar ...

I never called you a lair.
I did infer that you were obsessed.  Does not violate the rules of this message board.

Try again.

[stauffenberg]

From Zach, Reply # 74, to Organ Failure, at 01:01:00 today:

Quoting Hemodoc: "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."

Followed by a figure giving applause.

Thus, Zach, you have made Hemodoc's slander your own.  Try again with your defense, because this initial foray into the realm of courtroom eristics will not work.

I repeat the rules we are operating under:

From Sluff, July 9, 2008, 08: 09:44 PM, Transplant Stories section:

Any further personal attacks beyond simple disagreements will result in a minimum 90 day ban from all IHD family of sites.  Play nice.

[Sluff]

Any further personal attacks beyond simple disagreements will result in a minimum 90 day ban from IHD. 

Sometimes there is a grey area between disagreements and slamming another member. There is also a grey area between freedom of speech and what is a demeaning display of affection. It is the rule of IHD to keep personal attacks off the forum.

All decisions will be final and will be at the discretion of the IHD Administration team, when this rule is not adhered to. Please remember this in your posts and refrain from inflammatory remarks. If there is something you really need to say send each other a PM. Work it out amongst yourselves before we end up with members taking sides, we sure don't want a riot on our hands.  Play nice.

Sluff/Admin

[Zach]

Thus, Zach, you have made Hemodoc's slander your own.

Take a deep breath.

[Wallyz]

Addressing the issue of donation vs selling, what is the qualitative difference between blood, plasma, kidney and/ or ova donation that makes some acceptably compensated and some not?

Just a quick stab at it:

Blood -- virtually unlimited over time for the individual.  Many hospitals ban paid blood.
Plasma -- virtually unlimited over time for the individual.  Many hospitals ban paid plasma.
Hair -- virtually unlimited over time for the individual (unless they go bald).
Sperm -- virtually unlimited over time for the individual (unless they can't find a dirty magazine).
Ova -- limited number per woman over a lifetime.
Kidney -- only one in a lifetime, unless you've been born with three or four (from the twin you never knew).
Liver --  a partial lobe can regenerate.  I like mine smothered in onions.

The last three have greater risk due to the use of full anesthesia and surgery in the abdominopelvic cavity.

I don't think anyone is suggesting that hospitals be forced to take compensated kidneys if they don't want them.

The list of  Plasma, blood , ovum, liver, kidney goes from lower risk to donor to higher risk to donor, and it doesn't make sense that the more risk you undertake,the less compensation you receive.  It's rational to compensate for the higher risk, higher benefit donation.

[paris]

At this time, Duke is accepting egg donations from healthy women of child bearing years and they will be compensated $3000.  It is hard sometimes to understand why one is "paid" and another donation isn't.   And this thread makes my head spin, so I am back to just watching again.

[Hemodoc]

Sorry to sign back on, but I have once again been completely misrepresented.  I have not spoken out against living related or unrelated donation to the exclusion of either as a form of renal replacement therapy as Wallyz incorrectly infers.  Please go read my multiple posts where I have repeatedly made that point.

I have stated strongly that all renal patients have a duty and an obligation to take seriously the potential harm that living donation might cause.  For myself, those that are willing to donate to me have their own health issues and needs that I have determined for MYSELF, that I am not personally willing to place them at risk especially since I have an alternative treatment in daily dialysis which offers equal mortality reduction.

I see many going so far as to place the entire burden of renal replacement therapy on a renal draft and secure kidneys by complete coercion.  I personally believe that is a very selfish position for a CKD-5 patient to take.

I have further stated that not all patients are good candidates for daily dialysis just as not all patients are good candidates for renal transplantation.  Yet, in the media and on renal blogs, the current bias is completely in favor of renal transplantation without any consideration whatsoever that there even is an alternative treatment.  My personal opinion is that this is irresponsible reporting by the media, and irresponsible informed consent by my colleagues.  I have stated that in numerous posts for several months and I have not wavered from that position.

I have further stated that if I could no longer consider PD or HD to sustain my life, then I would absolutely consider accepting even a living donor transplant if death would be imminent without it. Those willing to donate to me are willing to take those risks, yet unless I have no other options, I will not and would not place their lives in jeopardy even if the risk is very small.  Otherwise, I would first consider a cadaveric transplant.

With in the confines of the false conclusions, false statements by Wallyz and Stauffenberg, I have concluded that it is impossible to hold a debate when the two of you deal with misinformation, out of context comments and complete confusion of my stated position.

Once again, do we as CKD-5 patients have a duty and a responsibility to consider the potential harm we could cause another individual in pursuit of our own renal replacement therapies?  The answer is absolutely yes.  Any person that would place their own benefit above another person's benefit without considering the harm that could occur is in my opinion selfish to a high degree.  I hold that opinion especially when the real effects of renal vendors in countries such as Pakistan, India, and the Philippines is trivialized and dismissed by small data sets from exclusively screened western nation donors.  There is a significant disconnect in doing this comparison in these different populations since the burden of disease is so much greater in the very people that have become the targets of transplant tourism.  Many conclude that this is a practice that should be put to an end since it is exploiting these people who often are vainly trying to improve their situation, but in the end, a large majority end up worse off.

Further, since I have met my extended Filipino family in person, I have the personal face of many such potential donors and the overwhelming poverty that could lead a person to take upon themselves the burden of renal vending without any hope of an actual improvement of their economic and financial outcome even within a short few year period of time. Further, there is data suggesting the long term financial outcome is worsened by donating their kidney by decreasing their lifetime earning potential.  Thus, the arguments of no ill health consequences and a vastly improved financial status for these people is not a sustainable argument.  The Declaration of Istanbul explains this point in great detail.

Therefore, for all of the above reasons, I stand with the NKF against payment for renal donation here in America or across the world.  The current demand from western nations is in my opinion driven by a selfish state of being where in America where only a fraction of those that could do home hemo or PD do not even consider it as an option.  Since only 1% of the potential 30% of people that could do home hemodialysis do not likewise have the opportunity to do so due to the media bias and lack of informed consent by my medical colleagues, I stand in opposition to those current entrenched positions.  Doing the math, I contend, in my own opinion,  that maximizing the opportunity for home hemodialysis here in America would have a much greater potential for improving not only the general outcome of all American CKD-5 patients, but it would in itself significantly lower the number of people seeking renal donation in the first place and lower the cadaveric renal transplant list and improve waiting times for those on the list.  How many of the 1/3000 that will die giving a living kidney donation does it take in prevention  by first considering other treatment options to justify a little bit more of a less self centered approach to renal replacement therapy?

That is my own opinion on all of the issues presented on this thread.  Anyone that infers anything differently from this point of view and poses it as my view, I stand ready to refute as needed.  My opinion is not derived from a specific theologic standpoint.  I have only discussed general Christian principles due to the false statements started first by Stauffenberg.  If my viewpoint is not falsely represented, then I am through with this discussion, but I do absolutely reserve my right to defend the correct manner in which I have voiced my opinion should further posts slander my views summarized above.  

[karen547]

Wow, people really need to calm down lol! This is getting way out of control.

[okarol]

It's a good discussion, as long as it stays on topic.

One might argue that "harm" is being done to society in general by a person who uses Medicare to fund their years of dialysis when a transplant would reduce this cost.

I am not 100% sold on paying for kidneys. I have no experience and not enough brain cells to keep up with this debate.

I do know, however, that the living donors I have met are amazing and giving people. They are bright and articulate and determined to help.
I am sure none of them did what they did for fame or fortune.

No one should get a transplant, nor give a kidney, until they have been fully informed of the pros and cons. Hopefully this is improving as centers gain more experience.

Ok I am watching and listening, done talking.       

[Hemodoc]

Dear okarol,

Thank you or staying on topic and adding positively to this discussion.  I must confess that is a breath of fresh air and puts the fun back into a proper debate.

I will once again come out or retirement myself to add that I have been very careful in my comments to stick to medical risks and potential medical harm in my comments on this thread. I have done so simply for sake of discussion to limit the topic to one that can be managed.  However, since America has only 1% of its patients on home hemodialysis, it is not operating on the best dialysis economy of scale.  I would dare to venture that no one is stating that we can supply 100% of all CKD-5 patients a kidney by a pay for organ scheme here or anywhere.  If the current level of organ donation in America is increased a thousand percent with some miracle procurement system, whatever it is, that is only approximately 1/3rd of all patients in need of renal replacement therapy.

Renal transplantation is a long, long way away from being the complete and solo renal replacement therapy if it ever will come to that point.  I did a couple of articles on this back in June on Bill's page.

Competing or Complimentary? Transplant or Daily Dialysis

http://www.billpeckham.com/from_the_sharp_end_of_the/2008/06/competing-or-co.html

The truth about paying for kidneys

http://www.billpeckham.com/from_the_sharp_end_of_the/2008/06/the-truth-about.html

I argue that daily dialysis and renal transplant are not competing treatment options, but instead, they are complimentary.  I further believe that daily dialysis is the best "bridge to transplant" for those that cannot receive a preemptive transplant.  It is time for America to catch up again with the rest of world and utilize the other life saving renal replacement therapy.

Now, as far as costs, daily dialysis and incenter self care dialysis have already been shown to dramatically reduce costs from conventional 3X/week dialysis.  Once again, here is an article I have done on this subject of incenter self care costs in Bill's blog.  I will prepare an article on the costs of daily dialysis after I return home from my vacation in a couple of weeks, but the data is there for this as well for a $10,000 - $39,000 decreased total cost per patient per year.

Cost effectiveness of incenter daily dialysis - The Real Story

http://www.billpeckham.com/from_the_sharp_end_of_the/2008/07/cost-effectiven.html

Ignoring the Evidence - Self Care In-Center Contains Costs

http://www.billpeckham.com/from_the_sharp_end_of_the/2008/07/ignoring-the-ev.html

Thus, the health benefit of daily dialysis rivals the health benefit of transplant and needs to be a complementary part of the American renal replacement therapies to a higher degree than it is now.  Further, although the 3 years costs for transplant are less ( we don't have data on the long term costs including some of the devastating renal transplant specific complications), a complimentary approach including a bridge to transplant where patients will have a 70% less chance of dying on the list, reduced total current costs and improved quality of life is needed to reduce the overall cost structure of American renal replacement therapies.  There is absolutely no reason not to advance to an all encompassing system here in America that includes optimal hemodialysis for all eligible patients that choose to do so.

[Hemodoc]

Dear okarol,

Here is an excellent compiled list by Home Dialysis Central on the cost savings of daily dialysis.  I hope that this information is useful.

Peter

http://www.homedialysis.org/files/pdf/pros/HomeHemoCostBib.pdf

[Hemodoc]

Dear okarol,

Here is an article noted on RenalWeb today, just below Bill and Anna's articles from DFTSEOTN, offering an editorial on home hemodialysis including the cost aspect.  I hope that this is also helpful information for this discussion.

http://www3.interscience.wiley.com/cgi-bin/fulltext/121387572/HTMLSTART

Peter

[Hemodoc]

http://www.renalweb.com/

[Wallyz]

Dr Dr Laird- I am sorry you feel I am misrepresenting.   What I have heard is from you from the beginning if this thread is that transplant is inferior to daily home hemo therapy, and that when people have  a choice, they should choose daily home hemo.  I am of the opinion that daily home hemo and transplant need to both be radically expanded.

[Zach]

Dr Dr Laird- I am sorry you feel I am misrepresenting.

I think the problem may be simply misreading what Hemodoc wrote.
Perhaps you and my good friend stauffenberg should use the quote tool to more accurately refute what Hemodoc writes.

What I have heard is from you from the beginning if this thread is that transplant is inferior to daily home hemo therapy, and that when people have  a choice, they should choose daily home hemo.

I have not read such a declarative statement as you suggest -- perhaps you need to quote his words, not interpret his words.

[Hemodoc]

Wallyz, you heard no such thing from me that transplant was in any sense inferior to daily dialysis..  Once again, thank you for your misinterpretation and false inferences of my views.  I believe that I have very clearly stated my points that most people have and do understand.

If you are truly interested in a debate of these issues, then please debate honestly and without false inferences.

[Hemodoc]

"I argue that daily dialysis and renal transplant are not competing treatment options, but instead, they are complimentary.  I further believe that daily dialysis is the best "bridge to transplant" for those that cannot receive a preemptive transplant.  It is time for America to catch up again with the rest of world and utilize the other life saving renal replacement therapy."

Wallyz, why not comment on this above instead of making up your false dichotomies of what you falsely state I have said.  Complementary, not competing, never have I stated anywhere or at anytime that transplant is inferior. 

So, what is your opinion on the statement that daily home hemodialysis is a complementary treatment option to renal transplant?

[stauffenberg]

Sluff: In your original statement of your fixed rule for governing this forum you clearly and emphatically stated that "ANY FURTHER PERSONAL ATTACKS," which clearly means FROM THAT MOMENT ON, will result in suspension from the IHD message board for the person making the attack for 90 days.  Now that you have before you undeniable proof that a FURTHER PERSONAL ATTACK, coming well your announcement of the rule, has been made against me, instead of enforcing the rule fairly and honestly to protect me by it, after I have abided by it myself, you now push back the goal posts and pretend that the rule DID NOT REALLY MEAN WHAT IT SAID.  Oh no, all the rule meant was that you were going to say at the next violation, that ANY FURTHER attacks AFTER THAT NEXT ATTACk would be punished.  What are you going to say the next time the rule is openly flouted?  That the rule will kick in on the next attack after that?  Either you have a rule or you don't.  Either you are going to enforce it honestly and fairly to protect all members or you aren't.

As for Hemodoc, with the following support of Zach, calling me a LIAR, being somehow in what you call "the grey area" between disagreement and personal attack, I must confess I cannot follow your logic.  What constitutes a more personal attack than calling someone a liar?  Also, Hemodoc's vicious, personal (and profoundly UNCHRISTIAN!) attack on me is even more emphatically made a personal attack and not merely a theoretical disagreement by his adding that my "lies and misrepresentations will be noted for the source it comes from," CLEARLY indicating that it is ME PERSONALLY who is to be regarded as so corrupt and defective that merely knowing that any statement comes from me already proves that it constitutes lies or misinformation.

If you won't enforce honestly and fairly your very own rule when it should protect me, after I have carefully abided by it, then I don't see why I should ever contribute to this forum again.

[Wallyz]

"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."

You have placed Daily Dialysis against and superior to  Live transplantation, (do it first)based of the selfishness of demanding an organ form another, and the negative effects of transplant therapy.

You have placed financial incentives ata lower ethical standard than "Altruistic" incentives.

The problem I have had from the beginning is that asking patients and providers to choiose dialysis instead of transplant, and to rejct a promising infrstructure for obtaining more willing donors is not in the patiens, not in the systems interest. You have made moral claims on the superieority of Daily dialysis over transplant, and of the two therapys similar outcomes. We diagree, both on the morla evaluaiotn,a nd the outcomes evaluation.

The original article made no reference to objection based on harm from compensation, it made refence to harm from donation.

I am in agreement withhe idea tht we need to expand optimal dailysis.  I am not in agreemant that voluntary  live donation needs to be disparaged or discouraged in any way.