I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: News Articles => Topic started by: okarol on August 18, 2008, 01:48:02 PM
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Organ Failure
By Sally Satel, M.D.
Posted: Monday, August 18, 2008
Early this summer, the American Medical Association voted to lobby Congress to permit the study of financial incentives for organ donation. With nearly 100,000 people on the national transplant list and 18 dying every day for want of an organ, the AMA resolution to address the organ shortage could not be more timely.
And yet the National Kidney Foundation, the nation's largest advocacy group for people with kidney disease, won't be a reliable ally. The NKF, which has a $32 million annual budget and is to kidney disease what the American Lung Association is to asthma, says it laments that thousands "die while waiting for that 'Gift of Life.'" But instead of locking arms with the AMA, the kidney foundation is poised to sabotage the association's efforts--in keeping with its recent practice of blocking any attempt to explore the possibility of compensating organ donors. Why the stubborn opposition?
Imagine the American Cancer Society bragging about having derailed an experimental project that might help breast cancer patients--especially when other respected groups were in favor of the measure.
When I spoke with Dolph Chianchiano, senior vice president for health policy and research at the NKF, he told me that "compensating donors would cheapen the gift" and lead to fewer people donating overall. As a kidney recipient, I find this hard to fathom. When I was facing years on dialysis, any healthy kidney, paid for or not, would have been precious to me. What about would-be donors? Won't some be more likely to donate their kidneys, or the organs of their family members, because of the prospect of a financial reward? And if others don't benefit in this way themselves, will they really be dissuaded because other people somewhere in the country accepted a form of payment? When asked in a 2005 Gallup poll commissioned by the U.S. Department of Health and Human Services whether "payments" would affect their willingness to give a family member's organs, 19 percent answered "more likely," while 9 percent said "less likely." That margin favors donation. Young people were especially receptive. One-third of 18-to-34-year-olds said the offer of incentives would make them "more likely" to give a family member's organs, compared with 7 percent who said "less likely."
There's additional evidence that the NKF is wrong here. Paying for other products of the body, such as sperm, ova, and wombs (as in maternal surrogacy) is accepted and has not created shortages. When someone donates his or her body to science, medical schools and tissue processing companies cover the costs of cremation or the burial costs of the entire donated body after dissection or experimental use.
The NKF also makes the standard argument that compensation for organs "could propel other countries to sanction an unethical and unjust standard of immense proportions, one in which the wealthy readily obtain organs from the poor." But India, Pakistan, China, the Philippines, Colombia, and other countries already harbor flourishing underground markets. Compensating donors in America won't spur more wealthy patients to travel abroad for organs. It's more likely to show other governments how to conduct a safe and transparent system of exchange under the rule of law. In the end, more people will receive transplants in their home country.
In the end, of course, the effect of compensation on organ supply is a question that only pilot projects can answer. This is what the NKF is trying to suppress. And yet the foundation once understood the need to experiment. In 1993, the NKF endorsed payment of burial expenses for deceased organ donors, a plan passed by the Pennsylvania Legislature. The foundation also supported a House bill in 1999 that would have granted a $10,000 life insurance policy to families with benefits payable upon transplantation of the deceased's organs. At the time, the chairman of NKF's Office of Scientific and Public Policy testified, "We would support at least a pilot study on financial incentives."
It is unclear why the NKF has become less tolerant of incentives as the organ shortage grows more critical with time. But whatever the reason, it forcefully obstructed efforts at reform in 2003--the last time Congress debated bold incentives. That year, House legislation called for noncash rewards, specifying life insurance policies or annuities to the families of the deceased, not an unfettered free market. But the NKF denounced the proposal, railing against "global economists who would import a poor person into this country" to sell an organ. The bill died in committee, partly because of the NKF's efforts. On the Senate side in 2003, the NKF used its clout to kill a provision to study incentives. Afterward, the NKF boasted on its Web site that "a successful advocacy effort by NKF resulted in the removal of the provision." Imagine the American Cancer Society bragging about having derailed an experimental project that might help breast cancer patients--especially when other respected groups were in favor of the measure.
I have long been mystified by the NKF's stalwart opposition to pilot studies. I was spurred to write now about my puzzlement by a recent encounter with the long arm of the foundation. At the end of July, I was invited to speak about the case for donor compensation at a regional transplant conference. Three days later, I was disinvited. Apparently, my chagrined host had not vetted the topic with the local NKF chapter, which was co-sponsoring the event. "I regret that I am having to withdraw my invitation," he wrote me. The co-sponsoring NKF affiliate, he continued, "was very much concerned about repercussions from the New York office, which they think would view the talk as a repudiation of the party line." The NKF similarly tried to stifle a debate on organ incentives at the American Enterprise Institute in 2006.
To be fair, the NKF does some good. It holds scores of fundraising charity events. It offers the public free screening for kidney disease and makes research grants to scientists. The NKF vigorously lobbies Medicare for better reimbursement rates for dialysis care, and, for better or worse (as some nephrologists will tell you), the foundation's guidelines for dialysis set the standard of care for the 380,000 U.S. patients who receive that treatment.
Congress listens to the NKF because it is a major force within the transplant community. But the foundation's recalcitrance on financial incentives for organ donors is hurting the very constituency it purports to serve. Last year, 4,000 dialysis patients died because they could not survive the wait for an organ. When Congress returns in the fall, the AMA will begin its push for demonstration projects on incentives. The NKF will have a chance to return to its earlier common-sense philosophy about rewarding organ donors. Unless it grasps the opportunity, the foundation should not call itself a true advocate for kidney patients.
Sally Satel, M.D., is a resident scholar at AEI.
http://www.aei.org/publications/filter.all,pubID.28476/pub_detail.asp
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This is a good example of what sociologists call 'institutional capture,' in which an organization established to cure a problem becomes so identified with the continuing existence of that problem that it eventually resists efforts to eradicate it. Thus police departments fear the legalization of marijuana, the Juvenile Diabetes Research Fund has spent a billion dollars of research donations over the last thirty years only on the most useless treatments it could find, and has consistently rejected all promising avenues of research, and now we see that the National Kidney Foundation is following the same pattern, fighting desperately to keep dialysis patients dying on dialysis so that it will forever have a reason to exist.
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Thus police departments fear the legalization of marijuana...so that it will forever have a reason to exist.
WTF??? There are much bigger problems than marijuana or any illegal drug. PD's will forever have reason to exist because there are people in society who do stupid things and need to be removed from society, even if only temporarily.
Now back to the topic - the NKF will also forever have reason to exist because there will forever be people with kidney disease who do not qualify for a transplant for one reason or another. Stauffenberg, I know that you think (or appear to think, anyway) that anyone related to the medical field is completely incompetent and out only for their own gains, but the NKF does do some work on topics other than transplant. So regardless of whether donors get paid or not, the NKF will have a reason to exist. I'm not claiming to understand why they're fighting this so hard, but I really don't think they're in any danger of running out of work to do.
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While I certainly agree that there will always be need for a police force, even if cannabis were legalized, the police would certainly face considerable trimming of their budgets, their opportunities for promotion, and their social power if soft drugs, which take up so much of their time, were legalized. They need things like this not only to serve their material needs for employment, advancement, and authority, but also for a sense of social importance.
The National Kidney Foundation spokesman in the article above justified the death of the 4000 people in the US who died in 2007 waiting for a life-saving transplant on the 'reasoning' that permitting an increase in the number of transplants by offering payment to living donors or the families of cadaver donors would, by some mysterious process the spokesperson did not bother to explain, "cheapen the value of the gift." If I give a friend a car for Christmas, the gift is not cheapened by the fact that the car can also be purchased; quite the contrary, the fact that I could have gotten money from someone else for the car but chose to give it away to a friend enhances the value of the gift!
So on the basis of indefensible reasoning, the NKF is willing to throw its full weight in the scales in favor of promoting the death of the people it exists to protect! Before acting so as to increase the death rate of any group of humans, we had better be sure, if we have a shred of morality, that we are 100% certain that the value for which we are slaughtering thousands of people a year is so sacred that it absolutely necessitates these preventable deaths. Any yet what is the reason the NKF offers? It "cheapens the gift"?! If every gift ever made in the history of mankind became utterly worthless by reducing the death rate of dialysis patients by one person a year it would be worth it.
Talk about institutional capture, this is more like institutional hypnosis! The NKF has gotten so used to its life-and-death, paternalistic 'ownership' of the patients trapped on its 'dialysis plantation' that it can't even think straight anymore.
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No one has a right to demand a kidney from another person. It is our disease. It saddens me that you and me and millions of other people have this dreadful disease, but yet it is our disease and not our neighbors or the poor farmer in Pakistan that is trying to feed his family. Sally Satel offers a very selfish explanation for her views in my opinion. For those that have received the gift of a renal transplant, good for them. Yet, they should never, ever forget the sacrifice a person made, a family made, a mother made or a wife, child or husband made in offering that kidney. I am quite saddened also by those that stand in a tirade and rant about their RIGHT to have others kidneys. Sorry, but that type of selfishness is not defensible.
Here is my response to the Satel article on Bill's page.
Just my opinion.
http://www.billpeckham.com/from_the_sharp_end_of_the/2008/08/bashing-the-nat.html
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Hemodoc, are you actually on dialysis yet? From reading your response, I think not. Dialysis is only as good as you access. I'm on nocturnal 8 hour dialysis and Sunday night my arterial needle stung the whole 8 hours. Not fun. Why live on dialysis when a normal person can live fine on 1 kidney?
You would let a family starve before parting with your 6 figure income to let them sell you a healthy kidney that they don't need? Tests and more tests are done before they let a donor be a donor.
The gift of life is wonderful, but the only one not compensated is the donor. If it is such a great benevolent act why isn't it all free. The surgeons, the labs the hospital. XXOO
There is a bigger reason for the NKF for flip flopping on this issue. We might ask BIG OIL and see if they have an answer. :waving;
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Thank you rerun for your response, I think.
The short answer to your question, is yes, I am on hemodialysis for over a year and a half. Not much fun at times, yet not anywhere as bad as most folks portray it as well. I have been fortunate to date to not have any dialysis related complications and with my exercise program, I am able to still stand upright on "all fours" so to speak.
Now, perhaps you should go back and read my article and you will see that I am not in the least advocating against renal transplantation if that is your choice, I am instead making note that no one has the right to demand a kidney. It is sad that my two kidneys that I was born with no longer can sustain my life. Yet, that does not give me any right to demand a kidney from someone else. Obviously, there are many that have given the gift of a kidney to many others and we must all focus on this simple fact that it is and always will be a gift of great sacrifice and potential risk for the living and a great sacrifice in time of tragedy for those that have died and donated.
Now, that so called normal person in your response appears to have no adverse consequences by your statement which is not true in the least starting first with a 1/3000 risk of death. If you wish to have that normal person's healthy kidney, that is fine to wish for such a thing, yet you still have no right to demand that sacrifice.
I stand firm in my support of the NKF and many others who continue to oppose cheapening the gift and turning human organs into a commodity for sale at the right price. I assume the position that my opposition is a failing opposition since there is a lot of money behind the effort to place payment systems into place. Just wait a little while and perhaps you will be fortunate to live in a society like China that will not only get you a kidney, but heart, lungs, pancreas and liver if you need them as well from some poor peasant who stole a chicken or pig just to eat or some other egregious capital crime.
In fact, why not move to Iran or China now? Well the answer to that rhetorical question is that yes, Iran has "no waiting list" (well they start by excluding most women and anyone over 50) but most Americans would not feel comfortable in the rest of their society. Likewise, most Americans would not like the rest of the social pleasantries of "red" China as well. That rerun, is the purpose of my opposition to payment for renal donation in the consequences to society when the ethical standards are lowered no matter for what utilitarian good that people can conjecture will come from it. We do not live in a glass bubble, there are consequences to isolated choices when expanded to the entire society in general.
For instance redefining death for the benefit of more renal and heart and liver donations in the isolated realm of cadaveric donations might be generalized into much darker sentiments for those that define death as the loss of upper thought processes and apply that same definition to demented people, brain damaged people or even mentally ill people.
There are consequences to our actions.
So, if you wish, then move to Iran and get your kidney now real cheap. And then stay and live there for long as you want and enjoy your new kidney.
I will on the other hand thank my wife, my daughter, my in laws in the Philippines for offering me a kidney and instead do the best I can with the opportunity to start daily dialysis as soon as I can. It is my choice, and I choose not to place the burden of my disease on another person with no health problems. It is my disease after all, not theirs.
Just my own opinion.
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Hemodoc, I agree 100% that you should not and cannot demand someone else to give you a kidney. That position is a long way from buying an organ for a "fair" amount of money. You cannot demand a Honda dealer to give you an Accord, but you can buy one and everyone walks away happy. Although, with organ donation there is no 7 year 12,000 mile warrenty! ;D I feel the same as you and would never let any of my friends donate a healthy kidney to me. My family has not offered probably because they have heard me say I would never take a live kidney. Someone who has the unexpected loss of life and their family has given their loved ones organs for donation is a different story. Even then, as I have accepted this gift, it is very hard to accept. In our society, we have a hard time accepting "gifts". Does your wife get extra gifts at Christmas just in case someone shows up at the door with a gift for your family? Then she can say "Oh, my here is a gift for you too"...... Yeah, I do it too. I felt so beholden to that family it made me sick to my stomach and I had to work through it. After I met the family I left them money in my will. I've now changed that since my kidney failed. (See how we Americans are). Buying a kidney would be the only organ that would be for sale obviously. We are not China, or we would have our children working 14 hour days. As it is here you can't get a kid to work 1 hour. America would put more restrictions than Sandoz has pills on purchase of organs. That is like people saying that same sex marriage will lead to sex with animals. So ridiculous! What buying of KIDNEYS would bring is relief from the current transplant list. Those that could afford it would get off the list so the POOR in America would move up on the list. There is NO way that the black market would bring over poor Filipinos and take their kidney because the Transplant evaluation team would not let that happen. They barely approve good Samaritan donors until the donor cries and pleads with them. It would also relieve the recipient of the guilt for someone dying so they could live. I can't even express how bad that made me feel. I thought about that poor person and his family for years! I would rather pay my money and go on with my life. Right now if someone who can't have children goes and pays $10,000 for invetro fertilization and it doesn't work.... they know there is no going back for a second try. You get one shot and then you pay again and start over. Seem unfair? That is already understood and accepted before they even try. So, it again would be a written agreement for organ donation. Believe me, and I've thought this over for 20 years, payment for organs in the United States would be a big relief for everyone. Think of the young Law Student or Pharmacy student (both of my nieces) who are in debt to the Universities in this country hundreds of thousands of dollars... if they could sell a kidney and pay off their debt and finally get on with their lives as well as the recipient.
How wonderful is that for both?
Another thing you should realize Hemodoc is that it already happens in the Unites States. People are paying for organs very discretely. I know if I had a good Samaritan approach me and want to give me a kidney They would end up with a Honda Accord in their yard! A green one!
I don't want another transplant because of the loss I felt when I lost mine. I lost my life support for freedom, I lost my best friend, my job and my way of life and my 5 figure income. The biggest problem with buying organs is what is going to be considered a "fair" price. To me it would be what I could afford.... a new Honda Accord. But, that would be the big question. This is not China sir, this is the United States and we already have standards set in place. I wish you the very best with daily dialysis. I know nocturnal made a huge difference for me. I just wish my access was better. I refuse to get another access placed in my leg, so my days are very numbered. I wish I had the opportunity to buy a kidney, but in this country I don't.
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Dear Rerun,
I am sorry to hear of your difficulties with your access. You are correct that is the biggest issue with dialysis. I understand that there are some surgeons doing remarkable grafts and fistulas with thoracic and abdominal arteries and veins. I don't know if you have discussed that with your surgeons, but yes, avoiding access in the legs is something that I can sympathize with you that it is not the best.
I hope that you are able to obtain the kidney you need soon. I just don't believe that we should go to system of paying for kidneys. Unfortunately, even a system of paying for organs would not likely meet the demand for kidneys and in such a situation, with high demand and low supply, most patients in need of a kidney would not be able afford it anyway.
My thoughts and prayers are with you and I truly hope that your days are not really as short as you believe they may be. There are no quick and easy answers for our disease. Fortunately, we have more options than many other patients with other forms of organ failure. Life is precious indeed.
May God bless,
Peter
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Patients fees for kidneys would be standardized and paid by the insurance or Medicare.
Rerun has said she does not want another kidney transplant.
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No, I really don't want another transplant because losing one after you build your life up is too damn hard. But the other reason is the guilt of getting THE GIFT. If someone would like a new Green HONDA ACCORD give me a call. Of course the license plate would have to say
"PD4WTHKDNY". Probably too many letters.
Just kidding!
Peter, I hope we can agree to disagree. I'll hang in there or die trying! :oops;
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No, I really don't want another transplant because losing one after you build your life up is too damn hard. But the other reason is the guilt of getting THE GIFT. If someone would like a new Green HONDA ACCORD give me a call. Of course the license plate would have to say
"PD4WTHKDNY". Probably too many letters.
Just kidding!
Peter, I hope we can agree to disagree. I'll hang in there or die trying! :oops;
:rofl; :rofl; with a green bow too :cuddle;
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Within two years of initiating its financial payment plan for live kidney donors in Iran in 1997, the waiting list for kidney transplants was reduced to zero. So much for the false argument that there will never be enough kidneys generated by organ purchase to meet the need.
As for no one owing a kidney to dialysis patients nearing the maximum limit of their vastly foreshortened life span on dialysis, what one person 'owes' another is a highly artificial social construct of where the margins of public responsibility begin and where the limits of private selfishness end. I would have thought a Christian would be in favor the assumptions of the legal structure underpining the social concept of rights and duties promoting more individual social responsibility and less personal selfishness when it comes to using a spare organ to save someone's life, but then again, Christians never cease to surprise me by the ways they interpret their own supposedly authoritative texts.
Suppose America had been invaded by the Nazis in World War II, and the invaders announced that while they did not intend to harm the general population, they intended to kill all the Jews they captured. This is essentially what the Nazis actually attempted to do in Denmark, where the general population was treated well for not having put up armed resistance to the German invasion, but efforts were made to collect the Jewish population for execution in the death camps. Now suppose your country announced that it was drafting people into the army to resist the invasion, compelling people under threat of severe criminal sanction to undergo a risk of serious bodily injury or death infinitely higher than that faced by the donor of a kidney, all for the sake of rescuing the small minority (2%) of Jews in the population. Would you oppose the draft on the reasoning that "no one has a right to demand injury to the body or perhaps even the death of another person just to save his own life," which is exactly your reasoning in asserting that no one has the right to demand a kidney from another person to save his own life? Why does your reasoning sound utterly selfish, terribly racist, and profoundly unchristian in the example of refusing to save the Jewish minority by accepting the corporeal risks of a military draft, but roll so comfortably off your tongue when you argue for exactly this same selfishness with respect to organ distribution, even if it has lethal consequences for the oppressed minority of renal patients?
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Within two years of initiating its financial payment plan for live kidney donors in Iran in 1997, the waiting list for kidney transplants was reduced to zero. So much for the false argument that there will never be enough kidneys generated by organ purchase to meet the need.
As for no one owing a kidney to dialysis patients nearing the maximum limit of their vastly foreshortened life span on dialysis, what one person 'owes' another is a highly artificial social construct of where the margins of public responsibility begin and where the limits of private selfishness end. I would have thought a Christian would be in favor the assumptions of the legal structure underpining the social concept of rights and duties promoting more individual social responsibility and less personal selfishness when it comes to using a spare organ to save someone's life, but then again, Christians never cease to surprise me by the ways they interpret their own supposedly authoritative texts.
Suppose America had been invaded by the Nazis in World War II, and the invaders announced that while they did not intend to harm the general population, they intended to kill all the Jews they captured. This is essentially what the Nazis actually attempted to do in Denmark, where the general population was treated well for not having put up armed resistance to the German invasion, but efforts were made to collect the Jewish population for execution in the death camps. Now suppose your country announced that it was drafting people into the army to resist the invasion, compelling people under threat of severe criminal sanction to undergo a risk of serious bodily injury or death infinitely higher than that faced by the donor of a kidney, all for the sake of rescuing the small minority (2%) of Jews in the population. Would you oppose the draft on the reasoning that "no one has a right to demand injury to the body or perhaps even the death of another person just to save his own life," which is exactly your reasoning in asserting that no one has the right to demand a kidney from another person to save his own life? Why does your reasoning sound utterly selfish, terribly racist, and profoundly unchristian in the example of refusing to save the Jewish minority by accepting the corporeal risks of a military draft, but roll so comfortably off your tongue when you argue for exactly this same selfishness with respect to organ distribution, even if it has lethal consequences for the oppressed minority of renal patients?
With what all you just said, what were you trying to say?
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The fact of the matter is no one is demanding anyone to give anyone a kidney. We are trying to buy them for a fair price. Like any other commodity. Transplants do increase the quality of life for the recipient 95% of the time unless God forbid something goes wrong.
I can't force my brother to give me a kidney. I would not let him give me one because I'd owe him for 'freaking' ever! I could hear it now..."after all I did give you a kidney the least you could is wash my car 'for life'). But, I would BUY his kidney. Now we are talking fair and square. He takes a very slight medical chance for $37,000. (the price of a green Honda Accord with navigation system)
I'm a Christian and there is nothing in the Bible that says you cannot buy or sell organs. God gave his Son for all our sins. Don't you think Jesus would have just as soon given a kidney?
:waving;
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WWJD = What would Jesus Donate?
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Hmmm, gonna have to think of a reply when I read it again
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I think I'll pass on this one.
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Actually, Jesus gave his all for all of us which is the basis of the longstanding ethical altruistic renal donation that is now in place. Jesus did not lay his burdens upon another man, but instead took up his own cross, bearing the sins of many upon his back and gave freely that we might be saved freely. Altruistic giving is at the heart of the gospel as a free gift to those that will receive it. He carried the cost himself. When is a gift not a gift?
The Bible further goes on to tell us that we are to bare our own burdens as well as the burdens of others. In complete contradistinction to the false portrayal by Stauffenberg, altruistic giving is the model from the Christian faith. In addition, the burden of our disease is ours to bare as well, yet when another man or woman is burdened with our burdens and gives a gift, that is following in the steps of Christ's example. There is no contradiction whatsoever to the gospel of Christ and the altruistic donation out of love for a fellow man burdened by disease. This has been and will be the most powerful motivator of good in this and other societies.
Just my opinion.
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I think I'll pass on this one.
I'm taking flips lead, passing on this one too.
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I'll be sitting over here with flip and Chris.
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Actually, Jesus gave his all for all of us which is the basis of the longstanding ethical altruistic renal donation that is now in place. Jesus did not lay his burdens upon another man, but instead took up his own cross, bearing the sins of many upon his back and gave freely that we might be saved freely. Altruistic giving is at the heart of the gospel as a free gift to those that will receive it. He carried the cost himself. When is a gift not a gift?
The Bible further goes on to tell us that we are to bare our own burdens as well as the burdens of others. In complete contradistinction to the false portrayal by Stauffenberg, altruistic giving is the model from the Christian faith. In addition, the burden of our disease is ours to bare as well, yet when another man or woman is burdened with our burdens and gives a gift, that is following in the steps of Christ's example. There is no contradiction whatsoever to the gospel of Christ and the altruistic donation out of love for a fellow man burdened by disease. This has been and will be the most powerful motivator of good in this and other societies.
Just my opinion.
Amen.
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Mikey and Queen Ruth will sit on the side with Circle, Flip and Chris.
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People back then didn't need kidney machines or transplants, Jesus laid hands on them and healed them, some were healed by faith alone.
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Actually, Jesus gave his all for all of us which is the basis of the longstanding ethical altruistic renal donation that is now in place. Jesus did not lay his burdens upon another man, but instead took up his own cross, bearing the sins of many upon his back and gave freely that we might be saved freely. Altruistic giving is at the heart of the gospel as a free gift to those that will receive it. He carried the cost himself. When is a gift not a gift?
The Bible further goes on to tell us that we are to bare our own burdens as well as the burdens of others. In complete contradistinction to the false portrayal by Stauffenberg, altruistic giving is the model from the Christian faith. In addition, the burden of our disease is ours to bare as well, yet when another man or woman is burdened with our burdens and gives a gift, that is following in the steps of Christ's example. There is no contradiction whatsoever to the gospel of Christ and the altruistic donation out of love for a fellow man burdened by disease. This has been and will be the most powerful motivator of good in this and other societies.
Just my opinion.
I would agree except no one else participating in the transplant process is into giving. They are into taking! They charge an "ungodly" amount for what they do for such a benevolent process. Greed cannot be in the same boat. So, let's all get on the same page and get what we can for that kidney. Fair is fair.
Zach? :cuddle;
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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! :waving;
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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?
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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.
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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.
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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.
8)
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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! :waving;
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?
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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.
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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.
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I'm going to go sit with Chris and Flip~
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I'm going to go sit with Chris and Flip~
:shy; :welcomesign; :rofl;
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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.
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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. :-\
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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.
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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.
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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 (http://http:/cjasn.asnjournals.org/cgi/content/full/1/6/1136) 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.
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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.
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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 (http://www.aynrand.org) 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.
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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.
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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.
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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.
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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.
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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 :popcorn; Epoman would have enjoyed this discussion! He loved a good debate and stong opiinions.
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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.
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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.
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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.
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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.
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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.
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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.
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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. :urcrazy;
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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)
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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?
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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).
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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.
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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.
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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.
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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.
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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.
8)
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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/
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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?
8)
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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.
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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."
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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.
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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.
:clap;
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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.
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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.
8)
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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
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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.
8)
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?
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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.
8)
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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.
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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.
8)
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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.
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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
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Thus, Zach, you have made Hemodoc's slander your own.
Take a deep breath.
8)
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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.
8)
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.
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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. :2thumbsup;
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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.
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Wow, people really need to calm down lol! This is getting way out of control.
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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. 8) :lol; :popcorn;
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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.
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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
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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
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http://www.renalweb.com/
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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.
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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.
8)
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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.
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"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?
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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.
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"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.
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Dear Stauffenberg,
If we are to follow your concept of avoiding negative comments, then we should instead just throw out all debate rules on this site. Let me give others just a few examples of you attributing to my character: “medical misinformation,” “defective ability to doctor,” “Pleased with lynchings,” “in favor of genocide against the sick.”
One of the definitions of a lie is:
Lie: anything that gives or is meant to give a
false impression
I contend that all of the following negative attacks against me are designed to give a false impression of my comments. Yes, I stand by my comment that you have made false impressions against my comments. Whether you or others wish to consider that a lie, I will leave to others judgements. This is even more blatant in your numerous blasphemous comments on my religion. Yes, I agree, please keep negative comments off of this site. You could contribute more to this than anyone else on this site by simply keeping your own advice.
“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.”
http://ihatedialysis.com/forum/index.php?topic=9502.msg162291#msg162291
“I sincerely hope I never have to rely on a doctor for treatment whose understanding of his primary and overriding commitment to helpling the sick is as defective as yours is.”
http://ihatedialysis.com/forum/index.php?topic=8946.msg146268#msg146268
“I feel like a Black man listening to someone talking about how pleased he is with lynchings.”
http://ihatedialysis.com/forum/index.php?topic=8946.msg146691#msg146691
“By trapping dialysis patients in a medical and legal system which unnecessarily and artificially denies them transplants in the numbers needed or as quickly as needed, society imposes on them conditions of life which destroys them in whole or in part. Denying financial inducements for organ donation is just one part of this lethal, genocidal trap.”
http://ihatedialysis.com/forum/index.php?topic=8946.msg146004#msg146004
“I am surprised to find that someone who calls himself a doctor would be in favor of genocide against the sick.”
http://ihatedialysis.com/forum/index.php?topic=8946.msg145657#msg145657
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Dear Wallyz, once again, my point is that daily home dialysis is complementary and not competing. I have never stated it is superior morally or medically. You are confusing my objection against making kidneys a commodity to be bought and sold without noting that we do have a moral obligation to take responsibility for our own treatment options without imposing upon another man's adverse financial situation. Many agree that this is legalized exploitation of the poor and on this ground, I and many others object.
You have once again juxtaposed a false inference laying claim that I hold dialysis superior medically or morally from kidney transplantation. Your assertions are not supported by my statements or those of the NKF.
I have not once disparaged live donation. Please try to keep your facts correct.
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i finally got around to reading this entire chain of posts. my head is spinning and i'm going to go sit on the sidelines and be dizzy. in a minute anyway.
my :twocents;
while i don't think donors of any type should be handed a check they should be fully compensated for their time and medical costs and i don't see why that should be considered paying for their donation after all we compensate a surrogate mother for her living expenses and medical costs and don't call it buying a baby.
those of you on the sidelines, move over, here i come
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I am still "on the fence" and contemplating whether I will opt for a transplant or dialysis. I have aprox 20% functioning kidneys.
It is in viewing perspectives like these presented here on this strand (with the many links), that a person like me becomes educated and able to make an informed decision when my time to make the "Big" decision arrives: Transplant vs Dialysis. It is imperative discussions like these be allowed to proceed, though it would be nice if personal bashing could be left aside. Both Stauff and Hemodoc have relavant information to provide. This forum is better because ALL perspectives are allowed. Information is presented, people can decide for themselves. I like seeing the arguments people make on topics discussed. Some are more passionate than others; some are more logical. Either way, the personal convictions evoked provides for educational and even entertaining discussions (and if you can't handle it, simply pass over this strand and move on to others).
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Crap! I need to build a bigger bench or stadium for everyone else watching :rofl; :rofl;
Otherwise I need to tape this and call it "As The World Turns"
-Crap that title has been taken already :rofl; :rofl; :rofl; :rofl;
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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.
It is not my rule. It is the forum rule that Epoman set in motion. I will enforce the rule when and if I see fit. The decision rests on the Administration team on a case by case basis. That rule has been on the forum from the beginning when Epoman set the rules. If you really want to challenge me on this you can PM me. Otherwise keep this out of the forums. Any future challenges in public forum, will force me to take a defensive posture regarding this subject. No matter how I fix this issue someone will be offended and I will get a bunch of PM's from all sides of the subject. Administration makes the final decision and we have decided that a warning was appropriate. Anyone who knows me, also knows I have no problem using the ban button if necessary, however I try to be patient because sometimes what is typed is not always taken as intended. We try to do what we think is best for the forum.
If you decide to take your ball and go home than I guess that is your choice. I want you to know that I hope you don't leave, but threatening me will not change my mind.
Sluff/Administrator
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:popcorn; I mean really, this is turning into something its not supposed to. Everyone should respect others opinions, whether they PERSONALLY agree with them or not. Epoman would be disappointed in us for fighting like children over this, so can we all just play nice?? :thumbup;
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Epoman would be disappointed in us for fighting like children over this, so can we all just play nice?? :thumbup;
Actually, I would like to think that he's enjoying this immensely.
8)
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Epoman would be disappointed in us for fighting like children over this, so can we all just play nice?? :thumbup;
Actually, I would like to think that he's enjoying this immensely.
8)
I have to agree with Zachariah on this one. Epoman was all for a good debate.
xoxo
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Epoman would have been pulling up a chair, getting out the :popcorn;, and watching the feathers fly! He loved a good debate. He believed in giving us a safe place to voice our opinions. I don't like it when it gets personal--just my :twocents;
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Epoman did love a good debate and he would be right in there debating it as well. :boxing;
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I get that, but the two of them just keep personally attacking one another