Letter to the Editor, Houston Chronicle: Needed: living kidney donors

[Clark]

http://www.chron.com/disp/story.mpl/editorial/outlook/7676788.html

Needed: living kidney donors
By WHITSON (PETE) ETHERIDGE, M.D.

I applaud the Houston Chronicle for its recent coverage of living donor kidney transplants in which three fathers each donated a kidney to one of their children whose kidneys had failed. It's vitally important to make the public aware of the need for living kidney donors. These dads literally gave their kids the gift of life.
First, some background: Some 26 million Americans over age 20 suffer from chronic kidney disease (CKD), a gradual and usually permanent loss of kidney function. CKD is growing in prevalence because the diseases that cause or contribute to it are rampant — diabetes, hypertension and obesity.
CKD often leads to end stage renal disease (ESRD), in which the kidneys fail. This is irreversible and life-threatening. The only treatment options are dialysis or transplantation.
Additionally, other conditions can cause temporary or permanent kidney failure, including polycystic kidney disease, sepsis (infection), toxic medications, trauma, nephritis and cancer.
Statistics for 2008 indicate nearly 548,000 people in this country were treated for ESRD, with a staggering cost of $35.3 billion in public and private spending. Approximately 400,000 Americans were on dialysis in 2009, which is life-saving but can present lifestyle and health complications. This number is growing each year.
The optimal solution for many patients with kidney failure is transplantation. This is the most common transplant operation, accounting for more than 68 percent of all solid organ transplants worldwide.
However, a huge gap exists between the number of kidney transplant recipients and the number of kidney donors. In 2009, 16,830 transplants were performed in the United States, while 86,071 people were on the waiting list for a new kidney, according to the Scientific Registry of Transplant Recipients.
More than 4,000 people die every year waiting for a kidney transplant, while another 1,000 to 2,000 are removed from the wait list because they become too sick on dialysis to undergo transplantation. The waiting time in Houston for a deceased donor kidney is three years and rising.
Not surprisingly, the fastest-growing age group in need of kidney transplantation is adults 50 and over, while there is an increasing shortage of kidney donors in the ideal age range of 18-49. Kidneys from older donors are less likely to function well. As potential recipients age, they are poorer transplant candidates due to an increase in medical issues. These factors exacerbate the shortage.
A kidney for transplant can come from a living or a deceased donor. The best source for a transplant is a relative with matching blood and tissue types. The transplant team will ensure that the closest possible match is made between donor and recipient, even if the donor is unrelated. Unrelated living donors are the fastest growing source of new transplants. Donor surgery today is pretty straightforward, with a short recovery time. You can live an active, productive life and have a normal lifespan with just one kidney.
Recent studies indicate that the typical ESRD patient will live 10 years to 15 years longer with a kidney transplant versus dialysis. Patients tend to have more energy, a less restricted diet and fewer health complications with a transplant than if they stay on dialysis. Even professional athletes have made comebacks in their sports after receiving a kidney transplant.
On the financial side, transplant is far more cost-effective than dialysis. Although a transplant is initially expensive ($100,000 and up), the cost of long-term dialysis is even higher. The Kidney Register estimates that Medicare's cost of maintaining a kidney transplant recipient is $8,550 a year compared to $50,938 for dialysis.
Of course, we want people to consider organ donation upon death; it can actually save up to seven lives. However, I urge you to consider giving the gift of life now by becoming a kidney donor. Learn about being a living donor at www.livingdonors.com, part of the National Kidney Foundation web site. If you don't feel you can commit as a living donor, register to donate your kidneys and other organs to save lives after you are gone. Check out www.DonateLifeTexas.org, the statewide registry.
Take steps for good kidney health today so that you will never be faced with the choice of dialysis or transplantation. Prevention is the key. Eating a sound diet, maintaining a healthy body weight, exercising, controlling high blood pressure and diabetes, avoiding long-term use of pain relievers and having regular medical checkups are a strong defense against kidney disease later on.
Etheridge is senior partner of Renal Specialists of Houston, one of the 10 largest nephrology practices in the country, and is medical director of the Cooley Transplant Center at St. Luke's Episcopal Hospital.