Kidney donation and its consequences

I read with interest Dr. Reyes’ article on “What’s new in kidney transplants?” (Phil STAR, May 22, 2012). Donating a kidney for a highly altruistic reason is truly a soul uplifting act. How can one bear a dying loved one when everything fails and the only alternative for a near normal life is a new kidney? Hemodialysis whether done once, twice or three times a week and even daily, is no guarantee of a comfortable existence.

Patients with chronic kidney disease are at great risk of cardiovascular deaths. Over 50 percent of patients die of the latter cause despite adequate dialysis. Substances that cause the high incidence of stroke are not or insignificantly removed by dialysis. Recently a powerful antioxidant has been introduced for clinical use to combat the vasculotoxic effect of chronic kidney disease and also delay the onset of dialysis. A Japanese-developed drug, it has limited availability at present. Another similar drug being developed by Americans will soon hit the market as it has completed its phase 2 trial. Both drugs are evidence based. The decrease in serum creatinine is only a gauge of the adequacy of dialysis.

Kidney donors should be thoroughly lectured of its consequences. The removal of one kidney is a major operation that can on rare occasion cause death; more often than the latter is the complication of acute kidney injury of the remnant kidney. Not many surgeons would like to do laparoscopic removal of the gall bladder. Cholecystectomy is a hundred or even a thousand times more often performed than nephrectomy. Removal of the kidney for whatever cause is an uncommon procedure, more so when done for organ donation. Therefore there is little experience about it especially when the technique is laparoscopic.

Late complications for the donor is the development of hypertension in five to ten percent of the cases. Diabetics should not be allowed to donate is well taken. Persons with a family history of diabetes should also not donate. As far back as the late fifties it was shown that biopsied prediabetics (those with a family history of diabetes) have kidney changes of diabetes. One case that is known to me involved a married brother with three children who donated one of his kidneys to a beloved brother. Four years later he has developed hypertension, positive protein in the urine and a serum creatinine slightly above normal. His fasting blood sugar on several occasions was slightly above normal.

The Divine design is for us to take care of our kidneys (body). To say that donors are healthy is true, but documentaries about kidney donation that I have watched so far have been from poor communities. The “transient wealth” the young men got failed to sustain their previously robust health in the months needed for recovery. All regretted having donated (sold their kidneys). As one commentator succinctly stated, organ donation go on unabated because of poverty, ignorance and most shocking of all, unethical doctors.