Kidney Transplant Essay

Zhiyan Foo (Tony)

March 12, 2011

Kidney Transplants Essay

! The human body is a collection of organs and tissues, each that, with the exception

of the appendix, serve a specific vital function, together forming a fully functional human

body. Unfortunately each of these organs and tissues are all vulnerable to affliction, and

when a human beings does suffer from any of these misfortunes, depending on the which

organ, either his quality of life will decrease drastically or he/she would have to be sent to

an early grave. Fortunately for us our scientific knowledge has advanced enough so that it

is now possible to transplant different organs and tissues from one donor to another, giving

a second chance to those whose life might have deteriorated out of control or whose life

might have ended. Unfortunately despite all this, controversy has still surrounded

transplants.

! This essay aims to provide information on the kidney and how it is transplanted, the

benefits and dangers that accompany the transplant and insight on how the subject of

kidney transplants have helped shaped our social landscape through two key issues

surrounding it, which are economical and ethical in nature.

! A human beings kidneys are located in the rear of the abdominal cavity, just below

the rib cage. The two kidneys are each located at either side of the spine and are bean

shaped. The kidneys perform a variety of different functions in the human body, however

the majority of it does not involve processing or the creation of substances but more to do

with the regulation and filtration of your body and achieving a desired consistency in the

amount of certain substances in your body

They involve

• Regulating your bloods composition.

• Keeping Acid/Base concentration in

your body constant

• Helping regulate your blood pressure

• Maintaining your bodyʼs calcium levels

• Stimulating the making of red blood

cells

• Keeping the water in your body

constant

• Removing waste from your body

(Freudenrich,Ph.D, 2011)

! The kidney is a fascinating organ, capable of performing a variety of essential tasks,

that no other organ can compensate for, however that also means that if a kidney stops

being functional, the human body would die. A kidney would not be able to sustain life and

is not considered functional when itʼs renal function drops below 15%, with renal function

being how efficiently the kidney filters the blood. Serious health problems however already

emerge when it drops below 25%(The Kidneys and How They Work, 2011). This is when a

transplant is needed. Our body however has two kidneys and most people would still be

able to function without noticing anything unusual or face any discomfort even if the

kidneyʼs are only capable of functioning at 60% of their normal capacity. Therefore a

human being is capable of functioning well with only one working kidney with slight

discomfort and if precautions are taken. This also means that it is possible to donate a

Diagram 1: This diagram illustrates the position of the kidney in the body and shows what body parts it is intimately connected with. (Your Kidney, 2011)

kidney and still maintain a relatively high quality of life. This differentiates a kidney

transplant from most other transplants for it allows both life transplants to take place as

well as transplants from cadavers.(Rose, 2011)

! If one seeks to get a kidney transplant, one must first find a certified

doctor who would an evaluation and a series of test to find out is he/she is a

good candidate for a kidney transplants. They would then first seek to find a

suitable donor who is a relative and is willing to donate their kidney. If there is

non available then they would go through something dubbed the kidney

exchange program in which a donors and recipient who are incompatible with

each other will be put through a list to find another donor and recipient pair(s)

who would be genetically matched to one another and in which a kidney

transplant can be performed. If one is found with they will exchange kidneys to

enable a more favorable compatibility and allow a transplant to take place. For a

clearer view of the process look at Diagram 2 on the bottom. If all the above

producers fails and it is not possible to obtain a living donor then a person would

Diagram 2: This diagram depicts of transplant between 3 donors and recipients who were incompatible with their each other but were matched to other recipients/donor and therefore a successful transplant was allowed to take place (Paired Kidney Exchange Program, 2011)

be placed on a waiting list and would have to wait for a suitable kidney from a

deceased person. It is usually a 4-5 year long list and the person would have to

be on dialysis while he waits.

! Once a suitable donor is found then surgery and a transplant would occur. There a

two methods of too take out the kidney open nephrectomy and laparoscopic nephrectomy,

open nephrectomy involves creating a 15.2–25.4-cm incision in the abdomen, and then

cutting out the kidney along with the surrounding ureter before sealing up everything

again. This is procedure is used normally to take out kidneys from cadavers although it

can be used for living donors. This should take 2-3 hours. Laparoscopic nephrectomy on

the other hand involves using instruments on long, narrow rods, inserted through 4 small

incisions in the abdomen, to view, cut, and remove the donor kidney .Once the kidney is

freed, it is secured in a bag and pulled through a fifth incision, approximately 7.6 cm wide.

This is a form of minimally invasive surgery that takes slightly longer to complete but

promote a faster recovery time, shorter hospital stays, and less postoperative pain for

kidney donors.

! The surgery to place the kidney in the recipient is similar to open

nephrectomy but is just done for the opposite effect, instead of taking out a

kidney we are placing one in. In this surgery the incision is placed in the flank of

the recipient for usually the old kidneys are left in place to reduce chances of a

surgical accidents or complications and is instead placed above the pelvic bone

and below the existing, non-functioning kidney. It attached to the nearby blood

vessels and then everything is sealed up. All this usually takes 3-4 hours. After

the surgery the patient is required to take immunosuppressive drugs for the rest

of his life to prevent rejection of the donor organ and he would have to stay on

dialysis for a few days before going

home to allow the new kidney to heal.

(Kidney Transplant...,2011)

! The reasons why one would opt

for a kidney transplant is numerous.

The include the fact that having a

kidney transplant include less

restriction on fluid intake and diet,

which means the patient would have

the much more freedom to indulge itself

with whatever food he likes and not run

the risk of the kidney getting too overworked which could lead to dangerous side

effects, the elimination of the need for dialysis so the patient can enjoy a life with

more freedom and is cheaper than dialysis in the long run because kidney

transplants on average cost U.S 73,000 and after that U.S 16,000 every year for

immunosuppressive drugs, which dialysis costs about U.S 46,000 every year

meaning that in about 3 years having a kidney transplant with cost less than

having dialysis.

! However kidney transplants do not come without its flaws. Disadvantages

include the fact that there is a chance that your body would reject the new

kidney and attack it. This occurs when your body recognizes your kidney as a

foreign body and therefore attacks it automatically. To minimize the chance of

this that you still have to take immunosuppressive drugs for the rest of your life

which cost a lot and have side effects. The biggest side effect being its main

Diagram 3: A picture of the location of a the donors kidney after a transplant(Kidney Transplant Aftereffects, 2011)

intention actually which is to suppress your immune system, this means you are

more susceptible to diseases. This is the biggest problem and risk that comes

from kidney surgery but usually drugs can be taken to combat this. Also If you

want to get the kidney from a living donor you would have to cost someone else

their kidney, and if not thereʼs a waiting list usually 4-5 years long for a kidney

from a cadaver.

! While direct issues and benefits have originated from kidney transplants,

it has also caused controversial rulings and problems to arise, challenging

peoples view on life and values thereby creating controversy. This issues,

economical and ethical in nature are the sale of kidneyʼs and the unaffordability

of kidney transplants for a people of a lower income.

!

! Right now there is a scarcity in the number of kidneyʼs available in all

countries but in Iran. This is due to the fact that often enough donors to do not have

a willing or suitable donor available and because there are not enough people who

die in the right place and time. There are right now 88,102 people who need a

transplant but only 16,000 transplants per year. On average that means a donor

has to wait 5 and a half years for a kidney transplant and but certain personal

issues such as background, life expectancy, personal issues affect your standing on

a waiting list and slightly more than 10,000 people have been waiting for more than

5 years and still have not gotten a transplant. Due to these issues many people

have turned to the practice of obtaining an organ by buying it. This is illegal on all

countries but Iran and Iran has right now no waiting list. Also the life expectancy of a

living kidney is 22 years compared to 18 years for a dead one. For these reasons

some people opt to instead purchase kidneyʼs from willing sellerʼs. This has raised

much controversy and has since been made illegal in all countries but Iran.

!

! The arguments supporting this ban is varied but their is only one main one

that holds up to most scrutiny and form the backbone for this outlawing. The first

being if kidney trades are legalized, it is supporting the exploitation of a human

being by a person with more power namely the rich. Opponents to this ban on the

other hand claim that people who are desperate enough to sell their kidneys usually

fine some way to do this despite this ban and there is evidence of large

underground markets that promote kidney trade especially in India and North Africa

along with the Philippines(Srinivasan,2011)(Organ Shortage Fuels Illicit..., 2011). In

these places where illegal kidney trade is conducted, often times the chunk of the

money would go to the middle man who arranges this trade. The donation is often

down in a non sanitary place in an unprofessional manner that increases the risk of

harm to the donor many times fold. Then after the surgery the donor is often left

with no after care despite being promised that. The ugliness of this underground

trade some argue that the ban victimizes does people that the ban tries to help.

! In this authors opinion, the first argument does not carry enough weight to

support the ban for firstly if things were to remain the same the rich be able to

exploit the poor to a lager degree than if it were legalized. In a legal system in which

steps are taken to educate to people on actions their about to take and the

consequences which follow and in which the middle man is cut out, fair prices are

set out and it can take place in a well equipped modern hospital with certified

doctors and where the expenses are all taken care of is a much better alternative to

the present one. If exploitation does occur is the lack of education or information

that the system would have provided however stops can be taken to combat this

and just because people the set of circumstances indicate that only a rich person

could afford this and a poor willing to do this does not mean that the rich are

automatically exploiters and poor victims. While it is definitely repulsive that their

are people who are in such low levels of poverty that their are willing to trade organ

parts in exchange for money, the fact still remains that it does not mean that

legalization is automatically wrong and banning this wonʼt change the fact that

people are still that desperate, it simply means that the world is in a horrible state.

This ban however only attempts to ignore this reality and is only adding more to this

depravity.(Organ transplants: Psst, wanna buy a kidney?,2011)

! The other issue that has arisen due to kidney transplants has come form

the fact that kidney transplants are unaffordable to the general population. In the

U.S over 47.39% of the people in the U.S alone earn less than U.S 25,000

annually(PINC-01--Part 1,2011). Also the majority of the uninsured tend to be in

that income category. This proves to dangerous combinations and 62% of

bankruptcy filed where due to inability to pay medical bills. On average the

amount that had to be paid was 27,000, Seeing that kidney transplants cost

73,000 without the additional yearly cost of medicine which is U.S 16,000, one

can imagine the cost of kidney transplants have led to quite a few bankruptcies.

(Harmon,2011)(Himmelstein,2009)(Tamkins,2011) The induction of universal

health care has made the amendment that economical reasons cannot play a

factor for the person to put lower on the the list. However seeing that dialysis is

more expensive that kidney transplants this is more of a no-brainer than

anything else and should have been implemented a long time ago. Some argue

that the universal health care should be a burden shared among the whole

nation so that the poor have a better chance at life without having to shoulder

debt of the misfortune themselves and that if universal health care is achieved

then and that it would cost the nation as a whole much less as it would be

cutting out the insurance company and therefore the middle man. On the other

hand some says it is the responsibility of each man to take care of him self and

not the responsibilities of others to pay for another man. This are both points of

extreme merit and there is a raging debate on this in the U.S right now

especially with its newly legislated universal health care system.

! This author believes however that there is not definite right answer to this

and believes that the majority in a country should decide what system should be

in place. He believe that once a country is rich enough it and has relatively little

national debt then it would be a good investment, unfortunately there are very

few countries that actually fit this bill. Until then adding higher taxes and

increasing a countries national debt is only going to hinder a countries

progression and the happiness of the overall people than having a universal

health bill is.

! This essay has covered aspects of the kidney itself but more importantly

the process in which a transplant occurs and the pros and benefits of having one

and the certain consequences and issues that surrounds it. In this authors

opinion despite its shortcomings and certain flaws, kidney transplants are still

extremely beneficial to humanity as a whole helping 300,000 people so far in the

U.S alone. It has greatly increased the life expectancy of these people and

maybe even more importantly, the quality of their lives. As for the controversy

surrounding organ trade this author believes that it would be beneficial to

humanity as a whole to legalize it but to place a system that would allow benefits

to occur to both sides of the party and no exploitation to occur. However greater

effort should be placed to make sure that no human being would ever be

deprived so much that it would be worthwhile to trade his organs. Despite it

being rather unfortunate for those in need of a kidney the world would be a much

better place when no one would need to trade their kidneys. The unaffordability

of kidney transplants is a much more thornier issue and I believe it depends on

the country itself, however while it might not be right for some countries at this

point in time, it is a goal that they should strive to achieve.

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