Sunday, February 11, 2007

kidney allocation debate

Recently, there have been changes to the way kidneys are going to be allocated. More precisely, the way people will be listed will be changed. They are going to change it from "length of time" on the list (i.e., the longer you've been waiting, the higher up you are) to how well you'll survive after the transplant.

Now I am all about this. Right before my transplant the lung allocation system was changed to be this way. That way the "sickest" patients could be priority. I was #1 on the AB+ list.

Transplant allocation is a fine line; you have to be sick enough to need one, but healthy/strong enough to survive the actual surgery and rehab. I had to go through pulmonary rehab before my transplant so that I could survive the rigorous after effects of a major surgery. Some people aren't healthy enough or didn't take good enough care of themselves before to qualify. A host of psychological, physical and social factors go into deciding who makes a good transplant candidate, because there are so few organs to go around. With every transplant, you want to make sure that you are giving to a person who will: 1) survive the operation 2) follow the very strict regimen post transplant 3) have a support system in place to help you follow this regime 4) and make sure that you can psychologically handle all the changes that will happen post transplant. Some people can't. Some people, believe it or not, have made their entire lives about being sick. It has defined them. They can't do anything else. They didn't finish high school, didn't go to college, don't have a job. Believe me, I know people like this. Or, coversly, they decided they were going to live fast since they would "die young" and have four babies by different boys, don't take care of themselves, and are on the fast track to hospice. I also know people like this. They are not good transplant candidates because they never adjusted to living a real life with their illnesses to begin with.

Some people talk about how organs sohuld go to "children or young adults". Well, OK. Or that by changing it to sickest/most likely to survive, old people won't have a chance. The thing is, medically, someone always has an edge. No one is equal. It doesn't matter how much money you have, who you are, or what you do. Medically, someone is ahead. Someone is always a better match. And in transplant medicine, you want the best match possible for the transplant to succeed. Dr. A used to talk about finding "optimal" organs for me. This is a delicate science. By putting someone who is not medically capable of handling the surgery and its after effects, you're not only putting the recipient's life in danger, but you are also, in effect, denying someone who is a better match for the organ the chance at life. You're sort of "wasting" the organ. I know that sounds callous, but it's true. 18 people die every day waiting for an organ. We need to make sure that the best candidates are getting them. Yes I can say that because I got mine. But still, it's true.

So many people are ignorant of this aspect of transplantation. They still think it's about money, or status, or prestige. The only "status" that matters is your medical status: blood type, tissue type, height, weight, and various other factors depending on the particular organ. It's not about the money. It's about the person who is medically right for the organ.

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