Theory and practice disparity

Are your kidneys available to me? - Eighth in a series

In theory kidney transplantation, begun in 1954, is being perfected as a medical procedure to save lives and and to improve healthcare; the future looks bright. In practice it is a boondoggle of financial wreckage for taxpayers, questionable truth in advertising to prospective donors, a cauldron brewing up a black market for human organs, a quandary of legal matters, a patchwork of medical and government coordination, and an ethical minefield.

Various approaches have developed to try to resolve these dilemmas.

Public relations efforts are ongoing to recruit living donors. Numerous medical communities hire the best people to achieve results in all program aspects. (example) More living donors will save taxpayers money. (See previous post.)

Changing the law to permit selling ones kidneys is possible, to address the black market mess (previous post). Iran alone among the nations legalized kidney sales, but some countries are very well known for trafficking so much so that selling seems accepted; an internet search will return these perpetrators.

Churches set guidelines to try to enforce an ethic of life that nevertheless upholds transplants, to help clear the ethical minefield (previous posts). Clearing minefields is slow and dangerous work. For example, the Catholic church catechism states:

Organ transplants are in conformity with the moral law if the physical and psychological dangers and risks to the donor are proportionate to the good sought for the recipient. Organ donation after death is a noble and meritorious act and is to be encouraged as a expression of generous solidarity. It is not morally acceptable if the donor or his proxy has not given explicit consent. Moreover, it is not morally admissible to bring about the disabling mutilation or death of a human being, even in order to delay the death of other persons. (#2296)

The tricky word in this teaching is death. The Catholic hierarchy accepts the neurological definition, or brain death, as true death, but a sizable number of parishioners do not. (example)

They hold to the “the time proven, generally accepted criteria for death — the cessation of circulation, respiration, and reflexes.” This controversy is delineated on the Truth about Organ Donation website.

At a Vatican conference to explore the differing definitions, one doctor provided background information for the controversy:

Dr. Hill recalled that the earliest attempts at transplanting vital organs often failed because the organs, taken from cadavers, did not recover from the period of ischemia following the donor's death. The adoption of brain-death criteria solved that problem, he reported, "by allowing the removal of vital organs before life support was turned off--without the legal consequences that might otherwise have attended the practice.” 
While it is remarkable that the public has accepted these new criteria, Dr. Hill remarked, he attributed that acceptance in large part to the favorable publicity for organ transplants, and in part to public ignorance about the procedures.
“It is not generally realized,” he said, “that life support is not withdrawn before organs are taken; nor that some form of anaesthesia is needed to control the donor whilst the operation is performed. As knowledge of the procedure increases,” he observed, “it is not surprising that — as reported in a 2004 British study – ‘the refusal rate by relatives for organ removal has risen from 30 percent in 1992 to 44 percent.’” Dr. Hill also suggested that when relatives see with their own eyes the evidence that a potential organ donor is still alive, they harbor enough doubts so that they are not ready to consent to the organ removal. (ref)

Dr. Paul A. Byrne may be the best known physician in this camp. His articles have been so helpful to me. He is in agreement with Catholic classical doctrine, but not with the Vatican’s acceptance of the definition of death.

I have gotten off on a rabbit trail exploring the definition of death controversy. We will pause here and take up a few more approaches to resolving dilemmas arising from the practice of transplantation in the next post.

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How much is a kidney worth in America today?

Are your kidneys available to me? - Sixth in a series

A general understanding of chronic kidney disease (CKD) and its treatment is important for any who would pass judgment on whether kidney transplants are ethical, so let’s take a look.

Some forms of kidney disease stem from heredity or environmental factors, but most CKD results from diabetes, high blood pressure and old age. A number of medications can harm our kidneys including pain meds, aspirin, ibuprofen, antibiotics; and alcohol and street drugs like heroin and cocaine are culprits, too. (ref)

Our kidneys remove waste from our bodies including drugs, balance our fluids, help to regulate blood pressure, control production of red blood cells, and manufacture a form of vitamin D that contributes to bone health. (ref)

Diabetes and hypertension are the leading causes of kidney failure for adults. Kidney failure is called end-stage kidney disease (ESRD), leaving a person three options: 1. No treatment, but adjust diet or take medication to help symptoms; 2. Dialysis (two forms); and 3. a transplant.

Undoubtedly, any of us who has a loved one with ESRD would want the best option for their overall health. It would be beyond sad to see them suffer without relief. We probably would initially embrace transplantation as wise and desirable.

transplantation statisticsMany facts about the prevalence of ESRD and CKD are on the internet, and we find that CKD moved from 27th in the list of causes of death worldwide in 1990 to 18th in 2010. This advance up the list was second only to that for HIV and AIDS. Kidney failure statistics rise in countries where the number of older people is increasing. (ref)

It is worth noting that CKD can be slowed or stopped with early diagnosis and treatment, and today there are over-the-counter tests for the condition.

In the graphic, we see that about 117K people need a lifesaving organ transplant and only about 17K organ transplants have been performed so far as of mid-August, 2017. Statistics do not make clear from where or whom organs for transplant are received. But we can see that there is a wide gap between supply and demand.

It is stated that —

About 30 Americans a day either die on the waiting list or are removed from it because they have become too ill to receive a transplant. Taxpayers also bear a significant burden in the case of kidneys because of the special status of renal dialysis within the Medicare program. In 1972, Congress mandated that Medicare cover the costs of care for end stage renal disease regardless of patient age. In 2011, over 500,000 people took advantage of this benefit at a cost of over $34 billion, which is more than 6% of Medicare’s entire budget. (ref)

With such staggering costs, it is easy to see why a cost-benefit analysis of government compensation of kidney donors has been researched. A summary of the study follows.

From 5000 to 10,000 kidney patients die prematurely in the United States each year, and about 100,000 more suffer the debilitating effects of dialysis, because of a shortage of transplant kidneys. To reduce this shortage, many advocate having the government compensate kidney donors. This paper presents a comprehensive cost-benefit analysis of such a change. It considers not only the substantial savings to society because kidney recipients would no longer need expensive dialysis treatments—$1.45 million per kidney recipient—but also estimates the monetary value of the longer and healthier lives that kidney recipients enjoy—about $1.3 million per recipient. These numbers dwarf the proposed $45,000-per-kidney compensation that might be needed to end the kidney shortage and eliminate the kidney transplant waiting list. From the viewpoint of society, the net benefit from saving thousands of lives each year and reducing the suffering of 100,000 more receiving dialysis would be about $46 billion per year, with the benefits exceeding the costs by a factor of 3. In addition, it would save taxpayers about $12 billion each year. (ref)

Chronic kidney disease is widespread, expensive, and projected to afflict nearly 17% of our population by 2030. Curing it is a medical priority. WaitListZero has lots of statistics that underscore the great need for donors, and its leaders have donated a kidney — They lead by example.

All around, we see pressures building to solve this societal dilemma.

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Angel fish
Public Domain, Link

...and every living creature that moveth, which the waters brought forth abundantly, after their kind, and every winged fowl after his kind ... the living creature after his kind, cattle, and creeping thing, and beast of the earth after his kind ...the beast of the earth after his kind, and cattle after their kind, and every thing that creepeth upon the earth after his kind: and God saw that it was good. -Genesis 1


A SistersSite eBook

Flesh and Bone and The Protestant Conscience is an e-book on It is 99¢ and in the Amazon lending library as well. It is also available here in PDF format. The book description follows.

Would you let your conscience be your guide?

Does God care if the skin and bone of the dead are passed along to the living for medical uses? Is organ donation OK with God? Should you sign a Living Will?

Did you know that dead organ donors are often anesthetized before their organs are removed? Do you know the current definition of death? The conscience cannot function without facts.

As we ponder the ethics of in vitro fertilization, stem cell research and man-made chimeras, our thoughts trail off. How then should we live? (Ez 33:10)

How should a Christian think about euthanasia by starvation when doctors and the state attorney general all agree it is time to withhold feeding from a brain injured patient? Some things are family matters, but someday it may be our family.

Here is a small book to help you think about whether you want to sign your driver's license, donate a kidney, cremate your loved one, and many other practical questions that may arise in the course of your healthcare decisions or watch over others.

It offers a special focus on the doctrine of the Resurrection that is related to such decisions. Sunday School classes and Bible Study groups could use this book to facilitate discussion about the issues covered.