Live kidney donation is in the news

Are your kidneys available to me? - Twelfth and final in a series

hospital ward off limits

A story in the NY Post on 9/23/17 reports that singer-actress Selena Gomez’ kidney transplant may save more lives than her own. Her friend donated a kidney because Selena has Lupus, an illness that can cause kidney failure. “The National Kidney Foundation’s web traffic — including inquiries on how to donate — has surged by 350 percent since the stars’ heart-rending Instagram post on Sept. 14…every day 12 people die waiting for a kidney…”

The 2017 Kidney Disease: Improving Global Outcomes clinical practice guide on the evaluation and care of living kidney donors was published in August. One of its sections on the Ethical and Legal Framework of policy considerations states: Where local laws or policies impede the ethical practice of living donation, avenues to advocate for change should be explored. (18.2)

Here is a video (not recent) where you will hear a Christian lady express her deep conviction that Christ’s death on her behalf encouraged her to give up her kidney to help her husband live.

We have looked at lots of information about live kidney donation in this blog series. This seems to be a good stopping point.

I am a layperson without any post graduate education in ethics or science. Blogging lets us share thoughts and questions, and I hope any passersby will expand the discussion through comments. In a future series I hope to look at more Scriptures relating to this and similar issues.

If God gave us two kidneys why should we think we need only one? According to the Jewish Virtual Library, there may be a need for two kidneys in times of stress. “Under normal conditions, healthy kidneys do not work at their maximum capacity; there is a certain reserve that can be activated in times of stress.”

How far are we from paying kidney donors? We already do pay egg donors. Would you accept $45,000 for one of your kidneys, realizing it would save taxpayers a substantial amount relative to the current practice of Medicaid or Medicare coverage of dialysis for all?

In the previous post, we considered the idea of doing a good work, of sacrificing — playing the odds with our health — to be a live kidney donor. This does not seem wise, for if we risk our health to help someone and end by damaging our own prospects for a healthy life, then we can no longer do many good works at all.

To what extent and in which ways is a Christian his brother or sister’s keeper? If you agree that live kidney donation works in some situations, and we cannot know each specific need, then your generally permissive view may encourage a weaker brother to be moved to compassion to help a friend in need of a kidney. How would you feel about that?

If we go along with the cultural practice which ends by involving destitute people the world over, including prisoners in some countries, to “donate” kidneys for the better-off people, do we bear any responsibility for their tribulations?

How do you feel about movie stars and public figures advocating live kidney donation?

Do you feel your church should have a statement or position on live kidney donation?

Would you be comfortable to say: No live kidney donation, ever. ? Understand — you would only be expressing your own view as a Christian, realizing that not all Christians would go along with your stand, and you would be swimming upstream against the world.

Do unto others

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

We’re tackling a number of questions that Christians should ask about live kidney donation.

Some were posed at the end of the fifth post of this series, and we have not yet addressed three of them:

  • How would changing our laws to permit payment for human organs affect our society?
  • Would payment for organs be supported or opposed in Christian doctrine?
  • What types of questions in the Christian life are bonafide matters for individual conscience?

And in the previous post, we ended with this question:

  • In some cases, would God approve of live kidney donation?

If as Christians we determine that live kidney donation is contrary to God’s perfect will for our lives in every case, then we do not need to wonder if payment for organs would be OK with God. We could study how that might affect our society, but only from a negative perspective.

Perhaps we can never agree on what the bonafide issues for individual conscience are, but could kick off a great debate.

So, can God ever approve of live kidney donation? God does permit it, but that does not signify it is his perfect will. With many things, he allows us to proceed, though we are walking in our own way. A theological discussion of that is here, which spotlights this Scripture: Do not be conformed to this present world, but be transformed by the renewing of your mind, so that you may test and approve what is the will of God-what is good and well-pleasing and perfect (Romans 12:2).

How does one renew his mind? Reading the Bible, prayer, Christian fellowship, church attendance, keeping the Sabbath to rest and worship; all these play a role. Perhaps you could add to this list in the comments section.

It is still possible that Christians doing all these things will arrive at different conclusions. We inch along in our walk with Christ, holding one viewpoint at a certain stage in our spiritual growth, and changing later on.

Christians are not a monolith, but a mosaic, living stones being built up into a spiritual house. (1Pe 2:5) Such work takes long suffering.

Wonderful, sincere physicians and scientists have been and are involved in seeking ways to improve the quality of life through organ transplantation. How could anyone fault them for their natural curiosity and diligent labor to find ways to make transplantation successful? Why would anyone do that?

A surgical operation at Royal Liverpool University Hospital. Wellcome L0029417.jpg
By http://wellcomeimages.org/indexplus/obf_images/be/07/ae498371cfd18c7f616d656b28d2.jpg Gallery: http://wellcomeimages.org/indexplus/image/L0029417.html, CC BY 4.0, Link

Perhaps the answer is: life extension for the recipient should not outweigh consideration of risks for the donor. We know there are risks and consequences for the donor, so the question becomes: Is risking one’s health for the ideal and possible reality of saving or improving a human life what God would want a person to do?

We have looked at the various risks to this procedure, and a related question is: What are the chances or probabilities of incurring these risks? It is stated on various websites: The risk of problems from surgery is less than 5%, that is 1 in 20 donors, and the risk of death is 1 in 3000 donors, less than 1%. (ref) However, as brought out on Livingdonor101.com, the actual statistics are unknown:

We have NO comprehensive data on living donor health and well-being. The Secretary of health mandated one year of follow-up on all living donors in 2000, but the centers have been so noncompliant that a 2009 report said the database was woefully incomplete and useless for research or analysis. In 2013, OPTN admitted that 35% of LKDs were reported "lost" to follow-up with no indication contact was attempted….
According to OPTN, 4.4 living kidney donors die every year in the US within 12 months of donating. AND 20% of living kidney donors experience complications. Some require surgical intervention and/or lifelong maintenance. (ref)

So, first a prospective donor must choose whose data to believe. Or, we could ask, is it right for a donor to accept any level of risk? It is a certainty that the person who donates a kidney is taking a risk with his own health and future quality of life. Each one would know how this may affect those close to him.

Is this comparable to a civilian entering the military or police force? He or she knows that in duty there is risk of injury or death, yet they agree to this, ideally because they desire to protect the national interests of the USA and to preserve our country. Likewise, the living donor realizes there are risks, but desires to preserve or lengthen the life of the recipient.

We know that people feel called to serve in the military, but what about there being a call to donate a kidney? Could a Christian hear a call from God to donate a kidney? Perhaps only the person who has actually experienced the situation could answer this.

Analogies can confuse rather than clarify. The Military is not analogous to the Medical Profession. To conflate the two through clever comparisons will be a big waste of time. Suffice to say, our world is set up so that a military or police commander has the right to send his underlings into the fray, but a doctor is not empowered nor trained to send his patient into harm’s way unless to restore his health such as through radiation therapy. Though in extreme cases, as a last ditch measure, new therapies may be tried to save a life that instead end it, as a rule, doctors do not take risks with their patients’ lives.

On the websites encouraging live kidney donation, we see this question: What are the risks and benefits?

What are the benefits? The only benefit is the happy feeling that one has helped another to have a better quality of life. (ref) On the Living Kidney Donors Network, ALL of the benefits noted apply to the recipient! (ref) On the Johns Hopkins Medicine site we are told: There are many benefits to becoming a living donor. One of the most obvious benefits is that you can save a life, or drastically improve the quality of life for the recipient. The only other benefit listed is: Many living donors experience positive feelings of life and joy. (ref) Those are not MANY benefits.

If a doctor were to advise a patient to donate a kidney, then he is suggesting that he should take a risk with his health. He is not adhering to the Hippocratic Oath to “Do no harm” nor the Christian ethic to “Do unto others…”.

And what about the donor: Isn’t the donor doing unto others as he would have them to do to him?

If that is his motivation, then he hopes others would risk their health to help him out in a dire need which is not a Christian ethic. Is he not, rather, bypassing the Golden Rule to achieve a good work that he could not advise others to do?

Angel fish bild.JPG
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...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

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A SistersSite eBook

Flesh and Bone and The Protestant Conscience is an e-book on Amazon.com. It is 99¢ and in the Amazon lending library as well. 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.