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 exceptionof the appendix, serve a speciﬁc vital function, together forming a fully functional humanbody. Unfortunately each of these organs and tissues are all vulnerable to afﬂiction, andwhen a human beings does suffer from any of these misfortunes, depending on the whichorgan, either his quality of life will decrease drastically or he/she would have to be sent toan early grave. Fortunately for us our scientiﬁc knowledge has advanced enough so that itis now possible to transplant different organs and tissues from one donor to another, givinga second chance to those whose life might have deteriorated out of control or whose lifemight have ended. Unfortunately despite all this, controversy has still surroundedtransplants.! This essay aims to provide information on the kidney and how it is transplanted, thebeneﬁts and dangers that accompany the transplant and insight on how the subject ofkidney transplants have helped shaped our social landscape through two key issuessurrounding it, which are economical and ethical in nature.! A human beings kidneys are located in the rear of the abdominal cavity, just belowthe rib cage. The two kidneys are each located at either side of the spine and are beanshaped. The kidneys perform a variety of different functions in the human body, howeverthe majority of it does not involve processing or the creation of substances but more to dowith the regulation and ﬁltration of your body and achieving a desired consistency in theamount 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 Diagram 1: This diagram illustrates the position of the kidney in the body and shows what body parts it is intimately (Freudenrich,Ph.D, 2011) connected with. (Your Kidney, 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 stopsbeing functional, the human body would die. A kidney would not be able to sustain life andis not considered functional when itʼs renal function drops below 15%, with renal functionbeing how efﬁciently the kidney ﬁlters the blood. Serious health problems however alreadyemerge when it drops below 25%(The Kidneys and How They Work, 2011). This is when atransplant is needed. Our body however has two kidneys and most people would still beable to function without noticing anything unusual or face any discomfort even if thekidneyʼs are only capable of functioning at 60% of their normal capacity. Therefore ahuman being is capable of functioning well with only one working kidney with slightdiscomfort and if precautions are taken. This also means that it is possible to donate a
kidney and still maintain a relatively high quality of life. This differentiates a kidneytransplant from most other transplants for it allows both life transplants to take place aswell as transplants from cadavers.(Rose, 2011)! If one seeks to get a kidney transplant, one must ﬁrst ﬁnd a certiﬁeddoctor who would an evaluation and a series of test to ﬁnd out is he/she is agood candidate for a kidney transplants. They would then ﬁrst seek to ﬁnd asuitable donor who is a relative and is willing to donate their kidney. If there isnon available then they would go through something dubbed the kidneyexchange program in which a donors and recipient who are incompatible witheach 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 kidneytransplant can be performed. If one is found with they will exchange kidneys toenable a more favorable compatibility and allow a transplant to take place. For aclearer view of the process look at Diagram 2 on the bottom. If all the aboveproducers 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 adeceased person. It is usually a 4-5 year long list and the person would have tobe on dialysis while he waits.! Once a suitable donor is found then surgery and a transplant would occur. There atwo 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 thencutting out the kidney along with the surrounding ureter before sealing up everythingagain. This is procedure is used normally to take out kidneys from cadavers although itcan be used for living donors. This should take 2-3 hours. Laparoscopic nephrectomy onthe other hand involves using instruments on long, narrow rods, inserted through 4 smallincisions in the abdomen, to view, cut, and remove the donor kidney .Once the kidney isfreed, 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 butpromote a faster recovery time, shorter hospital stays, and less postoperative pain forkidney donors.! The surgery to place the kidney in the recipient is similar to opennephrectomy but is just done for the opposite effect, instead of taking out akidney we are placing one in. In this surgery the incision is placed in the ﬂank ofthe recipient for usually the old kidneys are left in place to reduce chances of asurgical accidents or complications and is instead placed above the pelvic boneand below the existing, non-functioning kidney. It attached to the nearby bloodvessels and then everything is sealed up. All this usually takes 3-4 hours. Afterthe surgery the patient is required to take immunosuppressive drugs for the restof 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, Diagram 3: A picture of the location of a which means the patient would have the donors kidney after a transplant (Kidney Transplant Aftereffects, 2011) the much more freedom to indulge itself with whatever food he likes and not runthe risk of the kidney getting too overworked which could lead to dangerous sideeffects, the elimination of the need for dialysis so the patient can enjoy a life withmore freedom and is cheaper than dialysis in the long run because kidneytransplants on average cost U.S 73,000 and after that U.S 16,000 every year forimmunosuppressive drugs, which dialysis costs about U.S 46,000 every yearmeaning that in about 3 years having a kidney transplant with cost less thanhaving dialysis.! However kidney transplants do not come without its ﬂaws. Disadvantagesinclude the fact that there is a chance that your body would reject the newkidney and attack it. This occurs when your body recognizes your kidney as aforeign body and therefore attacks it automatically. To minimize the chance ofthis that you still have to take immunosuppressive drugs for the rest of your lifewhich cost a lot and have side effects. The biggest side effect being its main
intention actually which is to suppress your immune system, this means you aremore susceptible to diseases. This is the biggest problem and risk that comesfrom kidney surgery but usually drugs can be taken to combat this. Also If youwant to get the kidney from a living donor you would have to cost someone elsetheir kidney, and if not thereʼs a waiting list usually 4-5 years long for a kidneyfrom a cadaver.! While direct issues and beneﬁts have originated from kidney transplants,it has also caused controversial rulings and problems to arise, challengingpeoples view on life and values thereby creating controversy. This issues,economical and ethical in nature are the sale of kidneyʼs and the unaffordabilityof kidney transplants for a people of a lower income.!! Right now there is a scarcity in the number of kidneyʼs available in allcountries but in Iran. This is due to the fact that often enough donors to do not havea willing or suitable donor available and because there are not enough people whodie in the right place and time. There are right now 88,102 people who need atransplant but only 16,000 transplants per year. On average that means a donorhas to wait 5 and a half years for a kidney transplant and but certain personalissues such as background, life expectancy, personal issues affect your standing ona waiting list and slightly more than 10,000 people have been waiting for more than5 years and still have not gotten a transplant. Due to these issues many peoplehave turned to the practice of obtaining an organ by buying it. This is illegal on allcountries but Iran and Iran has right now no waiting list. Also the life expectancy of aliving 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 raisedmuch 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 onethat holds up to most scrutiny and form the backbone for this outlawing. The ﬁrstbeing if kidney trades are legalized, it is supporting the exploitation of a humanbeing by a person with more power namely the rich. Opponents to this ban on theother hand claim that people who are desperate enough to sell their kidneys usuallyﬁne some way to do this despite this ban and there is evidence of largeunderground markets that promote kidney trade especially in India and North Africaalong with the Philippines(Srinivasan,2011)(Organ Shortage Fuels Illicit..., 2011). Inthese places where illegal kidney trade is conducted, often times the chunk of themoney would go to the middle man who arranges this trade. The donation is oftendown in a non sanitary place in an unprofessional manner that increases the risk ofharm to the donor many times fold. Then after the surgery the donor is often leftwith no after care despite being promised that. The ugliness of this undergroundtrade 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 tosupport the ban for ﬁrstly if things were to remain the same the rich be able toexploit the poor to a lager degree than if it were legalized. In a legal system in whichsteps are taken to educate to people on actions their about to take and theconsequences which follow and in which the middle man is cut out, fair prices areset out and it can take place in a well equipped modern hospital with certiﬁeddoctors and where the expenses are all taken care of is a much better alternative tothe 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 thisand just because people the set of circumstances indicate that only a rich personcould afford this and a poor willing to do this does not mean that the rich areautomatically exploiters and poor victims. While it is deﬁnitely repulsive that theirare people who are in such low levels of poverty that their are willing to trade organparts in exchange for money, the fact still remains that it does not mean thatlegalization is automatically wrong and banning this wonʼt change the fact thatpeople 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 thisdepravity.(Organ transplants: Psst, wanna buy a kidney?,2011)! The other issue that has arisen due to kidney transplants has come formthe fact that kidney transplants are unaffordable to the general population. In theU.S over 47.39% of the people in the U.S alone earn less than U.S 25,000annually(PINC-01--Part 1,2011). Also the majority of the uninsured tend to be inthat income category. This proves to dangerous combinations and 62% ofbankruptcy ﬁled where due to inability to pay medical bills. On average theamount that had to be paid was 27,000, Seeing that kidney transplants cost73,000 without the additional yearly cost of medicine which is U.S 16,000, onecan imagine the cost of kidney transplants have led to quite a few bankruptcies.(Harmon,2011)(Himmelstein,2009)(Tamkins,2011) The induction of universalhealth care has made the amendment that economical reasons cannot play afactor for the person to put lower on the the list. However seeing that dialysis ismore expensive that kidney transplants this is more of a no-brainer thananything else and should have been implemented a long time ago. Some arguethat 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 shoulderdebt of the misfortune themselves and that if universal health care is achievedthen and that it would cost the nation as a whole much less as it would becutting out the insurance company and therefore the middle man. On the otherhand some says it is the responsibility of each man to take care of him self andnot the responsibilities of others to pay for another man. This are both points ofextreme merit and there is a raging debate on this in the U.S right nowespecially with its newly legislated universal health care system.! This author believes however that there is not deﬁnite right answer to thisand believes that the majority in a country should decide what system should bein place. He believe that once a country is rich enough it and has relatively littlenational debt then it would be a good investment, unfortunately there are veryfew countries that actually ﬁt this bill. Until then adding higher taxes andincreasing a countries national debt is only going to hinder a countriesprogression and the happiness of the overall people than having a universalhealth bill is.! This essay has covered aspects of the kidney itself but more importantlythe process in which a transplant occurs and the pros and beneﬁts of having oneand the certain consequences and issues that surrounds it. In this authorsopinion despite its shortcomings and certain ﬂaws, kidney transplants are stillextremely beneﬁcial to humanity as a whole helping 300,000 people so far in theU.S alone. It has greatly increased the life expectancy of these people andmaybe even more importantly, the quality of their lives. As for the controversysurrounding 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 beneﬁtsto occur to both sides of the party and no exploitation to occur. However greatereffort should be placed to make sure that no human being would ever bedeprived so much that it would be worthwhile to trade his organs. Despite itbeing rather unfortunate for those in need of a kidney the world would be a muchbetter place when no one would need to trade their kidneys. The unaffordabilityof kidney transplants is a much more thornier issue and I believe it depends onthe country itself, however while it might not be right for some countries at thispoint in time, it is a goal that they should strive to achieve.
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