From The Guardian, London, England, by Amelia Gentleman
As Mrs X begins to die in a lilac-painted hospital side room, surrounded by her husband and children who are perched on a semi-circle of purple plastic chairs, a team of surgeons and nurses is making preparations for her afterlife. In an operating theatre a few metres down the corridor, a six-person team of organ retrieval specialists has arrived to remove her kidneys, her liver and possibly her corneas.
It is midnight on a wet weekday night, and it isn't clear how long they will be here waiting. Once the extubation process (the removal of the breathing tube) begins, death needs to happen within three hours or the organs will no longer be in a fit state to be used. A square bag, not unlike a picnic cooler bag, filled with ice, labelled Human Tissue, is prepared and a courier is on standby.
Hospitals around the country have already been contacted to establish where the organs should go, and not long after the nurses have switched off the breathing apparatus, Mr Y gets a phone call, telling him to pack his bags and make his way to hospital as quickly as possible. He is at a late-night church service, so he asks the pastor to drive him in.
Elsewhere, another possible recipient receives a midnight call, and is summoned to a third hospital to await the second kidney.
For the operations to be successful, the removal of the organs and the transplant must happen very swiftly. Complex arrangements begin around lunchtime when Mrs X's family are made to understand that there is no hope of her recovering from the catastrophic heart attack that brought her to hospital two weeks earlier, and agree that it is time to let her die.
She has signed the organ donor register, and the family have supported her request, so a specialist nurse for organ donation (shortened with the ugly acronym Snod), has been paged in to help them, and to launch the laborious job of searching for the best recipients. If a recipient is found on the other side of the country, then air transport will have to be arranged, because once the kidney is out of the body there is only a 12-hour transplantation window, otherwise its functions begin to deteriorate.
The Snod is here before the donor has died, before the recipients even know their lives are about to be transformed by the long-awaited arrival of an organ. He will be here for a day's work that won't end until early the following morning, supporting the family through the process, performing the last offices on the donor, washing and dressing the body and placing her in a shroud once the organs have been removed.
The family has had two weeks coming to understand that their mother will not survive, so they are better prepared for the process than many. Doctors have scanned her head, established that there is an unsurvivable brain injury, and concluded that it would be in her best interests to withdraw treatment. In her late 50s, the dying patient is not too old to donate her organs. "Kidneys have no sell-by date," a doctor says.
The nurse has spent much of the afternoon talking to them, explaining what will happen. Families find it easier to talk to nurses than doctors. "Sometimes you have to explain information again and again and again, because they are at a stage of such great grief that we have to ensure they have understood. Doctors are not very good at having this conversation. They use medical terms people don't understand. It is a lot of information to take in. The consultant on the intensive care ward will be looking after 22 people. Nurses have more time. Families feel they can ask the silly question," he says.
Some families are uncertain about what their relative would have wanted, and staff wish this was a subject people were more ready to discuss. "We are asking people to do something for others at a time that is so devastating for them. It is an awful time to be asking someone this information. A lot of families say no because they don't know what their relatives would have wanted," he says. NHS Blood and Transplant(NHSBT) figures show that despite the fact that most people either want to donate their organs, or would consider it, only half have talked to their families about it. Figures also show that seven out of 10 families opt not to give permission for their relative's organs to be donated, if they don't know their wishes. [Read More]
From WISN, Milwaukee, WI, By Toni Valliere
Carl Vowels, 45, prepares to do peritoneal dialysis every night before bed.
"It basically draws the fluid out of your blood stream through the peritoneal cavity," Vowels said. "If I don't do that on a daily basis, within two days I'd probably be at a point where I'd die."
Vowel was diagnosed with kidney disease at 18, but in 2008, it became kidney failure, and he was put on a waiting list for a kidney transplant.
"I have no functioning (kidney) right now, none. I can function with one, and that's all I'm going to get is one," Vowels said.
Dialysis is what keeps him alive, but so he's tired it prevents him from taking part in life.
His wife, Michelle Vowels, said his illness has changed their lives.
"And I'm the only one that can drive the kids around, and take them to the places they need to go and go to their swim meets, and get them to their rehearsals and fill up the gas tank, and get the groceries and yeah," Michelle Vowels said. [Read more]
From CHCH, Hamilton, Ontario
Neighbour gives a kidney
A Dundas father in need of a new kidney took to Facebook to find a donor – but as it turns out, his perfect match was living just a street away.
Arie Pekar has polycystic kidney disease, or PKD.
“The kidneys grow several times the size. mine are about the size of footballs, normally they should be the size of your fist.”
As the name suggests, the disease causes multiple cysts take over the kidneys to the point where they are no longer able to function properly — hence the dialysis machine in his basement.
Pekar has known he’s had PKD since high school when doctors noticed he had high blood pressure. They said the 35 year old wouldn’t have to worry about the disease until he was in his 50s – but things progressed quickly.
“Once I graduated university cysts started rupturing a lot of pain. and that’s when they started to follow me a bit closer.”
And now, Pekar is in need of a new kidney. He’s been looking for a donor for about three years.
“They basically say ‘OK, go find a donor and come back. and find a donor.. come back and we’ll do it this year preemptively”
As if finding a living donor isn’t hard enough, PKD is genetic. Pekar’s mother has it and is in need of a kidney herself. He set up a Facebook page called Mom and me need a kidney to raise awareness”. That’s where family friend Darren Kudlats – who just lives down the road from the Pekars – comes in.
“Even the doctors at the hospital were surprised. Next to being twins we have a very close compatibility.”
Finding such a donor in the same country let alone living 500 meters away is highly unlikely.
Pekar says it’s amazing that a friend would step up to do this. “He’s as close to me as family.”
And when you ask Kudlats why he decided to donate an organ, it seems he didn’t think twice. “I was his friend and he needed a kidney. I guess I stepped up.”
The men will go into surgery February 20th. And hopefully, it’s a match made in Hamilton.
For the roughly 6,000 people each year who give up a kidney to someone in need of a transplant in the United States, a new study finds that generosity may come at a price: a roughly tenfold increased risk of kidney failure in the 15 years following their donation.
That increased risk, however, tells only half the story -- and not, depending on how you look at things, the more important half.
In the 15 years after he or she goes under the knife, a live kidney donor has a 0.3% likelihood of developing end-stage kidney disease requiring chronic dialysis or a transplant, researchers from Johns Hopkins University have found. While that is higher than the .04% probability he or she would have had as a nondonor, the fact is that kidney failure remains a highly improbable outcome.
The study, published Tuesday in the Journal of the American Medical Assn., is the first to assess both the absolute risk a kidney donor faces after the operation and the added risk he or she incurs as a result of it. It comes at a time when the gap between those needing a kidney transplant and the availability of the organs is vast: About 93,000 Americans are in line awaiting an available kidney, and most will wait at least five years before a kidney from a deceased donor becomes available.
Living donors -- relatives, friends and increasingly strangers -- are narrowing that gap. In 2011, 42.5% of kidney transplants came from living donors, with more than 31,000 such procedures performed in over 100 countries. And while donors are told the loss of a kidney cannot be without risk, they haven't had many hard facts to guide them in their decision. Now, they do.
“The extra risk they're taking from donating a kidney was very low,” said Johns Hopkins University transplant surgeon Dorry L. Segev, who led researchers in reviewing the records of all 96,217 people who donated a kidney for transplantation in the United States between April 1994 and November 2011. “It's actually very reassuring,” he added.
Crucial to this finding is the fact that kidney donors are not only unusually generous: They are also, as a group, unusually healthy. Compared with the U.S. population at large, they start with a much smaller risk of going on to develop kidney disease.
When you take their chance of developing end-stage kidney disease and multiply it by 10, said Segev, “the result is still a very low number.” [Read more]
Kidney News
From GlobeNewsWire.com, News Release
ATLANTA, Feb. 11, 2014 (GLOBE NEWSWIRE) -- The U.S. Food & Drug Administration has approved the start of the first human clinical trials in the United States for the Wearable Artificial Kidney (WAK) designed by Beverly Hills, Calif.-based Victor Gura, MD the inventor of this technology. The announcement was made during the opening session on Sunday of the Annual Dialysis Conference taking place in Atlanta.
The WAK from Blood Purification Technologies is a winner of the FDA award Innovation 2.0 an award from the FDA. The FDA Innovation program is intended to assist developers of dialysis technologies in obtaining accelerated approval to reach patients in a safe, timely, and collaborative manner.
Gura, a physician at Cedars Sinai Hospital and a Clinical Associate Professor from the David Geffen School of Medicine at UCLA commented:
"Our scientific team worked intensely for about a year in close collaboration with a dedicated team from the Center of Devices and Radiological Health of the FDA to make this approval happen.
"We are especially grateful to the talented hard working team from the FDA for their support and guidance in achieving this milestone. It establishes the FDA's commitment to bring about changes in healthcare through innovative technologies developed in the US."
Gura added: "Since its inception, more than 50 years ago little has changed in the way we deliver dialysis with machines that immobilize patients for many hours. Chronic dialysis is neither natural nor physiological as we replace the natural function of a human organ with a machine. However given the deadly alternative and the lack of available organs for transplant it is the best alternative we can offer to patients with kidney failure. While the dialysis industry appears to be faring well, dialysis has become institutionalized and, satisfied with what we have wrought in this field, we continue piling small improvements on top of other minor advances in dialysis technology and that ultimately current dialysis technology is entrapped in its own net for failure to break out in new directions. On the other hand the WAK has the potential of radically changing the way dialysis is provided and might offer substantial costs reductions, and the hope of improving quality of life and decreasing mortality in dialysis patients."
Gura also indicated that the WAK clinical trials will be carried out in several academic medical centers of excellence including the University of Washington and other major universities in the US. [Read more]
From Bayside Bulletin, Australia
THE team at the Redland Hospital renal dialysis unit fired up the barbecue last Wednesday in support of Kidney Health Australia.
The fun event was part of the organisation's Big Red BBQ campaign, which raises awareness of kidney disease while challenging groups and individuals to use at a barbecue five 'secret' kidney-friendly foods that are low in salt and potassium.
The Redland Hospital barbecue featured turmeric, couscous, strawberries, spinach and corn.
Redland Hospital has a 12-chair renal dialysis unit that cares for more than 42 patients.
The hospital also cares for 30 kidney transplant patients.
Dialysis patient Tarina Griggs, of Capalaba, said she lost her kidney function 18 years ago when she had an undiagnosed urinary tract infection.
Tarina said she had dialysis at Redland Hospital three times each week, for five hours each time.
"It's a good unit and I can't complain about having dialysis it's keeping me alive," she said.
Kidney Health project officer Amber Wilson, of Thornlands, who had a kidney transplant 12 years ago, said 1.3 million Australians had undiagnosed kidney disease.
"There are no warning signs of the disease, which means a person can lose up to 90 per cent of kidney function before experiencing any symptoms," she said.
Amber encouraged people to help protect their kidneys by staying active, eating a healthy diet, and asking their GP for a kidney function test.
For further information about kidney health, visit www.kidney.org.au
From inloughborough, Leicester, England
Chronic kidney disease (CKD) affects approximately eight per cent of the population and is increasing due to rising obesity, diabetes and hypertension levels.
Surprisingly, heart disease – not kidney disease – is the primary cause of death for patients on dialysis who are up 100 times more likely to suffer a heart attack or stroke than members of the general population.
Unfortunately traditional methods used to reduce the risk of cardiovascular disease, for example controlling diet, lowering cholesterol and good management of diabetes, have shown to be completely ineffective at improving outcomes in this patient group.
The new study will look at the effects and benefits of exercise on heart health in 130 patients with end stage kidney disease across the Leicestershire renal network. It is expected that the research will confirm that exercise during dialysis is safe, well-tolerated, and improves both the quality of life and cardiac health of dialysis patients.
Award recipient, Dr James Burton, Senior Lecturer in Renal Medicine and Honorary Consultant Nephrologist at the University of Leicester and Leicester General Hospital, explained: “There is something unique about patients with kidney disease who have very vulnerable hearts and so we need to start thinking outside the box to develop new therapies to reduce their risk of heart disease.
“Our dialysis patients come for treatment within the Leicester network for four hours three times a week, which makes them a captive audience. We want to use this time to encourage them to exercise. Cycling is the best form of exercise for these patients as it uses the most muscle groups and won’t interfere with their treatment, so we will be asking them to cycle for half an hour during each dialysis session.
“We all know exercise is good for us, but after spending three days a week in hospital, the last thing these patients want to do is go to the gym. Therefore if we can offer them an individualised exercise plan during their treatment, we hope to help the patients feel even better and live longer, reducing their risk of heart disease.”
A specially-adapted exercise bike will be utilised so that patients can undertake supervised exercise for half an hour, three times a week whilst undergoing their dialysis treatment. Previous studies have shown that exercise can improve the quality of life of patients on dialysis, but this will be the first of its kind to investigate the impact of cardiac health in this group. [Read more]
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