Re: There's a reason Grandpa can't get on the donor list

1

Eh. It's a completely personal decision.


Posted by: JH | Link to this comment | 04-23-10 11:40 AM
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Heh. My friend's father died of liver failure from alcoholism. My friend fiercely battled what she thought was an unsympathetic hospital, and ached to donate part of her liver to help him. But she couldn't, because she has Marfans, which also made her very tall. Nearly as tall as her very tall father.

She wanted to do everything to save her father, so her next thought was of her equally tall fiance. I tell you what, she'd have had part of his liver out within seconds of his permission. He did not want to donate part of his liver to a clearly dying alcoholic, which she thought was selfish and cruel.

The father died. They married and look to be very happy. I don't imagine they talk about the issue much.


Posted by: Megan | Link to this comment | 04-23-10 11:40 AM
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Eh. It's a completely personal decision.

Oh, I know this. I'm just trying to provoke a good, judgemental conversation.


Posted by: heebie-geebie | Link to this comment | 04-23-10 11:43 AM
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Where are the death panels when you need them?


Posted by: MAE | Link to this comment | 04-23-10 11:46 AM
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When my sister was too young to give blood at our high school blood drive, she'd sign me up instead. Apparently organs are communal family resources.


Posted by: Megan | Link to this comment | 04-23-10 11:50 AM
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I'm just trying to provoke a good, judgemental conversation.

The dude is a very bad candidate for dialysis, so heebie is condemning him to a lingering death.

I think y'all know that I strongly disapprove of alcohol consumption, but I don't believe drinkers deserve to die for their vice and contribution to the personal and social pathologies that cause the suffering and deaths of millions.

PS:Firefox screams at me for that spelling of "judgment"


Posted by: bob mcmanus | Link to this comment | 04-23-10 11:50 AM
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I wonder how many people would give completely different answers on this one based on whether it was presented to them as (a) a choice they had to make about whether to donate an organ (or part of one) to a loved one who had made some pretty bad mistakes, or (b) a choice that a friend had to make that they were giving advice about, with the recipient being someone they didn't know well, or know at all.

I suspect my intuitions would be completely different in the two situations and I'm not even sure I feel the need to reconcile them.


Posted by: widget | Link to this comment | 04-23-10 11:50 AM
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I could be mistaken, but isn't medical science increasingly coming around to the view that donating a kidney has fewer health risks than you might think? I know that shortly after donating one of your kidneys, the other one enlarges to take over the function of the missing kidney, and that total kidney function is scarcely affected at all.

There was an article in the New Yorker a few months ago about kidney donors, in which they mentioned that one of the only risks was greater vulnerability to trauma, because if one of your kidneys is destroyed, you don't have a backup. On the other hand, hospitals tend to compensate by placing kidney donors near the front of the list to receive new kidneys. If she likes her grandfather, I say go for it.


Posted by: Ace-K | Link to this comment | 04-23-10 11:51 AM
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Sometimes alcoholic people get scared enough, or have the will power to get sober after something like that; sometimes they don't. Without knowing the guy I have no idea whether your student has a chance of making a difference whatever she does. But if she's an adult and he's her grandfather- so presumably at least 70, it doesn't sound like a good investment to me.

Walking away from the quixotic option is not easy when you're 18.


Posted by: OFE | Link to this comment | 04-23-10 11:52 AM
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so heebie is condemning him to a lingering death.

Beautiful. Just beautiful.


Posted by: JP Stormcrow | Link to this comment | 04-23-10 11:55 AM
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It doesn't seem like a clear-cut situation based on the evidence here. I don't think anyone can make a decision about someone else donating an organ ("Of course my daughter will do it if she can!"), but if she were saying she definitely wanted to do it, that she couldn't live knowing she had a chance to save beloved Grandpa's life, there's no question in my mind--of course she should do it.

I have sort of the opposite problem, in that my mother is opposed to organ donation for some kind of weird voodoo-Christian reason having to do with not altering the body on purpose. My ID cards say I'm an organ donor, but I understand parents can reverse that if they want. Maybe if I get a tattoo she'll get the hint that it's a lost cause anyway.


Posted by: A White Bear | Link to this comment | 04-23-10 11:56 AM
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Donating a kidney is awesome and people should be admired for it.


Posted by: Lemmy Caution | Link to this comment | 04-23-10 11:56 AM
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I'm mostly with OFE. My understanding is that Ace-K is right, and the health risks from donating a kidney are pretty small -- about as small as any surgery can be. But we're talking about a sick seventy-year-old, at which point it seems debatable whether any risk is worth it. (Actually, both my parents are seventy now. So scratch that -- his age is entirely irrelevant.)

If his doctor is saying "With a new kidney, he could have a perfectly healthy ten or fifteen years yet," then maybe. Anything less enthusiastic from his doctor, it sounds like an awful idea.


Posted by: LizardBreath | Link to this comment | 04-23-10 11:58 AM
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I should probably add that even though it seems likely that if she donates, Grandpa will drink kidney #3 to death, and that she'll wind up resenting him and regretting her choice, you have to compare that to the other likely outcome: If she doesn't donate, she might spend the rest of her life racked with guilt over a life she had a chance to save, but refused. There's no point in looking for a good outcome when someone is dying slowly. Everyone is going to end up feeling bad no matter what. I just think that psychically speaking, resentment is probably better for you than guilt.


Posted by: Ace-K | Link to this comment | 04-23-10 11:58 AM
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Maybe if I get a tattoo she'll get the hint that it's a lost cause anyway

And just to be sure she gets the hint, the tattoo should say, "Satan is cool!"


Posted by: peep | Link to this comment | 04-23-10 12:01 PM
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And because I'm so cynical my thought on the OP was that some kids really get carried away in making excuses for not doing their homework.


Posted by: peep | Link to this comment | 04-23-10 12:02 PM
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14 is smart. I am sort of biased towards just letting people die if they won't get off their ass and try to live (i.e. quit drinking), but the considerations of 14 are important.


Posted by: togolosh | Link to this comment | 04-23-10 12:04 PM
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8 and 14 have it right, I think. My sister is working toward donating a kidney to my mom under more sympathetic circumstances, and if that doesn't work out I suppose I'll do it. The main issue is that getting a kidney out is pretty major surgery, and it squicks me out a bit for non-rational reasons, but there really doesn't seem to be a whole lot of reason not to do it.


Posted by: Not Prince Hamlet | Link to this comment | 04-23-10 12:06 PM
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I would like to give a kidney away to whomever needs one next. My wife would prefer a slightly more conservative process. She's not convinced that a) it's as safe as reported, b) I won't need it myself, c) someone known to us won't need it.

I'm probably not going to fight too hard on this one, but if our takes lined up, I'd go for it.

I interviewed Zell Kravinsky a long time ago, before the linked article came out or the events in it transpired. Fascinating fella. Not sure how he came to the conclusion that he should donate both his kidneys, though.


Posted by: k-sky | Link to this comment | 04-23-10 12:08 PM
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14 is smart, but I do wonder what the girl's feelings are, and what has been imposed on her. In my family, people are always telling each other that they're going to feel guilty about this or that when someone's dead as a last-ditch effort to force each other to do things. That guilt vs. resentment struggle can end up getting played out in every single area of your life until you end up doing everything everyone asks you to do.

Err, it's a slippery slope!!!


Posted by: A White Bear | Link to this comment | 04-23-10 12:08 PM
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I like the paintings at your site, Ace-K.


Posted by: k-sky | Link to this comment | 04-23-10 12:09 PM
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I just think that psychically speaking, resentment is probably better for you than guilt.

The catch-22 is that the sort of Grandpa most worth donating the kidney to is one who would refuse to accept it, thus freeing the granddaughter from the dilemma.


Posted by: MAE | Link to this comment | 04-23-10 12:12 PM
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Me too. Although the carbon-heaviness of organic molecules does constrain the color palate.

Why no fats?


Posted by: LizardBreath | Link to this comment | 04-23-10 12:12 PM
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23 to 21.


Posted by: LizardBreath | Link to this comment | 04-23-10 12:13 PM
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4 made me laugh.


Posted by: bill | Link to this comment | 04-23-10 12:16 PM
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Thanks, I'm glad to hear you guys like them. This is, to my knowledge, the first time anybody has ever clicked the link in a blog commenter's name. I always thought people just ignored those. There are no fats, I guess, because they are gigantic and dull looking. And if you want carbon-heavy, look at stearin. Something like butterfat, which mostly has shorter fatty acids, might work better, but it would still be a chore to look at.

20: I'm basically assuming that she really loves her grandfather, and that she would miss him if he were gone. Nobody should be pressured into giving up a kidney -- now there's resentment for you.


Posted by: Ace-K | Link to this comment | 04-23-10 12:19 PM
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Hey, how does one go about contacting one of the Unfogged crew these days? The directions on the home page aren't working.


Posted by: Charlie | Link to this comment | 04-23-10 12:20 PM
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I'm at ElizardBAThotmailDOTcom, or lizardbreathATunfoggedDOTcom should work as well (although for incompetence/forwarding related reasons, I can't read the unfogged.com address from home, so you won't get a response on weekends.)


Posted by: LizardBreath | Link to this comment | 04-23-10 12:23 PM
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apostropherATapostropherDOTcom


Posted by: apostropher | Link to this comment | 04-23-10 12:26 PM
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Oh, damn, I should have spamproofed myself, shouldn't I.


Posted by: LizardBreath | Link to this comment | 04-23-10 12:27 PM
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Huh. The @unfogged.com e-mails do seem to be error-producing at the moment; no idea there. I'm generally reachable at stanleysparks AT the google mail service we all know and love.

Related-ish to the post, I've been coming around to a view of the kidney as my favorite organ. It's a fascinating little workhorse.


Posted by: Stanley | Link to this comment | 04-23-10 12:29 PM
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31.2 has some quite low-hanging fruit. That's what I get for clicking "post" too quickly.

30: I can fix it if you're unable to log in from your current location.


Posted by: Stanley | Link to this comment | 04-23-10 12:33 PM
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I wonder how many people would give completely different answers on this one based on whether it was presented to them as (a) a choice they had to make about whether to donate an organ (or part of one) to a loved one who had made some pretty bad mistakes, or (b) a choice that a friend had to make that they were giving advice about, with the recipient being someone they didn't know well, or know at all.

Really? My intuition in both situations is: if you want to donate, donate! And I think I would want to donate. Then again, I've never had an alcoholic grandfather. But I really can't imagine doing anything other than donating in the OP's situation unless said grandfather was really evil or something.


Posted by: Ginger Yellow | Link to this comment | 04-23-10 12:36 PM
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34

32.2: Would you? Thanks.


Posted by: LizardBreath | Link to this comment | 04-23-10 12:39 PM
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33: It's funny, but my gut response is that the grandfather shouldn't accept the donation. That's my mother's influence -- she taught me that when old people get sick the best thing for them is to die quickly.


Posted by: peep | Link to this comment | 04-23-10 12:39 PM
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31: My 6 year old niece, a couple of weeks ago: "The brain is the most important part of the body... except for boys it's the paheenee!"


Posted by: togolosh | Link to this comment | 04-23-10 12:39 PM
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A friend of mine just donated a kidney to a vague acquaintance, based on a tw/tter request. You can read all about it with your googles and you ipads. It seemed like a pretty good bet, and my friend is the soul of generosity, so it's not really surprising that he did it. His recovery was extremely quick too. I have a feeling nobody's going to want any of my organs at this point.


Posted by: Natilo Paennim | Link to this comment | 04-23-10 12:39 PM
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34: Done and done.


Posted by: Stanley | Link to this comment | 04-23-10 12:42 PM
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26: I like the alcohol puppy the best.


Posted by: Natilo Paennim | Link to this comment | 04-23-10 12:43 PM
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36 is awesome.


Posted by: A White Bear | Link to this comment | 04-23-10 12:43 PM
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I have a feeling nobody's going to want any of my organs at this point.

Except the paheenee.


Posted by: apostropher | Link to this comment | 04-23-10 12:45 PM
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41: Coo Ducks, Oi didn't know you cared!


Posted by: Natilo Paennim | Link to this comment | 04-23-10 12:51 PM
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My nephew's response, somewhere in the elementary school years, to an assignment requiring him to complete the sentence "Life is ____": "Life is like a penis: sometimes it's hard."


Posted by: Not Prince Hamlet | Link to this comment | 04-23-10 12:53 PM
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Certainly nobody should have my organs if they want to live - some of them are made of tungsten, which might be worth mining, but it won't keep anybody going.

My parents made it clear to us, as they grew older (60+), that they would be very, very cross if we gave them any organs, but fortunately the question never arose. Because they would have been. Very.


Posted by: OFE | Link to this comment | 04-23-10 12:54 PM
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I should probably add that even though it seems likely that if she donates, Grandpa will drink kidney #3 to death, and that she'll wind up resenting him and regretting her choice, you have to compare that to the other likely outcome: If she doesn't donate, she might spend the rest of her life racked with guilt over a life she had a chance to save, but refused. There's no point in looking for a good outcome when someone is dying slowly.

See, that's why I'm thinking if it were my daughter, perhaps I'd try to prohibit the testing. To avoid exposing her to the dilemma whatsoever. She can blame me instead.


Posted by: heebie-geebie | Link to this comment | 04-23-10 12:58 PM
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44: Perhaps they were just trying to intimate that they were sick of being served haggis?


Posted by: M/tch M/lls | Link to this comment | 04-23-10 12:58 PM
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47

I heard resentment is bad for the kidneys, heebs.


Posted by: M/tch M/lls | Link to this comment | 04-23-10 12:59 PM
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48

If anyone's considering starting a band featuring the Hammond, Organ Freeman would be a good band name.


Posted by: Stanley | Link to this comment | 04-23-10 1:00 PM
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49

47: But great for the ass.


Posted by: heebie-geebie | Link to this comment | 04-23-10 1:00 PM
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Organ Stanley!


Posted by: JP Stormcrow | Link to this comment | 04-23-10 1:03 PM
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51

Organ Meat.


Posted by: Not Prince Hamlet | Link to this comment | 04-23-10 1:08 PM
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52

What if she donated some other organ, just to make clear that, while she wants to help, she's not interested in enabling him?


Posted by: Sifu Tweety | Link to this comment | 04-23-10 1:09 PM
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Byron Organ.


Posted by: Stanley | Link to this comment | 04-23-10 1:09 PM
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48: how about a Hammond Organ/Fairlight synthesizer duo called Organ Fairchild?


Posted by: Sifu Tweety | Link to this comment | 04-23-10 1:10 PM
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52: I say duodenum. I mean, it probably doesn't even do anything.


Posted by: Stanley | Link to this comment | 04-23-10 1:10 PM
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Someone should show up at Dying Grandpa's bedside in a clown suit, dragging a Hammond on a dolly, honk a horn a few times and say: "Hey! I heard this room needs an ORGAN DONOR!"

Yes, that's a cruel and tasteless joke. Luckily, I'm sharing it privately. With the Internet.


Posted by: DS | Link to this comment | 04-23-10 1:11 PM
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Or a plate of liver and onions. "Oh, shit, I thought you wanted an organ DINNER."


Posted by: Not Prince Hamlet | Link to this comment | 04-23-10 1:13 PM
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When ever a dish involves snow peas, I'm compelled to say, "Snoopies? This dish has bits of Snoopy?"


Posted by: heebie-geebie | Link to this comment | 04-23-10 1:15 PM
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Someone should show up at Dying Grandpa's bedside in a clown suit, dragging a Hammond on a dolly, honk a horn a few times and say: "Hey! I heard this room needs an ORGAN DONOR!"

That would be awesome, because then Grandpa's dying words could be "Fuck you, clown."


Posted by: MAE | Link to this comment | 04-23-10 1:15 PM
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59: Beautiful.


Posted by: DS | Link to this comment | 04-23-10 1:17 PM
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59: That truly is beautiful.


Posted by: peep | Link to this comment | 04-23-10 1:33 PM
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is there a reason you couldn't just reclaim the kidney once gramps kicks off?

also, if one wanted pics with less cabon, why not phosphodiesterase, glutamate, also lamotragine and topiramate.


Posted by: yoyo | Link to this comment | 04-23-10 2:50 PM
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So, more of a 'kidney loaner' than 'kidney donor'?


Posted by: NBarnes | Link to this comment | 04-23-10 3:41 PM
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When your kidneys run out of ink, you have to change the kindney toner. A lot of people don't know that.


Posted by: Stanley | Link to this comment | 04-23-10 3:43 PM
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kindney

Dammit.


Posted by: Stanley | Link to this comment | 04-23-10 3:43 PM
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Look, I've got nothing at all against hard-core alcoholics (though I'm a bit curious as to how the medical experts could determine that someone should be bumped to the back of the queue for said affliction...so, is it his age, eh? or is it his purported alcoholism?...inquiring minds want to know...). But I'm pretty damned sure it would pretty darned unethical for doctors to remove an organ from a young, healthy person in order to keep an old guy (whether drunk or sober is not really relevant to me) running for another year or two at best, unless they knew for a certainty that said organ removal would never negatively impact her (said young, healthy person's) future health whatsoever. Do they know that? (this an honest and genuine question, btw).

The thing about organ donation is that the need to give is potentially limitless, and once implemented as a new social norm, well, you can never give enough. Once the MDs decide that X-patient could potentially live Y-term longer (with Y defined in months or years or what have you), if only Z-potential-donor gave up an organ, well, there's no end to it in sight, is there?


Posted by: Mary Catherine | Link to this comment | 04-23-10 9:13 PM
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I will play the role of the death panel and argue that a healthy 18-year-old donating a kidney to a grandparent of about the age I'm assuming is a very inefficient use of scarce resources.


Posted by: emdash | Link to this comment | 04-24-10 7:20 AM
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You only have 1 kidney you can give. What if her best friend since preschool gets some sort of sickness? What if her husband is in a car accident?

And it depends on the prognosis. The kidney loaner would be awesome too.

I really think organ donor should be opt-out rather than opt-in, which would solve a few problems.


Posted by: bay of arizona | Link to this comment | 04-24-10 8:43 AM
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So has anybody read this book? (by some guy who looks like Harry Potter)


Posted by: emir | Link to this comment | 04-24-10 3:28 PM
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I gave a copy to my sister the transplant surgeon.


Posted by: LizardBreath | Link to this comment | 04-24-10 4:45 PM
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Bacteria are evolving antibiotic-resistance to current drugs, so in some cases doctors are turning back to older antibiotics that can cause kidney damage.

If more of us need these antibiotics in the future, will kidney donors be at more risk when taking them? Anyone know?


Posted by: Kidney Bogarter | Link to this comment | 04-24-10 8:37 PM
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I could be mistaken, but isn't medical science increasingly coming around to the view that donating a kidney has fewer health risks than you might think? I know that shortly after donating one of your kidneys, the other one enlarges to take over the function of the missing kidney, and that total kidney function is scarcely affected at all.

Yup. They told me before we started the process that I should expect about 95 percent of kidney function from my remaining kidney. They are lazy, lazy organs and only if one drops out does the other achieve its full potential. Also, they usually take out the weakest kidney for donation. Personally, after the recovery period after the operation I've noticed no difference between two or one kidneys.


Posted by: Martin Wisse | Link to this comment | 04-25-10 6:16 AM
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Ace-K@26: Thanks, I'm glad to hear you guys like them. This is, to my knowledge, the first time anybody has ever clicked the link in a blog commenter's name. I always thought people just ignored those.

I love Chlorophyll. Pity it costs about 30 times what I could pay for it.

m, print, print!


Posted by: max | Link to this comment | 04-25-10 7:45 AM
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Facebook to the rescue. Almon has more than 1,600 Facebook friends, but as she waded through her friends' status updates, she discovered that one of them needed something quite urgently: a kidney.


Posted by: JP Stormcrow | Link to this comment | 04-25-10 9:04 AM
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though I'm a bit curious as to how the medical experts could determine that someone should be bumped to the back of the queue for said affliction...so, is it his age, eh? or is it his purported alcoholism?...inquiring minds want to know...).

Meet the quality adjusted life year.


Posted by: | Link to this comment | 04-26-10 6:46 AM
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All right, as your resident transplant surgeon lurker, here are a few facts about organ donation, particularly kidney donation.

1. There is no national set of criteria that defines who is an acceptable candidate for a deceased-donor organ, so the decisions are made by the transplant center, and are strongly influenced by insurance company regulations. Many insurance companies will not pay for a transplant in an alcoholic unless they get straight.

2. It is difficult to drink your kidney to death, but there is a real concern that an incontinent (no, I do not mean one that pees on himself) alcoholic will not do what it takes to maintain the transplanted organ, such as keep adequately hydrated and take his anti-rejection medications religiously. Alcoholics vary widely, and certainly at my center we do transplant some of them, but only after a thorough psychiatric evaluation and generally only they agree to enter a program such as AA. We then require a certain time period of compliance with the program, say 6 months, and also keep in touch with their dialysis center to see if they are compliant with their medications and other requirements.

3. Live kidney donors, on average, live longer than the average 'man on the street,' largely because we only take the healthiest donors. For a young donor who hasn't developed any medical problems as of yet but who has a strong family history of diseases that may crop up later and hurt the remaining kidney, we will often recommend against donation. Any kidney donor that subsequently loses the remaining kidney will be sent to the head of the line for a new kidney. This is true no matter how long ago the original donation was - one of the first transplants I did was for a guy that had donated his kidney to his identical twin brother 38 years before.

4. QUAL's are still being hotly contested in the transplant world as a instrument for determining the ideal distribution of a limited resource. In Europe, they have a policy called 'Old-For-Old' I think, where older recipients are generally only given organs from older donors, with the idea that QUAL's will be maximized by putting the best organs in the youngest recipients. Here in the US, we only discriminate in the other direction - we rarely give old organs to the young, but we will give young organs to the old. Whether an older recipient can tolerate an organ from an older donor is largely dependent on their other medical conditions. 5-year survival for a person over 65 on dialysis is only about 25%, but if that patient is transplanted it is close to 60%, so although you may not get the same number of years out of an organ if you put it in a 70 year old, you can still make a remarkable difference. Dialysis is no cake walk, either. Grandpa may have a conversion once he experiences the reality of being hooked up to a machine for 4 hours 3 times a week, has his blood pressure dropped repeatedly, ends up with 4 catheter infections, and enjoys the inimitable pleasures of bad muscle cramps, fluid restrictions, and exhaustion.

IRT the OP, there are a number of issues. How much support does he have in the family? If he has alienated everyone, he is not going to do well. Is he willing to consider rehab/quitting the hooch? If he is, it is worth trying - you would be amazed at the turnarounds some people can make, but I would definitely require a period of adherence to a program before I let an 18 y.o. donate. What is the donor's motivation for all of this? Is her grandfather the most important person in her life, or is she grandstanding? (Not an uncommon issue in donors, especially the younger ones. Most programs require a psychiatric evaluation of some sort for the donor to make sure that they are not being coerced, and that they really understand the decisions they are making.)

Also, it is not unreasonable to go shopping for another transplant center to see if someone else would consider putting him on the list for a deceased-donor organ. There are small boutique centers that only take 'perfect' recipients and donors, and then there are big aggressive centers like the one I work at that will take a live donor for an 85 year old (wasn't our best moment, but hey.) If grandpa is the kind of alky that is routinely found in the gutter after closing time and delivered home after a night in the pokey he probably wont be considered, but there is a very wide range among centers and you can often find a place that is willing to consider a marginal recipient.

Sorry for the length of the comment, and I have not really proofread it, but I hope it makes some sense.


Posted by: Dr. Oops | Link to this comment | 04-26-10 7:35 AM
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Dude! I was wondering if you were going to weigh in.


Posted by: LizardBreath | Link to this comment | 04-26-10 8:25 AM
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I'm very grateful that my alky father never asked me for an organ when his liver was failing. I was told that he wasn't eligible for transplant due to being (great term) an incontinent alcoholic, but who knows if that was true or just something made up to spare guilt. When you're washing down your liver meds with MGD, you're probably not a good bet regardless.


Posted by: Amber | Link to this comment | 04-26-10 9:19 AM
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76: Thanks for the perspective (also whoever was 75 with the link to the quality-adjusted life year definition). Unfortunately, I do not think the public discourse in the US is healthy enough right now to really work through the issues that your comment raises ("ooh, there really *are* death panels") despite the fact that millions and millions have had worked through similar kinds of logic with regard to their own family and or friends' health situations. For instance, during the execrable national "debate" on the Terri Schiavo situation it came out that Tom Delay had been involved in a decision to not take extraordinary measures to extend his father's life after an accident despite the lack of a living will (not that the facts of the two case were the same, but Delay was leading the shout-y "know nothing" approach which completely derailed any ability to even have the facts discussion).

A bit scary when public rhetoric and inescapable private reality diverge to degree that they have with so much in the health care arena.


Posted by: JP Stormcrow | Link to this comment | 04-26-10 4:20 PM
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