I am travelling through London on my way to Jeddah, Kingdom of Saudi Arabia.
What are nephrologists in the UK talking about?
A couple of weeks back the editor of the BMJ Fiona Godlee set up a debate under
the title: Kidneys
Wanted. The question Dr.
Godlee asks is: “Is it unethical for doctors to encourage healthy adults to
donate a kidney to a stranger?”
In an earlier Clinical Review on Renal Transplantation (also published in the BMJ), Paul Thiruchelvam and colleagues from the Hammersmith Hospital
discuss the challenges of how to deal with the burgeoning prevalence of
end-stage renal disease as a global problem, and the difficulty of finding
adequate numbers of kidneys for potential transplant recipients.
Thiruchelvam writes: “Renal
transplantation increases survival and improves the quality of life for
patients with end stage renal failure. A recent UK estimate found that
transplantation conferred a cost saving of £25000 (€29 000;
$40000) a year per patient with end stage renal failure.”
An older article from 1986 the “Recommendations
on the use of living kidney donors in the United Kingdom. British
Transplantation Society" provides historical context (link).
The clinical context to this debate is this: “With three
people on the kidney transplant list dying in the UK every day, should doctors
encourage their patients to put themselves at risk for the benefit of others?”
In November 2011 saw the launch in the UK of a new
charity campaign, Give a Kidney: One’s Enough (www.giveakidney.org), which aims to push
this contribution up.
Dr. Godlee writes:
"How should doctors respond to this small but growing
trend? Should they actively encourage their patients to give a kidney, just as
they might encourage them to give blood?
Walter Glannon writing in the BMJ thinks not. It’s unethical, he says, because it contravenes the doctor’s
primary obligation to protect their patients from harm. The risks are small
compared with other surgical procedures, but they are not zero. One in 3000
donors will die, the figures suggest, and one in 10 will have some form of
perioperative or postoperative complication.
Antonia Cronin also writing the
BMJ makes a good attempt at arguing the other side of this head to head debate. Who
could disagree with her closing words: “if something is not wrong to do but
actually a good thing, then it cannot be wrong to encourage the doing of it.”
Several very interesting responses – here; the article by
Sue Rabbit Roff from the University of Dundee stirs the pot also.
In a previous post the risk of ESRD to living kidney donors was discussed. There doesn't appear to be a significantly increased risk. Of course, the question is: Is there even a small risk?
My own view, based on evaluating donors for the kidney transplant program for Children's Hospital in Boston, which I did for several years, is that doctors should defer from recommending kidney donation to their own patient's. If a patient expresses a desire to altruistically donate a kidney then our role is to educate the patients on the risks (and potential benefits -- largely emotional). However, I fear that we cross a line when we use our role as the patient's physician/care-giver to actively "encourage" the patient to donate a kidney.
In a previous post the risk of ESRD to living kidney donors was discussed. There doesn't appear to be a significantly increased risk. Of course, the question is: Is there even a small risk?
My own view, based on evaluating donors for the kidney transplant program for Children's Hospital in Boston, which I did for several years, is that doctors should defer from recommending kidney donation to their own patient's. If a patient expresses a desire to altruistically donate a kidney then our role is to educate the patients on the risks (and potential benefits -- largely emotional). However, I fear that we cross a line when we use our role as the patient's physician/care-giver to actively "encourage" the patient to donate a kidney.
