Friday November 4 2011
Many must rely on dialysis due to a kidney shortage
Increasing the number of kidneys that are donated to strangers could save both lives and money, says a new charity.
Several media sources have highlighted the campaign by Give a Kidney – One’s Enough, which aims to increase the number of “altruistic” kidney donations, where people offer one of their kidneys to help a stranger. The charity has highlighted the severe shortage of kidneys available for transplants, and that thousands of people are currently waiting for a transplant. Each year, around 300 people die while waiting for a donor.
The charity argues that if more people considered altruistic donation, the waiting list would shrink and thousands of people currently on dialysis would regain their health and independence. It also points out that the costs of a transplant are much lower than those for long-term kidney dialysis. Some news sources estimated that clearing the waiting list would save £650m a year.
The news also highlights the fact that most kidney donors live healthy and normal lives, as having only one kidney is unlikely to cause future health problems. That said, the decision to donate a kidney is a major one that needs much consideration. You can read more on the process at the Give a Kidney website and in our section on organ donation.
How big is the kidney shortage?
Despite long-running public campaigns to increase the number of donations after death, there is still a severe shortage of kidneys for transplant. In addition, the number of people who need a kidney transplant is increasing. The charity points out that:
- 6,500 people are on the waiting list for a kidney transplant.
- Only 2,500 kidney transplants take place each year.
- This means that 4,000 people who could benefit from a transplant each year do not get one and must remain on dialysis.
- 300 people die each year while waiting for a transplant.
The average waiting time for a kidney transplant is two-and-a-half to three years, and for some ethnic minority groups and people with rare tissue types it may be more than five years.
Who can donate a kidney?
Most living kidney donors are close relatives of the person who needs the kidney, but sometimes they are partners or friends. However, a small but growing number of people are putting themselves forward as altruistic donors – individuals who will offer a kidney to a recipient they do not know. It is this type of donation that Give a Kidney – One’s Enough wants to see increase.
There is nothing in the law to stop living donors giving their kidneys to anyone they choose, including a stranger. The Human Tissue Authority, set up by the Human Tissue Act which came into force in 2006, regulates organ transplantation in the UK. It oversees all organ transplantations by living donors, whether or not they are related to the recipient.
In England, Wales and Northern Ireland, there is no lower or upper age limit for being a donor, although most donors are over 18. In Scotland, kidney donors have to be over 16. Old age does not necessarily mean that someone is unsuitable to donate a kidney, and the Give a Kidney charity presents the account of a man who donated a kidney at the age of 72.
What sort of person needs a kidney transplant?
A wide range of people need kidney transplants, although most have chronic kidney failure, which causes long-term deterioration in their kidney function. The kidneys are crucial to human health, removing excess water, salt and waste from the body and producing hormones that keep bones and blood healthy.
Causes of kidney failure can include diabetes, inflammation, polycystic kidney disease (an inherited condition) and renovascular disease (where the blood vessels to the kidney are furred up). However, in up to 30% of patients with kidney failure, the cause is unknown.
For people with advanced kidney failure, a transplant is the best option. Until that becomes possible, they have to have dialysis, which takes over the kidneys’ job of filtering our waste products. There are several different forms of dialysis, but generally they are time consuming for patients and require regular medical support. For example, patients undergoing haemodialysis (which involves a special machine filtering the blood) usually have to attend four-hour sessions three times a week.
Kidney failure is more common as people get older, but it can affect people of all ages, including children. People whose personal stories appear on the new charity’s website include a 52-year-old father of two with polycystic kidney disease and a 41-year-old man who has had kidney problems since his 30s after a bad attack of gout.
Can I choose who gets a kidney?
While you can donate to someone you know, being an altruistic kidney donor means that the kidney is given without you knowing who will receive it. Last year, altruistic donations accounted for just 3% of all living donor kidney transplants.
The NHS Blood and Transplant Centre finds a suitable recipient, and the transplant is then arranged by local kidney transplant centres. Most altruistic donors never meet the person who receives their kidney, although it is possible for both parties to meet after the operation if they want to.
Is it safe to donate a kidney?
In the short term, donating a kidney carries some risk, as all operations do. Donors may be at risk of infections and, more rarely, bleeding or blood clots. There is a very small risk of death for a kidney donor, estimated to be 1 in 3,000. However, donors go into the operation in good health and undergo rigorous testing and evaluation of their health before the donation to make sure any risks are minimised.
In the long term, there is a small possibility of a slight rise in blood pressure and excess protein in the urine. However, studies have shown there is no long-term effect on the health of the donor or on the remaining kidney.
It is perfectly safe to live with one kidney. People who live with one kidney are at no greater risk of developing kidney failure than anyone else. Once you have recovered from the operation, no change in lifestyle is required, and a donor should lead a normal healthy life as before. For example, having one kidney should not affect what you can eat or drink.
What happens if I choose to become a living donor?
You will need to go through a series of tests and examinations to ensure you are healthy enough to donate a kidney. These tests include medical, surgical and psychological checks and may take three to six months. Blood tests will be carried out to assess the donor’s tissue type and blood group, so that they can be matched with a potential recipient.
If all the tests are successfully passed, potential donors are usually invited to meet the transplant surgeon to discuss the donation, details of the operation and possible dates. The final stage involves seeing an independent assessor, trained by the Human Tissue Authority, who will ensure you understand the process and are giving your kidney freely and voluntarily.
The operation to remove a kidney is major surgery. It requires a general anaesthetic and takes about two to three hours. The kidney may be removed by either open surgery, in which an incision is made in the side of the abdomen, or using “keyhole” (laparoscopic) techniques, which involve smaller incisions. The kidney is then taken to the recipient, who is usually in another hospital.
Recovery from a kidney donation can take between two and 12 weeks, depending on whether the surgery was keyhole or open. Most donors are more or less back to normal within six weeks.
What are the benefits of a living kidney compared to one from someone who has died?
Living donor kidneys are sometimes referred to as the “Rolls-Royce” of kidney transplants, and there are several benefits to living kidney donation over donation from a deceased donor:
- The kidney comes from a person who has been found to be fit and well.
- The transplant can be planned some time in advance, in some cases before there is a need for dialysis.
- Recipients who have a transplant before going on to dialysis have a better chance of the transplant being successful.
- Transplants from living donors are significantly more successful than those from deceased donors.
Will giving a kidney benefit me?
There is no financial benefit to kidney donation, and the process is carefully regulated to ensure that no payment is involved. However, many donors have said they found helping a stranger through donation rewarding, positive and meaningful.
Some studies have shown that donors live longer than the average person, although it is not clear why this is. It’s thought that this could be due to donors being selected on the basis of good health, or because of the extra medical attention and monitoring they receive before and after their transplant.
It has also been estimated by some that higher rates of transplants could save the NHS money, as it is cheaper to perform a transplant than to keep patients on long-term dialysis. According to figures published in the Daily Mail, clearing the 6,500 patient waiting list could save £650m over the next five years, and while a transplant costs around £50,000, five years of dialysis and care will cost around £150,000 for each patient.