Solutions for dealing with kidney shortage

In previous posts I have mentioned about growing number of patients waiting for kidney and the large number of patients who die waiting for a kidney.  Here is a promising solution:

1. Public Advocacy: This is the low hanging fruit. We can increase donor organ awareness.  More number of people can sign up to become organ donors via their driver's license or otherwise.  Over a 100 million people have signed up to become donors and we can probably get more signed up here at organdonor.gov.  There is also a site which I like a lot which has become a resource for donor advocacy (waitlistzero.org). This site helps donors with lost wages, travel as well as with paired kidney. But to put it bluntly, is clear that eligible donors are not dying at rate fast enough to make up for the kidney shortage. 
2. Science: Here is a 4 minute audio blurb on NPR about scientists trying to grow kidneys from your own stem cell (link to npr site with audio and text description). One of the benefits of this is that recipient will not need any immuno-suppressants and that will a big deal. 
3. Market Economics: Perhaps the most controversial, but this involves creating some form of regulated marketplace for organ sales. In past postings I have talked about this happening in Iran (where there is no waitlist for organ donors). There are number of prominent economists (including Nobel Prize winners) who have given this some thought, Becker/Posner. Becker, Posner think the market price is around $15,000 while some others think a price of around $50,000. Along the same lines is another thought from Rohit Dhar where he suggest that instead of a marketplace, Medicare buys organs and provides it to recipients. This is not such an outrageous thought because Medicare spends 100,000s of dollars on patients with kidney failures. This would be more cost efficient, alleviate shortage problem, and provide public oversight.  This is a complex topic (from a policy standpoint) but to most economists this is not a problem that cannot be solved. 

I have enumerated them in the order of realistic outcomes. On 1), Clearly, it is up to each one of us to become organ donors (if we have not signed up).  So if you are reading this (and have not registered), then consider registering.  We can also do to support option 2) by ensuring that we support public funding (NIH, etc), oppose legislation that bans stem cells research. On 3), I think we are far from having a non-academic discussion which is what we need to make progress on this. But think about it, our own lives or lives of our loved ones may depend on this.....

Thoughts on Thanksgiving Day

Besides the thought of having a wonderful, sumptuous dinner and upcoming holiday season (and the company wide shutdown) there are few other things on my mind

• I am so thankful that I am in a position to help my brother. Truly a "good for me" moment that I am thankful for
• I am thankful for friends and family who have offered their support and best wishes during this journey
• I am thankful for friends and family who are traveling to Madison for the surgery. It's going to be a blast. (For members traveling from warmer climates, it will be a chilling experience. But a trip to State Street and Memorial Union on Thu/Fri evening will bring back some memories of their own youthful/college days)
• I am thankful to my friends Rajesh and Deepika who are going to host us in Madison in two weeks time. 

How much is a kidney worth

This is really hard question. Clearly, to a recipient especially those in dire need of it is worth a lot. Further, given that with the exception of Iran no country allows the sale of kidneys. But here are some data points.

• Kidney trafficking in the US: A kidney trafficker was convicted for trying to sell a kidney for $120,000
• Kidney prices in Iran: According to Wikipedia reference it varies between $2000 to $4000.
• Disqus: This is a blog devoted to kidney sale where there is a post about 9 days ago offering donors $150,000. The doctor and hospital appear to be legitimate. 
• Kidney for sale for $500,000 on blogger.

Risks associated with kidney donor

This data is from WaitList Zero, an advocacy site for kidney donors.

• Chance of death during surgery:
• Risk of death in surgery is 0.031% (3.1 in 10,000) for all donors.
• Risk of death in surgery is 0.013% (1.3 in 10,000) for donors without hypertension.
• Risks from surgery related complications: Based on 2010 study with 6331 donor between 1995 and 2005 findings were 
• Kidney donation was associated with an 18.4% complication rate.
• Reported complications included bleeding (4.3%), infection (4.2%); and respiratory, (4.5%), Gastro-intestinal, (6.1%) urinary (1.7%) tract complications.
• Complications were most pronounced in older, obese, and hypertensive donors.
• High volume hospitals (>50/year) were associated with significantly lower complication rates.

Here is a sobering article from NPR  on organ donation consequences for some donors. The article is stating that the data on long term effect of donation on donors is scant and advocates that the system should track donors for a longer period and more consistently to monitor for long term effects. 

Last marathon run on two kidneys

Ran my 15th marathon on Saturday, Nov 15th. Finished in 3 hr 29 min. This was my second best time ever (and fastest in the last 15 years). It was so good that my finishing time meets the qualifying time for my age group (in 2017 by which time I will be 50). The transplant unit in Madison wanted a gap of at least 10 days from the time of the marathon and the surgery.  There is no data/study to support this recommendation. Three days after the race I feel completely fine and it appears to me (on the outside) that my body (and kidneys) have completely recovered.

The doctors have assured me that one kidney will not affect my running in any noticeable way. I should ensure that I am hydrated but that is good advice even for people with two kidneys.
To keep myself motivated and test this theory, I have a personal goal to finish another marathon within one year (on one kidney) and finish within 10 minutes of the above time. 

Some statistics about kidney transplants

Here is an excerpt from an article from New York times

Last year in the United States, more than 4,000 people died while on the waiting list for a new kidney. An additional 3,600 people left the list when they became too sick for a transplant.

The kidney shortage is a global problem. The world’s need for kidneys is growing alarmingly — largely because kidney failure is one consequence of diabetes and high blood pressure. Yet the supply has barely increased. In 2014, there were 17,106 kidney transplants in the United States, but more than twice that many people went on the waiting list.

In the coming days, I will post more on what is being done to address this gap. In the meanwhile I am eager to get comments. 

Good for you

When people find out my upcoming organ donation, I get a range of comments usually with adjectives like generosity, admirable, courage, sacrifice, etc. The one I like the most is when someone says "good for you" and typically this is often said by strangers like a nurse, technician, etc when they find out about it.  

So in my own way, I was trying to list why it was good for me and then I found this list in WaitlistZero which pretty much captures it. 

Benefits reported in the scholarly literature include

• Deep gratification in helping another person. 
• Desire to improve the recipient’s quality of life and health
• Improving their own quality of life
• Avoiding the loss of the loved one
• Improving the quality of life for the recipient
• Increased self-esteem
• Improved relationship with the recipient
• Positively influencing the lives of family and loved ones.

There is additional research on well-being/happiness that indicates gratitude can increases happiness, so there is additional derived benefit. 

Happy Monday

It is about four weeks to surgery and I wanted to share this funny clip from Dumb and Dumber 2 on kidney donation.