I was offered organs for my patients from donors with leukaemia and Hodgkin's disease
You report how "two transplant patients were given kidneys from a donor with a rare and aggressive form of cancer" (Patients given kidneys from donor with cancer, 22 March). And, your article states: "One senior official at the NHS Blood and Transplant Service (NHSBT) warned: 'We can minimise risk but we can't abolish it.'"
Though it's difficult to comment without full details of the cases, I am not surprised that this has happened ? especially with the recent increase in the number of inappropriate offers of kidneys. Prior to my retirement as director of a transplant unit, I was offered kidneys for my patients that came from donors known to have Hodgkin's disease (a form of lymphoma), leukaemia and sepsis, all of which I refused.
Donor families should not be placed in the invidious position where their generous offer to donate kidneys is turned down. In many units, the decisions to accept or reject kidney offers are made by trainees with fewer years of experience than a consultant.
I agree with lawyer John Kitchingman, who says: "Kidney transplantation isn't urgent like liver or heart transplant." There is the alternative of dialysis. The vast majority of kidney transplants take place to improve the quality of life ? as such there must be a low tolerance of failure. While the public harbour the erroneous belief that it is all-important to have the chance of a kidney transplant, the goal surely is not just to have had a transplant, but also to survive the operation with a working kidney graft.
Robert Law, one of the recipients, had a living donor "who had been tested and gone through all the procedures" and yet was offered the cadaver kidney, when a kidney from a living donor offers the best possible results. Kidney transplants, like much surgery, are a question of balancing risk against potential benefit. In the case of living donor transplants the risk is to both the potential donor and recipient, while the benefit is mainly to the recipient (any benefit to the donor is usually psychological). A decision has often to be made by clinicians in the face of uncertainty. Was the right balance struck in this case?
The recent aim to increase the number of kidney donations by 50% by 2013 is a process target and, crucially, not an outcome target. It costs �150,000 to keep a kidney failure patient alive for five years on dialysis. The figure for a successful transplant is �43,000 ? �23,000 for the first year and �5,000 for each of the subsequent four years (the cost of the immuno-suppressive drugs and outpatient monitoring).
Following this logic, the cheapest option would be to give the patient a transplant, followed by death after the operation! A cynic might at least be tempted to suggest that the policy decision by the bean-counters in hospital management to increase kidney donation is connected to the fact that kidney failure patients, although making up only 0.8% of the NHS patient population, consume 4-5% of the total NHS resource. Thank goodness it's doctors not bean counters who look after our patients.
Source: http://www.guardian.co.uk/commentisfree/2011/mar/25/kidney-transplant-worth-the-risk
Aung San Suu Kyi Queen Elizabeth II King Abdullah Mahmoud Ahmadinejad Omar al-Bashir
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