Many people die of organ failure every year. The media recently reported the story of the Ma family and the challenges they faced as the mother donated part of her liver to save her daughter’s life is a moving example of a family coming together in the face of adversity.
By Sept. 27, the father’s Facebook page had received 70,000 messages of support, offering prayers for the survival of mother and daughter. However, it is also at times like these that we should ask the question: Is it really necessary to put family members through the ordeal of organ donation? Why can’t we take them, for example, from patients diagnosed as brain dead?
Rough estimates put the number of patients waiting for a liver transplant in Taiwan in 2008 at 1,456, of which 293, or 20.1 percent, were lucky enough to receive one. Of these, 71 patients received liver transplants from brain-dead donors, while the remaining 222 patients received living-donor liver transplants from their immediate families or relatives. For every liver transplant from a brain-dead donor in Taiwan, therefore, there are three transplants from a living donor related to the patient. In the US, the number of transplants from deceased donors is 22.4 times higher than that from living donors.
Living-donor liver transplants are risky even with today’s sophisticated surgical techniques. Family members are often, then, forced to risk their own lives for the sake of their loved ones because of the paucity of available brain-dead donors.
Compared with living-donor liver transplants, living-donor kidney transplants are relatively simple, with long-term research revealing no clear harm to donors.
Again in 2008, 5,218 Taiwanese patients were waiting for a kidney transplant, of which 259, or about 4.8 percent, received such a transplant. Among these, 178 patients, or about 68.7 percent, received kidneys from a brain-dead donor, while the remainder received one from a living relative or family member.
The number of patients waiting for a kidney transplant far exceeds the number of patients waiting for a liver transplant in Taiwan. However, the number of patients having a living-donor liver transplant far exceeds the number of patients having a living-donor kidney transplant. This bucks the trend of what is happening in developed countries.
Doctors and medical professionals have to put patients’ rights first. Governments and nephrologists — medical practitioners specializing in kidney diseases — in the US and Europe have developed various scientifically based policies promoting the use of kidney transplants. In addition to hemodialysis and peritoneal dialysis, they have also focused on postoperative care and relevant research to make sure patients get the treatments they need.
However, as surgeons dominate kidney transplants today in Taiwan, only 3 percent of nephrologists participate in the process. Another problem is that neither the government nor the public is aware of the importance of kidney transplants. As a result, the increasing number of patients on renal dialysis is straining the National Health Insurance (NHI) system. To improve this situation, the Transplantation Society of Taiwan and Taiwan Society of Nephrology should cooperate with each other to reach a consensus on future treatments.
Taiwan has a 94 percent five-year patient survival rate for living-donor organ transplants. For kidney transplants this is 87 percent and the rate for renal dialysis patients is 56 percent. Only 11 percent of this last group have a full-time job. The Bureau of National Health Insurance and the medical profession need to accept the fact that kidney transplants can truly improve the survival rate and quality of life of those with kidney disorders.
Bureau statistics show that outpatient renal dialysis costs over NT$30.2 billion (US$975.5 million) per year and even this fails to take into account the hospitalization costs resulting from the huge number of potential complications renal dialysis patients have to deal with.
I suggest that the bureau compare the costs of outpatient and hospitalization services for renal dialysis patients and kidney transplant recipients. It could then estimate how much money each kidney transplant recipient saves compared with each renal dialysis patient, as well as how much they could save the NHI system over one, five and 10 years.
Under the bureau’s “global budget payment system” for renal dialysis, hospitals can increase their average point value by reducing the number of renal dialysis patients they have to treat and plow the extra resources into providing better care for their patients. Promoting kidney transplants would therefore benefit everyone in the long run. It seems silly not to do it.
If the focus on kidney transplants is successful, that would provide the impetus for other organ transplants. If such donations fail to take off, it will be a drag on other transplants. Living-donor liver transplantation can be a very traumatic experience for families and long-term renal dialysis is also a very unpleasant business. The hope is that fewer families will have to go through this experience in the future.
Lee Po-chang is a professor of surgery at National Cheng Kung University.
TRANSLATED BY EDDY CHANG
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