For a patient of end stage renal disease, Maintenance Haemodialysis (2-3 times a week) or a Kidney Transplant are the only available options. Worldwide medical literature supports the fact that longevity and quality of life is far better after a transplant than on maintenance dialysis.
In India barely 2% of all ESRD patients are lucky enough to undergo a kidney transplant operation. The causes are many – non availability of a donor, financial constraints, non availability of a suitable center or simply lack of awareness of Kidney Transplant.
In India there is a gender imbalance in live-transplants with more females donating to males. In my own center more than 90% of the donors in the live-transplant programme are females.
I present herewith a few observations and thoughts on kidney donation in my practice:
1. There still persists a misconception in the population that live kidney donation can create long standing health problems to the donor.
This is not true. In the case of all organ donors a detailed health assessment is done. All precautions are taken to ensure that organ donation will not adversely affect the donors’ health. During these evaluations quite often we have diagnosed unsuspected diseases in the donor like Hypertension or Diabetes. Sometimes even structural defects in the kidney like Horse Shoe Kidney or Solitary Functional Kidney have been diagnosed, and all these donors have been rejected.
Moreover after the transplant has been done, all donors are carefully followed up for a long duration. These measures heighten the health awareness of donors and maintain their good health.
2. Post organ donation (live-transplant), a male member will not be able to support the family.
This aspect is partly related to the above surmise. In most instances where a male member has donated an organ to a near relative, there has not been any loss in their productivity. I have personally encountered this on many instances. A busy travel agent who donated his kidney continues, two years post surgery, to travel all around the world, conduct tour programmes and accompanies his clients on treks.
3. The female member of the family is bound to donate to her husband or children.
I have personally seen many families where in the mother or sister is emotionally pressurized to donate a kidney to a near one. In some instances the gender bias of society plays so strongly that the mother or sister will not permit a male member like the brother or father to donate a kidney. So it works both ways.
Much of these patterns are a reflection of the gender bias prevalent in North India in general.
4. Sibling donation is strong.
A boy of only 21 willingly donated his kidney to his 15 year old affected younger brother. Such strength of conviction is extremely rare to otherwise see in any 21 year old youth, is it not? This sibling bond is probably the only real relation that can break the barrier of gender.
5. Deterrence by some Doctors.
There are unfortunately still some doctors who are not willing to advise their patients to consider renal transplant and organ donation. Examples are cited of complications that have occurred during transplant surgery to suggest that dialysis is a better option than transplant and donors are also desisted from considering the operation. The main underlying factor here may be the fear of “losing a patient from the maintenance dialysis pool”. This is unfortunately a great disservice to the patient community and needs to be addressed by doctor education programs.
This scenario is otherwise changing slowly. With proper understanding of the reality of the morbidities of long term dialysis, the number of patients coming forth for transplantation is slowly increasing.
To conclude, I feel that good counseling and patient education may go a long way to encourage male members of a patients’ family to go ahead for organ donation.