Friday 31 August 2012

Altruistic Directed Kidney Donation?

ITV's "Tonight" programme last night was about an American website which matches altruistic kidney donors with suitable recipients.  They claim to have matched over 250 altruistic donors with recipients (presumably mostly in the USA) although I didn't hear how long that took.  Apparently they are now launching a website for the UK as well.

Now, it turns out that this is not illegal in the UK, but it is contrary to the "accepted" way of doing things here.  In the UK, an "altruistic donor" is also called a "non-directed donor", because such a donor agrees to give a kidney to anyone (who is selected by the NHS, I presume).  Since this was made legal in the UK in 2006, there has been only just over 100 altruistic donations made (the figure they quoted was 117).  In this context, the US figure is quite significant.

The big question is whether this is the way to go?  The samples of videos from the USA frankly made me cringe.  I can see that there's an issue that the person who is loudest, with the best video and best self-promotion, is the one who gets a donor; this does not seem "fair".  It almost seems like a beauty pageant where the most attractive person wins, and I really do not think that we want to go down that route, do we? I can understand why the NHS wants to preserve anonymity as it avoids lots of issues and makes the process simpler but, if selecting your recipient actually has a significant effect on the total number of altruistic donors, then surely that's a good thing?

As you can see, I have no decided view on this matter; there are pros and cons for both sides.  However, I have a suggestion which is a compromise: given that the number of potential recipients far outweighs the realistic number of potential donors, why not let the donor (if they want to) specify (as I think they do on the US website) the type of person to whom they wish to donate and then select a receipient from a list of, say, 10 or 20 potential recipients?  These recipients must be happy to know their donor, and would surely be tested anyway to allow them to be matched to the donor.  Then the beauty parade is avoided as the NHS will have made their choice of the list on the basis of suitability and need (which is how I assume that they select a recipient already).  The current system could work alongside this for those who prefer anonymity.

I'm sure that more will be heard about this website...

Changing the subject slightly, I never mentioned the result of my fasting blood sugar test.  My score was 4.5 which of course is meaningless to most of us, but when I mentioned this on the phone to one of the transplant co-ordinators she said that 4.5 was "absolutely normal".  After my experience with the renal ultrasound (see this earlier entry), I didn't want to ask if she had omitted the caveat "for a man of your age"!

Friday 10 August 2012

...With Many A Winding Turn...

I've just returned from another day at my (relatively) local transplant hospital, after the last tests as described in my last post.  These appointments were for a "CT Angiogram Renal/Abdominal", a Glomerular Filtration Rate (GFR) test and a Renal DMSA; as expected it was quite a long day, but I must compliment the hospital for making it a relatively stress-free experience, as all three appointments were conducted at the times specified and I was not kept waiting unnecessarily.  Sadly, the necessary bit of waiting involved two waits of 90 minutes and three waits of 60 minutes, but there was no getting around those.  The good side of this is that I have now finished reading "Pilgrim's Progress" (at last).

The abdominal CT ("Computerised Tomography", in case you wondered) scan in Radiology was first. You lie down and are moved feet-first into a large doughnut-like machine which is basically a rotating X-Ray with some clever software to build up a 3D picture of whatever part of you they are interested in.  Part of this 30 minute procedure is three timed injections of a surprisingly large quantity of an iodine solution; the radiographer fitted a cannula into my left arm to save me looking like a pin cushion after the whole day; I was surprised that radiographers could do this, and she was cautious as she got someone in to check it. I spent some time trying to calculate the quantity of iodine based on the size of the transparent container and eventually came up with 125ml ("almost an armful!").   I assume that the iodine goes to/through my kidneys and is picked up by the X-rays thus highlighting the interesting features like the number and position of arteries. You are warned that this iodine can have three effects: a hot flush, a metallic taste in your throat, or the feeling of sitting on a warm car seat (although I don't have such a device in my car so could only guess); this last one has also been described as a feeling that you are wetting the bed!  I had only a hot flush on my palms and a slightly warm feeling in my nether regions. 

The other two appointments were done in the adjacent "Nuclear Medicine Department".  The GFR test starts with an injection and then the four subsequent blood tests (using the same cannula) will give an accurate figure for how well my kidneys are working - I think this is for future reference, as the eGFR has already told them that they work OK.  For the Renal DMSA, you are injected with a small amount of radioactive fluid and after the 90 minute wait they do a scan which picks up the radioactivity and shows the distribution of arteries etc around your kidneys.  (I think this confirms the CT scan.)  Because of this radioactivity, you are shown to a different waiting area (with toilets marked "radioactive hazard"!) when you come back for the scan - this is to protect the staff like the receptionists who otherwise would suffer a particularly large unwanted dose over a long period from many patients like me hanging around near them.  In doing the scan you lie down and they move a large scanner down to your body; I wondered if it had some sort of safety stop on the maximum travel as otherwise it could be a new way for someone to try and kill James Bond!  Or perhaps by this time I was starting to fantasize.  NB For this scan of my abdomen, I had to remove my shoes (why?) and was moved under the scanner to a position where my feet stuck out the other end in a draught! Just a small point...

I mentioned the Renal DMSA in my last post.  Since then I have found out (from Wikipedia) that DMSA stands for dimercaptosuccinic acid, which makes me no wiser.  It has the chemical the formula HO2CCH(SH)CH(SH)CO2H if you're into that sort of thing.  Slightly worryingly, the Wikipedia articles on DMSA and dimercaptosuccinic acid do not mention its use for assessing kidney function, while the article on Renal Function does not mention DMSA at all.  More questions for the list!  [NB I also mentioned Di Franks' excellent website last time.  I have also found that in fact she has covered the same topic of eGFR and Renal DMSA in some useful detail - see this link.]

In one of my long waits, I visited the Transplant Co-Ordinator to ask a couple of questions.  Since this is my last visit to this hospital, I also wanted to thank her in particular for making my testing so painless (both literally and metaphorically).  They will send my results to London and my further participation (if any!) in this process will all be there, so I won't see her again but I will keep her informed.  As far as I am concerned, the Churchill Hospital in Oxford have been excellent throughout this process of tests, and I think they have all been wonderful to me - nurses, radiographers, phlebotomists and receptionists have all been happy, helpful, efficient, professional and just right in their approach to me. Well done, I say.

Finally, on being picked up by my wife, I kissed her after greeting her with the ultimate chat-up line: "Hiya.  I'm Radioactive Man!"