BIOLOGY Volume 3 - A Guide to General Biology - 2004

20. EXCRETION AND OSMOREGULATION

20.9. Kidney diseases and their treatment

20.9.4. Kidney transplantation

The first Kidney transplants were performed in the UK in the 1960s. Today, it is the most common and lowest-risk type of organ transplant surgery. Around 1,800 such Procedures are carried out annually in the UK, a figure that could be higher if more Donors were available. Most other European countries perform a higher number of kidney transplants per capita. The success rate is very high, and Structure/149.html">The problem of organ rejection has been largely overcome through The Use of the drug ciclosporin A. In 1996, a new agent was introduced that reduces the risk of acute rejection (within the first 3 months) by a further 50%. These issues are discussed in more detail in Section 25.7.13. The advantages of transplantation over dialysis are that it is significantly less expensive, and following a successful operation, patients can lead a much more fulfilling life. In the mid-1990s, the annual cost of dialysis was approximately £20,000, whereas post-transplant drug therapy costs only about £300 per year. In 1989, 3,700 people were on the waiting list for this Procedure in the UK.

Close relatives sometimes act as donors, which significantly reduces the risk of rejection, and a person can live a normal life with just one kidney. National and international systems exist to find compatible donors. A patient's Tissues are typed for Antigens, and an organ is matched on this basis. If the kidney is to be sourced from a deceased donor, Brain death must first be officially confirmed, after which the Kidneys are rapidly excised and placed on ice while tissue typing and screening for hepatitis and HIV are simultaneously carried out. The organ must be used as soon as possible, and in any case within 48 hours. Patients on the waiting list are often notified of the surgery just hours before it takes place.

Kidney transplantation and dialysis raise numerous ethical dilemmas, the most prominent of which are outlined below.

1. How much does it cost? What level of taxation should we contribute to the National Health Service?

2. How should healthcare funds be allocated? Would it be more cost-effective to prioritize other areas, particularly the Prevention of renal failure?

3. Is it fair to treat everyone in need of dialysis and transplantation equally when a waiting list exists? Should certain individuals receive priority?

4. Is it ethical to ask a relative to become an organ donor?

5. Should post-mortem organ donation be encouraged through formal consent agreements?

6. How should permission be obtained from relatives to use the Organs of a deceased person?

7. Should there be a market for donor organs? There are numerous documented cases of individuals selling their kidneys due to financial hardship. Is this acceptable?

8. Is the current criterion for brain death adequate? Is there a significant risk of declaring brain death prematurely when there is an urgent need for a donor organ?

Some of these issues are discussed in publications issued by the Association for Science Education.