
Artificial kidneys and miniaturized dialysis could save millions of lives - sohkamyung
https://www.nature.com/articles/d41586-020-00671-8
======
ahelwer
My older sister had end-stage renal failure (from IgA nephropathy [0]) and was
on dialysis, so I donated my kidney to her. If you want to make an incredible
difference in someone's life, I can't recommend it enough!

There are cool computer science problems involved: imagine person A1 wants to
donate their kidney to their partner A2 but they aren't a match. Now imagine
many such pairs exist (B1/B2, C1/C2, D1/D2 etc.) and you start noticing that
while A1 can't donate to A2, they _can_ donate to B2, and B1 can donate to C2,
and so on! Thus the kidney chain is born. You get everyone together and have
them agree that if their partner gets a kidney donation, they'll pass on the
favor to someone else. All that's needed is a single purely-altruistic donor
to start the fire. The longest such chain has reached over 100 people! [1]

Anyway, the surgery is laparoscopic and has an extremely low fatality rate:
around 1/10,000, which is an order of magnitude lower than the all-cause
mortality rate for living a single year of your 20s. The kidney is a fairly
isolated organ, basically only attached to you via the renal artery/vein, the
ureter (which carries urine to your bladder), and some fascia (internal
connective tissue). You can see a full video of the surgery at [2] (if you're
into that kind of thing). I was walking within hours of the surgery,
discharged within two days, and back in the gym within 5 weeks. My life is not
any different than pre-donation, and if anything goes wrong with my remaining
kidney I go to the top of the donation wait-list! If you're interested, you
can see more info at [3].

[0]
[https://en.wikipedia.org/wiki/IgA_nephropathy](https://en.wikipedia.org/wiki/IgA_nephropathy)

[1] [https://www.beckershospitalreview.com/quality/nation-s-
longe...](https://www.beckershospitalreview.com/quality/nation-s-longest-
kidney-transplant-chain-surpasses-100-donations.html)

[2]
[https://www.youtube.com/watch?v=x8-YhyYrMsc](https://www.youtube.com/watch?v=x8-YhyYrMsc)

[3] [https://www.kidneyfund.org/kidney-disease/kidney-
donation.ht...](https://www.kidneyfund.org/kidney-disease/kidney-
donation.html)

~~~
xoa
Kidney donation may be one of the most admirable and heroic things many people
can do for another. I too have had family with renal failure (though I was not
a match), and the potential to simply _fix_ it with a match is wonderful. But
anyone considering it should internalize upfront that there are potential real
long term risks, and a surprising paucity of data since long term outcomes are
apparently not rigorously followed. See for example "At 18 years old, he
donated a kidney. Now, he regrets it"[0]. It's very much not to discourage
anyone, but it'd be a shame to not go in with eyes wide open and have what
should be something to be proud of marred by any feelings of deception. I have
definitely seen the lack of hard long term data on real risks of kidney
donation downplayed, it's not fair to portray "we don't see high risks" when
that's because we just don't see much period. "Going to the top of the
donation wait-list" for example is good, but there is in fact still a wait
list.

All that said, the positive vs negative ratio certainly still appears high
depending on the situation. And developments like the one in this article
could also reasonably factor into an individuals analysis, after all in 20-30
years it may be a solved problem with high quality synthetic organs, so a
young person giving a kidney now is more helping to bridge the gap, and by the
time they themselves might have an issue they'll have saved a life yet not
have the same trouble. Even so, donators should fully recognize that, all of
them should absolutely feel as good about it as you clearly do.

\----

0: [https://www.washingtonpost.com/national/health-
science/at-18...](https://www.washingtonpost.com/national/health-
science/at-18-years-old-he-donated-a-kidney-now-he-regrets-
it/2016/09/30/cc9407d8-5ff9-11e6-8e45-477372e89d78_story.html)

~~~
random314
As for the guy regretting it, the only real issue is the possibility of
getting kidney disease going up from 0.1% to 1.0%. He is greatly over
exaggerating the risk. You are screened for potential kidney risk factors
before donating.

Your life expectancy is not affected.

------
mistrial9
a USA Registered Nurse colleague casually mentioned while we were driving past
one of the many, many chain store dialysis locations, that the service is
inefficient and literally unsafe for many patients, and generally is over-
prescribed. I assume because the drive-through model of the service, and the
chain store, franchise-type setup, and reducing face-time with MDs, that this
factory-like practice fits more to billing models and automation, so is chosen
in a pseudo-market evolution. disclosure- I have no direct experience with
kidney dialysis, nor known anyone who goes there.

~~~
C1sc0cat
I was on dialysis in the UK - Um not sure what you mean though the US has less
home dialysis and prefers Hemo vs CPD

Dialysis helps you both stay alive and also helps extend the life of the
failing kidneys - and a better outcome for a trasplant

Normally based on my experience you are prescribed your dialysis based on your
remaing kidney function.

Dialysis is ideally a long process starting years before you start, combined
with going on the transplant list (ideally you get the call before you go on
dialysis)

I was doing home CPD dialysis BTW

