> came across some stats on how safe it was to donate and it totally changed my picture. I thought, 1/3,000 risk of death in surgery is like sacrificing yourself to save 3,000 people. I want to be the kind of person who'd do that, and you just have to follow these few steps.
What these noble gestures based on statstical thinking invariably omit is the fact that kidney donors have an elevated chance of suffering from kidney disease themselves. This risk is much higher than the 1/3000 risk of death in surgery reported in the article. For example:
> Two studies report a higher risk of end-stage renal disease (ESRD) among donors than among healthy nondonors; however, the absolute 15-year incidence of ESRD is <1%. All-cause mortality and the risk of cardiovascular events are similar among donors and healthy nondonors, although one study provides evidence for a 5% increase in all-cause mortality after 25 years that is attributable to donation.
So it's not like you sacrifice yourself to save 3000 people, it's sacrificing yourself for a chance to have two kidney patients where you only had one. And while "less than 1%" sounds like a small personal risk, it is a large risk at a population level. And as more people are convinced of the altruism of donating a kidney, while alive, it will affect more people.
In this, I'm speaking as a kidney patient and one who would never accept an organ from a living donor, exactly because of the above.
And that's before thinking of the trade-offs in quality of life that come with transplantation, and the potential effect of "freezing" research in finding true cures for kindey disease (which is not one disease) because we can keep people alive for more than 10 years with transplants and dialysis.
> So it's not like you sacrifice yourself to save 3000 people, it's sacrificing yourself for a chance to have two kidney patients where you only had one.
This is somewhat dismissive and feels unfair.
There is a huge QoL difference between an existence on Dialysis (CAPD being less miserable than haemo - but still hard) and post transplant life.
However, I agree with your end position. I don't think I would accept a live donor kidney from a loved one, so accepting from a stranger would feel unreasonable.
I keep hoping for the mythical "grown" organ to resolve issues - but I have concluded it will not be in my lifetime
Maybe I'm being unfair. I would feel more charitable if I saw a concerted effort to warn potential living donors of the risks they get themselves into. There is virtually no such effort and I believe this leads at least some well-meaning people to make a life-changing decision with less than complete information.
And that is what I think is the most unfair thing, the greatest injustice, of all. To deprive an independent adult from the freedom to make an informed decision about their own health.
I'm speaking from personal experience again and this is probably coloring my views. In any case, since I will probably need kidney replacement therapy sooner or later I can say with certainty that both options, dialysis (both kinds) and transplant, just suck.
> I can say with certainty that both options, dialysis (both kinds) and transplant, just suck.
You're not wrong, and you have my sympathy. I'm somewhat leery of over-sharing on here, so will leave there. Hope you're not overly weighed down by the inevitability.
I mean, it's pretty obvious that the expected additional kidney cases per donation is less than 1. We aren't talking about an exponential explosion of kidney transplants, it tends to a finite sum with fewer deaths.
Because it's an argument against the idea that kidney donation doesn't make sense since it causes more cases? I mean I guess there's a world where 25% of global GDP goes towards surgeons moving kidneys around, but between you and me I suspect that this particular function trails off a lot quicker than that.
> 1/3,000 risk of death in surgery is like sacrificing yourself to save 3,000 people
If I’m being honest with myself, I’m entirely sure I would ever sacrifice myself to save 3,000 random strangers.
There are movies like (spoiler alert) Failsafe which explore how difficult the choice of self-sacrifice is to save even 3 BILLION people, let alone 3,000.
What these noble gestures based on statstical thinking invariably omit is the fact that kidney donors have an elevated chance of suffering from kidney disease themselves. This risk is much higher than the 1/3000 risk of death in surgery reported in the article. For example:
> Two studies report a higher risk of end-stage renal disease (ESRD) among donors than among healthy nondonors; however, the absolute 15-year incidence of ESRD is <1%. All-cause mortality and the risk of cardiovascular events are similar among donors and healthy nondonors, although one study provides evidence for a 5% increase in all-cause mortality after 25 years that is attributable to donation.
https://pubmed.ncbi.nlm.nih.gov/25941060/
So it's not like you sacrifice yourself to save 3000 people, it's sacrificing yourself for a chance to have two kidney patients where you only had one. And while "less than 1%" sounds like a small personal risk, it is a large risk at a population level. And as more people are convinced of the altruism of donating a kidney, while alive, it will affect more people.
In this, I'm speaking as a kidney patient and one who would never accept an organ from a living donor, exactly because of the above.
And that's before thinking of the trade-offs in quality of life that come with transplantation, and the potential effect of "freezing" research in finding true cures for kindey disease (which is not one disease) because we can keep people alive for more than 10 years with transplants and dialysis.