write a dialog between doctor ne patient about kidney donation
Answers
Dr. Barry: Good morning. Your Nephrologist has referred you to our center for evaluation of your kidney transplant surgical candidacy. I understand that the cause of your end stage renal disease is Diabetes Mellitus Type II and that you are not yet on dialysis.
Pt: yes, that’s correct.
Dr. Barry: Do you have any friends or family members that are interested in donating a kidney to you?
Pt: What are the advantages of living donor kidney transplant?
Dr. Barry: The main benefit is that we can perform the transplant within months of identifying a suitable donor. The waiting time for a deceased donor transplant (formerly called cadaveric transplant) is 4 to 5 years here in our region. Also, living donor kidneys are more likely to function immediately, lessening the likelihood of the recipient needing temporary dialysis after the transplant. Finally, living donor kidney transplant recipients enjoy better long term graft survival.
Pt: Can I have a transplant before going on dialysis?
Dr. Barry: Yes, but if your kidney function is not too bad, we need to wait until you are closer to needing dialysis. If we perform a transplant too soon, the benefits of receiving a new kidney are cancelled out. We measure your creatinine and creatinine clearance to help us decide the optimal timing of your transplant before going on dialysis.
Pt: Will you remove my own kidneys during the transplant?
Dr. Barry: Usually we don’t have to do this. However, if you have a kidney disease that causes ongoing problems, for example, multiple blood transfusions, persistent kidney infections or intestinal blockage, then we would consider removing your own kidneys. The two most common medical conditions requiring “native nephrectomy” (removal of your own kidneys) are Congenital Reflux Disease and Polycystic Kidney Disease. If you have these diseases, we would decide based on your symptoms or complications whether you would need to have your kidneys removed.
Pt: Getting back to living donor kidney transplantation, what if I have no friends or family members who can donate, or what if I am uncomfortable about asking anyone to do this?
Dr. Barry: That’s perfectly fine. It’s especially important to realize that if you are uncomfortable about asking anyone to donate, then you shouldn’t do so. Organ donation is a gift and it should come from the heart, not by emotional coercion. Financial coercion for organ donation is illegal in the United States.
Pt: What is the surgery like?
Dr. Barry: The kidney transplant operation is a straightforward procedure. The surgery takes about two hours and starts with an incision (usually about 6 to 8 inches) from your pubic bone up to your hip bone. We place the new kidney in your pelvis and connect it to the blood vessels in your groin as well as connecting the kidney to your bladder.
Pt: How long do I stay in the hospital?
Dr. Barry: Most people stay five days.
Pt: Does the new kidney start working right away?
Dr. Barry: Usually it does, but sometimes the new kidney is “stunned” or “sleepy” and it doesn’t start working immediately. This is more common with deceased donor kidney transplants but can, very rarely, happen even with living donor kidney transplants.
Pt: What happens if my new kidney is “sleepy”?
Dr. Barry: Sometimes patients will require dialysis after their transplant operation until the kidney starts working. If it is a simple matter of delayed kidney function (that is, if there are no technical or surgical complications and there is no rejection), then kidney will most always “wake up”. In these cases, the need for dialysis can last anywhere from a few days to a few weeks.
Pt: What about rejection?
Dr. Barry: You will have to take anti-rejection medicines every day after you receive your kidney transplant. These days, our medicines are so effective in preventing and treating rejection that it’s extremely unusual for someone to lose their kidney because of rejection in the first several years after transplant. Nonetheless, about 20% of all kidney transplant recipients experience an episode of rejection in the first few years.
Pt: Is that another operation?
Dr. Barry: No. A biopsy is performed by placing a small needle through the skin after numbing the skin with local anesthesia. It can be performed as an outpatient procedure.
Pt: Not at the moment, but I’ll contact you if I do. Thank you very much for your time.