Kidney donors?

I went to Tampa Hospital Tuesday for my initial screening for the transplant program. The facts are these. Over 92,000 people in the US are awaiting kidney donors and 4000 will die this year waiting. The best results are obtained from living donors but 1% of living donors will die as a result of the procedure. OTOH living donors, quite rightly, have priority should they need a kidney later in life.

We have in the US an enormous pool of potential donors in our prisons. Mostly men serving long sentences with no realistic chance of ever getting out short of having their sentence commuted or being granted a pardon by the President or state Governor. Has any effort been made by the National Kidney Foundation or anyone else to set up a program whereby prison inmates could offer kidneys as part of a sentence reduction program or just a humanitarian gesture to impress a parole board?

This is a horrific idea, not to mention profoundly inhumane and unethical. Would you also permit clinical trials and other medical tests be offered next? And why stop at prisoners - why not include the hopelessly poor and the homeless as well, and offer cash rewards? And, like the case of Dr Wegener - since the Nazi camp inmates were condemned to a murderous death anyway, perhaps it wasn't really immoral to perform medical tests on them?

I hope you get the point.

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Originally Posted by MaxD

This is a horrific idea, not to mention profoundly inhumane and unethical. Would you also permit clinical trials and other medical tests be offered next? And why stop at prisoners - why not include the hopelessly poor and the homeless as well, and offer cash rewards? And, like the case of Dr Wegener - since the Nazi camp inmates were condemned to a murderous death anyway, perhaps it wasn't really immoral to perform medical tests on them?

I hope you get the point.

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I don't think you do. There is a world of difference between 'volunatary' and forced donation although I admit I would also favor compulsory organ donation for condemned inmates. No point in letting them go to waste since they are to be put to death anyway.

MaxD, I think you went a little over the top there. I personally don't see anything wrong with a prisoner "willing " to donate an organ on their own. I wouldn't offer them money or a reward for it but I am sure that what ever they did to end up in prison was pretty horrific and probably inhumane maybe this would be a way for them to make up for what they had done. Kinda like giving a life instead of taking one.

I'm with Max --I'm going to take a hit on this, but I think some of us sorely need a basic ethics course.

I too see nothing wrong with voluntary donation by anyone, including prisoners, but would draw the line at any compulsory donation of organs by those condemned on death row. It is treating them like something less than human and denying them the right to make this decision on their own. They may have done something horrible to be on death row, but they still have rights to some autonomy as long as they are alive. (And let's not forget the people who have been wrongly put to death and their innocence proved later.)

All the ethics committees I know about have the view that anyone confined against their will, prison, jail, psych hospital, can not be viewed as voluntary subjects for any research unless there are very stringent guidelines and over sight of the research project to ensure there is no apparent benefit for participation or penalty for not participating that might influence their decision to participate or not.

And "ethics committees that you know about" have the final word? Based on what, that they self define themselves as 'ethics committees'?

Let's be honest, there is no independent standard by which people can determine what is ethical. Personal preference and circumstance are at play in determining what is 'ethical' and what is not: witness the eternal controversy over abortion. In other times and places human sacrifice was not only condoned but practiced by the 'religious authorities' of a society. We view that as barbaric today but, if you believed that without it the rains would not come and there would be famime, toss the virgins into the volcano for the 'greater good'.

Organ donation by a prisoner should not be required but there is nothing wrong, to me, with rewarding it with a reduction in sentence. It is no different than giving prisoners time off for 'good behavior'. In fact, the very purpose of incarcerating criminals was not to punish them or 'protect society'. That used to be accomplished far more cheaply and effectively with floggings or hangings. Instead we built 'Penitentiaries' or Reformatories and established departments of Corrections because, at the time. it was considered more 'ethical' to lock a man up for 5 years than whip him for a day in the hope his confinement would allow him to reflect on his life and thus be 'rehabilitated'

If there is one thing we might all agree on it is that our present system has failed and it has failed because convicted criminals no longer have a path back to a decent life. Organ donation would be just one way for those imprisoned for serious crimes might earn their way out of prison.

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Originally Posted by JeanMarie

I'm with Max --I'm going to take a hit on this, but I think some of us sorely need a basic ethics course.

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I am with you JeanMarie and with Max.

Although I have no problem with prisoners donating organs without gaining a reward, if more people donated we wouldn't even need to consider or discuss various scenarios and what is/isn't ethical! Perhaps that is the truly unethical situation.

I have read a report for English prison systems and living donors. In brief it lists logistical reasons, rather than ethical reasons for the very few organ donations from prisoners. Such as security in the hospital (to prevent escape) and follow up treatment after the procedure.

I am not sure if I agree with every point Sangell makes, but "It is no different than giving prisoners time off for 'good behavior'" is a valid point. Considering 'good behaviour' in prison is more akin to 'regular behaviour' out side of prison (i.e. you haven't attacked anybody) and prisoners get rewarded for that, then genuine good behaviour, such as donating a kidney, warrants more of a reward than 'good behaviour'.

As for prisoners gaining a reward I'm undecided. I have tried to imagine a prisoner who has committed the worst crime, which for me would be the murder of a loved one. Would I prefer the prisoner to fulfil his full sentence with no privileges and to have lost my loved one. Or would I prefer my loved one's death to have had a huge benefit (possibly life saving) to someone, at the expense of the prisoner getting some privileges?
I guess it would depend on what the privilege would be and what the original crime was.
If my son had been stabbed in both kidneys and he had the opportunity to receive a kidney from someone locked up for avoiding paying tax and his privilege was an extra hour of free time (e.g. playing pool, watching tv) rather than been locked in his cell, then I wouldn't deny my son a life saving/changing operation.

In my opinion, there is not a simple yes/no answer to if prisoners should be allowed to donate organs - there is too many variables. But I do see situations where it should be allowed, but NEVER forced, no matter hoe bad the original crime was.

Interesting read about some of the issues discussedhere.

https://en.wikipedia.org/wiki/Organ_...son_population

Sangell,I am very sorry that you are in this terrible situation of needing a Kidney transplant.The numbers you have given in your opening thread for the odds of getting a kidney transplant are very sobering.I know this would be giving me a wide range of emotions if it were me.Will kidney dialysis help you.At age 64 which I believe you are,maybe you don't have any family members to donate a kidney to you.I will pray for you like many others on this forum.The idea of using a prisoner as a donor,other than the organ being donated to their own family member is much too complex for me to even consider.Good luck to you.Keith.

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Originally Posted by Titus3:2

Sangell,I am very sorry that you are in this terrible situation of needing a Kidney transplant.The numbers you have given in your opening thread for the odds of getting a kidney transplant are very sobering.I know this would be giving me a wide range of emotions if it were me.Will kidney dialysis help you.At age 58 which I believe you are,maybe you don't have any family members to donate a kidney to you.I will pray for you like many others on this forum.The idea of using a prisoner as a donor,other than a family member is much too complex for me to even consider.Good luck to you.Keith.

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I agree with this point of view, that the person in need of a transplant should be whom we are most concerned about here. I'm not under the impression that all family members would be suitable donors, though psychologically, that would be the most comfortable and least stressful situation. The one person I know who got a kidney transplant (not a weggie) was apparently unable to find a compatible one, or a willing donor, until a close non-related co-worker got tested and was found to be a match, and donated. I'm not sure if the issue is blood type, or what. I need to be educated. But 15 years later, that kidney is still going strong. I don't blame Sangell for trying to think of whatever ethical resources might exist for finding a new kidney. I would agree the prisoner idea would not be at the top of anyone's list, but if it's a matter of life and death, it might seem less of a negative. I pray that you find a good match, Sangell, and one that involves as little stress and complication as possible.

Average life expectancy for a 55 year old American is 26 years
Average life expectancy for a 55 year old American on dialysis is only 5 years
Average life expectancy for a 55 year old American with kidney transplant 15 years.

Not only is dialysis a massive change in lifestyle which ranges from 3 days/week for a few hours to EVERY day a few times a day of treatment, dependant on which type of dialysis, but it doesn't prolong life that much.

The mean average life expectancy for an American on dialysis is LESS THAN 3 years. This is due to many elderly who survive for a very short period on dialysis.

If sangell was given the option of taking a donor kidney from a prisoner so that he could expect to live around 15 years in "relative" good health, or the option of being tied to a machine for his remaining few (5) years on earth, I would not have any ill feelings for him if he chose to accept a donor from a prisoner.

I do wonder if the lack of people donating kidneys is due to the idea that the patient can go on dialysis, without the potential donor realising that dialysis isn't usually a permanent solution and just a bit of an inconvenience.

Sangell, I'm still not with you on forcing deathrow inmates to donate, but can understand why you feel that way. I truly hope you get a transplant. Have you heard of pooling? If you have a friend or family member willing to donate, but aren't a match, your donor can offer there kidney to someone who has a match. All transplants are done at the same time and are swapped around. This greatly increases chances of a match. My wife has offered to do this for me. I am not in a good position asI have had many blood transfusions which means I have built up a large "database" of antibodies. Therefore a tissue match that my body won't fight against is going to be hard to find.

When my beautiful Phil was is the hospital in his last months on earth, we had few meetings with the transplant team, discussing the possibility of lung transplant. When Phil understood that the donor might be someone who's brain is considered to be "dead" and then they unplug the donor, Phil said that he prefer to die and not to be the one that for him, someone else was killed. Brain death is not death. There are many cases of recovery. Unplugging patient is killing him.
I cried like hell when Phil said so. Not because I didnt agree with him, but because I understood, accepted, and knew, in pure conscience, that Phil was right. I cried like hell because I understood that my sweetie was dying with not much chance to heal him. As much as I miss him, as much as I want him to live and to be with me, I wouldnt want him to be responsible or participent in someone else's death. I think the same about myself.

All people are equal. No one's life should be prefered over another one's life. No matter if it is a prisoner or a saint. We are not allowed to take other people's life. Unless it is a war and then one has no choice but to defend himself.

I am always shocked from the fact that you, poor americans, have death sentence, which in itself seems unethical to me. The only time that there was death sentence in Israel, was for Eichman, the Nazi who was responsible for the death of millions jewish in aushweitz.

Hang in there Sangell. They are working on 3 dimensional printed kidney or something like that.

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Originally Posted by Alysia

I am always shocked from the fact that you, poor americans, have death sentence, which in itself seems unethical to me. The only time that there was death sentence in Israel, was for Eichman, the Nazi who was responsible for the death of millions jewish in aushweitz.

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Alysia, as far as I know, having the death penalty or not is determined by the voters of each state. Someone can correct me if I'm wrong, but I'm pretty sure that there was no death penalty in California for a number of years, and then it was voted back in at some point. That is why Charles Manson is still alive and I believe Sirhan Sirhan, the convicted assassin of Robert F. Kennedy. Both of them were sentenced to their prison terms when there was no death penalty in effect. I can't say I'm in favor of the death penalty, but we are skating on thin ice to discuss it much, because it does enter into the realm of politics and religion, or we could call it ethics, but in any case, it is potentially as controversial as either of those forbidden subjects, it seems to me.

Alysia, this thread is specific to kidney donation. The type of transplant Phil needed would indeed mean the living donor would have to die, but this is not the case with kidney donation. :rolleyes1:
I have seen my nephrologist today and he is organising the pre dialysis team to visit my home to prepare me for dialysis. There is a lot of choices to be made in regard to which type of dialysis I should chose, but not are as effective as a transplant. I am not currently eligible for transplant as Wegeners needs to be fully in remission for at least 12 months.:predrage:
My wife is getting blood tests tomorrow to, hopefully, find she's compatible with me.
She stole my heart......now I get her kidney! That's a fair deal! :thumbsup:

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Originally Posted by annekat

Alysia, as far as I know, having the death penalty or not is determined by the voters of each state. Someone can correct me if I'm wrong, but I'm pretty sure that there was no death penalty in California for a number of years, and then it was voted back in at some point. That is why Charles Manson is still alive and I believe Sirhan Sirhan, the convicted assassin of Robert F. Kennedy. Both of them were sentenced to their prison terms when there was no death penalty in effect. I can't say I'm in favor of the death penalty, but we are skating on thin ice to discuss it much, because it does enter into the realm of politics and religion, or we could call it ethics, but in any case, it is potentially as controversial as either of those forbidden subjects, it seems to me.

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Thanks for the info, Anne. I didnt realize its a political issue. Otherwise I would not write that. Sorry.

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Originally Posted by Alysia

Thanks for the info, Anne. I didnt realize its a political issue. Otherwise I would not write that. Sorry.

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Really, no problem, Alysia. I just thought I'd try to nip it in the bud before a bunch of people started writing with their opinions on the death penalty. It could become a heated discussion.

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Originally Posted by gilders

Alysia, this thread is specific to kidney donation. The type of transplant Phil needed would indeed mean the living donor would have to die, but this is not the case with kidney donation. :rolleyes1:
I have seen my nephrologist today and he is organising the pre dialysis team to visit my home to prepare me for dialysis. There is a lot of choices to be made in regard to which type of dialysis I should chose, but not are as effective as a transplant. I am not currently eligible for transplant as Wegeners needs to be fully in remission for at least 12 months.:predrage:
My wife is getting blood tests tomorrow to, hopefully, find she's compatible with me.
She stole my heart......now I get her kidney! That's a fair deal! :thumbsup:

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Dear Pete.
I am so sorry that you will have to be back on dialysis. Who knows, maybe you will be able to recover from it like you did in the past ?
I hope your wife can help. It will be so beautiful. I wish I could have share my lungs with my sweetie.
I keep you in my prayers ♡

Gilders and Sangell ,I am sorry you are both having to go through dialysis. I pray that you are both able to find a suitable donor soon.

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Originally Posted by gilders

My wife is getting blood tests tomorrow to, hopefully, find she's compatible with me.
She stole my heart......now I get her kidney! That's a fair deal! :thumbsup:

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Pete, a friend who read this thread sent me the following link for you:

Renal transplantation for end-stage renal disease following bone marrow transplantation: a report of six cases, with and without immunosuppression. - PubMed - NCBI

Hi Alysia,
Thank you and your friend for thinking about me and taking time to post some info.
At first, I thought it was study to show that there is an improvement with kidney transplants if you also receive a bone marrow transplant from the kidney donor at the same time. But as I read it through I don't think that is the case.
I have had a bone and bone marrow biopsy, but not a bone marrow transplant (I don't need one).
It is good to see 5 out of 6 were still alive up to 31 months. I guess I'm being greedy but I want to live much longer than a few years.

I'm learning more each day about dialysis (even though I was on it for a few weeks 20 years ago) and although this is a Wegener's forum I'm happy to answer any questions about dialysis. If I don't know the answer and I'm happy to find out as I want to increase my knowledge and to be prepared. Likewise, if anyone has any experience/advice I'd be happy to hear. Obviously, my main concern is choosing the best dialysis for me. Dialysis at home, through the night sounds the best in theory. But in reality, if it prevents me from sleeping then during the day I will feel terrible. The other extreme is dialysis 4-5 times/day, every day.

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Originally Posted by gilders

Hi Alysia,
Thank you and your friend for thinking about me and taking time to post some info.
At first, I thought it was study to show that there is an improvement with kidney transplants if you also receive a bone marrow transplant from the kidney donor at the same time. But as I read it through I don't think that is the case.
I have had a bone and bone marrow biopsy, but not a bone marrow transplant (I don't need one).
It is good to see 5 out of 6 were still alive up to 31 months. I guess I'm being greedy but I want to live much longer than a few years.

I'm learning more each day about dialysis (even though I was on it for a few weeks 20 years ago) and although this is a Wegener's forum I'm happy to answer any questions about dialysis. If I don't know the answer and I'm happy to find out as I want to increase my knowledge and to be prepared. Likewise, if anyone has any experience/advice I'd be happy to hear. Obviously, my main concern is choosing the best dialysis for me. Dialysis at home, through the night sounds the best in theory. But in reality, if it prevents me from sleeping then during the day I will feel terrible. The other extreme is dialysis 4-5 times/day, every day.

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Dear Pete. My friend sent the link for the idea that transplant of bone marrow can help with the kidney transplant.
Your offer about dialysis is very kind. Maybe it will be good to open a new thread under the title of dialysis.

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Originally Posted by Alysia

Dear Pete. My friend sent the link for the idea that transplant of bone marrow can help with the kidney transplant.
Your offer about dialysis is very kind. Maybe it will be good to open a new thread under the title of dialysis.

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I think your friend could be right after all. It was the first sentence that confused me, "Over 12000 bone marrow transplantations (BMT) are performed in the USA each year. This procedure is associated with significant morbidity including acute and chronic renal failure (CRF)". I read that as bone marrow transplants cause problems such as renal failure.
The study didn't actually say that the patients whom had bone marrow transplant had it for the sole purpose of helping to reduce kidney transplant rejection, but I think that must be the case as I've found other information regarding bone marrow transplant to help with kidney transplant. So thank you for bringing it to my attention.

From what I've read elsewhere the theory is good, but there is not enough long term evidence as it is a new idea. Patient are often still given immunosuppression drugs, so this also makes it hard to distinguish if it's the drugs or the marrow transplant that is helping prevent rejection.

Isn't bone marrow transplant often used to treat many blood cancers? That might be a higher number. I knew of one women who asked about it as possible treatment for her lymphoma and was told she was not appropriate because of high risk of mortality from the procedure. And her prognosis from her cancer was not likely to be terminal for several years.

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Originally Posted by drz

Isn't bone marrow transplant often used to treat many blood cancers? That might be a higher number. I knew of one women who asked about it as possible treatment for her lymphoma and was told she was not appropriate because of high risk of mortality from the procedure. And her prognosis from her cancer was not likely to be terminal for several years.

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I know almost nothing about this issue. I think that you are right. Thanks for the input.
Pete will still have time to check with his docs if kidney's transplant is more safe with bone marrow transplant (to reduce risk of rejection) or without it (not to add unnecessary risk). Tough decisions to make...
When I was with Phil in the hospital, I had a neighbour in the hostel where I slept, whose husband had a kidney transplant at that time. Without bone marrow transplant, I think. It was totally amazing how fast he recovered and went home, as good as new.