Diagnosed with ESRD - End Stage Renal Disease in 2010 with 28% kidney function left. In January 2013, it dropped to 5%. Started twice a week Hemodialysis in February. My beautiful and courageous wife, Ninette, came forward willingly to be my donor and we started with the work-up in March. We finally finished everything and got approval 08 July 2013. We had the procedure the 25th of the same month.

Our journey continues...

Monday, March 4, 2013

Transplant 101 (continued)

Image courtesy of 123rf.com

In my previous post, I said that, as a transplant recipient-candidate, I went to this orientation hosted by the National Kidney and Transplant Institute(NKTI). Attendance to the pre-transplant orientation is a must for any prospective recipient or donor transplant candidate. It ensures that all parties know what they are getting into and that they are properly informed. What requirements are expected of them. For example, the recipient must be made aware that s/he will have to be in immunosuppresant drugs after the transplant. Usually, this is for an extended amount of time, some of them even for life. This is so that the body curbs the production of antigens so that the body will not attack the foreign, newly introduced organ. Because of this, the immune system is also compromised and infections/infectious diseases maybe common if not careful. This is why a recipient is kept isolated for a period after the transplant, with limited or no visitors, and if visitors are allowed, it is a must to wear a mask. In the orientation, it was recommended that the first six months will be spent recuperating and making sure that no infections are contracted. These immunosuppresants may be reduced as time goes by but always with the doctor’s prescription.

Statistics on the success rate of transplants by the NKTI were presented. I was impressed by the numbers, over 200 transplant operations a year. Also the survival rate of transplant recipients way out do that of persons who stay with dialysis. Of course, the quality of life of dialysis persons is immensely improved after transplant surgery. Cost wise, the immediate expenses for transplant will even out with what a dialysis person would spend cumulatively  in 3 to 4 years. All indicators point to transplant as being a better option versus staying in dialysis for the rest of my life.       

On the other hand, the prospective donor should also know what is in store for him/her. A number of possible donors shy away from actually donating because of being misinformed. Some believe that the length of the recuperation period is the same as the recipients’ and that they also take the same kind and amount of medication. In fact with the advent of Laparoscopic Nephrectomy, the post-surgery recovery is reduced that some doctors dismiss it as ‘just like an appendectomy‘ with an incision only a centimeter or so in length. Maybe two weeks rest tops and the donor can get back to his/her regular routine.

Also discussed during the orientation is the responsibility of the recipient-candidate who is on the cadaver list to remain fit during the period of waiting. In case he/she is bumped up the list and called next by the hospital when a match is found, s/he should be fit to undergo the surgery. Otherwise, s/he is bypassed. It is also because of this that a recipient on the list commits to be on hand and ready to get to the hospital immediately if called. Another requirement is the submission of serum samples every month so as to update the records of those in the list and when there is s prospective donor, All these efforts are handled by the HOPE office of the NKTI. But of course, before getting into the list, you have to submit all medical as well as documentary clearances and requirements. And of course, show capacity to pay. There is the cash option as well as the Philhealth assisted option. And also the charity option for those who qualify. Ballpark fees were discussed and a recipient on cash option will need to raise around 1.5 to 2 million Philippine Pesos and be ready with the cash when s/he receives the call.

The panel was comprised of a nephrologist, a psychiatrist, a dietician/nutritionist, a rehab therapist, a social worker, an organ recipient, a kidney organ donor and a priest. The open forum that followed was a lively discussion as dialysis persons, prospective donors and companions fielded questions and contributed their comments based on their individual experiences. Because of this, we also learned a lot from fellow attendees.  

Again, I said that the wait time averages between six months to a year, but also it can be quicker than that. Hopefully, even if the NKTI is a government institution, I hope no politics/red tape/nepotism is involved and the list is handled judiciously. I once sought another nephrologist’s(from another hospital) opinion and she said that NKTI can have some politics in the way they treat the transplant list. But so far, I haven’t really picked up or confirmed any buzz about it.

Since the orientation is a requirement, attendees were given certificates. Well, I don’t claim to know all policies and procedures. These are just information that I gathered during the orientation and a month’s experience as a dialysis person. A live donor is preferred. Aside from it being cheaper, if money is not an issue, you can have the transplant as soon as you are cleared.