The Medical Frontier of Transplantation - or the Wild West?!

Perhaps you read the recent New York Times article by Kevin Sack entitled, “Hospitals Ordered to Do More to Protect Kidney Donors”. Were you as outraged as I was (and still am)?

The article highlights the UNOS Board meeting of November 12, in which the Board accepted a series of recommendations by the Living Donor Committee to provide for mandated and timed follow up of all living kidney donors with required acceptable percentages for immediate implementation, as well as the need for concrete medical information including urine and serum creatinine measurements. Sack also cited a number of horrible incidents that led to donor morbidity and/or mortality (27 of approximately 70,000). The UNOS Living Donor committee felt these new requirements were critical to protect our living donors and to make programs accept more responsibility for those donors and the article contends that the testing and follow-up are “a major development in living donor protection.”

But what was most shocking was the article’s characterization of transplantation: “a field long regarded as a medical and ethical Wild West.”

Over the past few months, I have been the representative voice of the largest transplant society in North America, a society that I value and am honored to represent. I am proud of our field and appreciate the continued efforts of our many volunteers. So I struggle with the light in which our field was painted in this article—that we solely focus on increasing the number of transplants, regardless of cost or effect, and that we have no sense of the gravity of donation. I know many of you personally and this could not be further from the truth. 

I realize that we must protect our donors but will these policies, aside from being costly and time-consuming, truly protect them? Can we improve the informed consent process for donors and make them better aware of the available data? How can we appropriately provide for our living donors for the long-term? 

While these are the crucial questions, there are limited data. And I continue to ponder how to change this public perception of our field as a cold and wild west. I would appreciate your thoughts and consideration on this topic.

- Roz


I believe we should not let this media pleasing or provocative crap (my apology) undermines the amazing work that transplant physicians have done over the decades. The only thing that was left in our life to be regulated by lawyers and bureaucrats was the relationship between physicians and the patients. This is no longer one of the holiest of relationship mankind used to know infected by "regulators, form makers and pseudo job holders". Physicians for whatever reasons tend to sit down and take it and form a strategy to go around it. I really admire who you are and fight for. I believe we have to fight back and use the main stream media communicate with commoners first, and second make sure people know how much damage has been caused by this sort of media to our health care. If we don’t, this non sense media will arm the regulators to come back as a huge monster with a bigger jaw to bite and more forms in his claws to fill.

In the UK, I believe that the donors are well looked after. Having universal health care helps. Every donor visits the hospital on annual basis for the rest of their lives. During that visit their basic tests are requested and their general well being is checked. If there is a problem, then they may be referred to the concerned specialty. Beyond that, they may visit their GP for minor ailments. I am sure that USA would have something similar!

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