In Poland, a patient with dialysis is first sent, and when he gets worse, he / she begins to consider transplantation. Meanwhile, it is best to start thinking about kidney transplantation before starting dialysis, because each month shortens the organ’s working life after transplantation – says the surgeon and transplantologist Dr. Piotr Domagała. She adds that living donor kidney transplantation is the most beneficial for patients. Unfortunately, Poles decide to give it to their loved ones much less often than the inhabitants of other European countries.
Do Poles – mostly Catholics who value family ties – more often than representatives of other nations share their most precious gift – donation of a kidney with their loved ones? How large a percentage of kidney transplants in Poland are family ones from living donors?
Unfortunately, compared to other countries, we have something to be ashamed of. In Poland, from 900 to 1100 kidney transplants are performed annually, of which only 40 to 60, i.e. 5%, are transplants from living donors. In the Nordic countries and the Netherlands, this percentage is 50%. If we take into account the number of living kidney donors per million inhabitants, it turns out that in Poland there are usually about 1,5, while in the Netherlands 31,8, in Turkey 30,3, and in Great Britain 17,3.
Why do you think there are so few family transplants in Poland?
The question arises as to whether, as a nation, we are less willing to make the greatest sacrifices for our loved ones. I think not. We simply lack awareness, both broadly understood in society, but also among medical personnel. Unfortunately, there are still doctors in Poland who do not know that it is possible and have no idea where to refer such a patient. There are also many common myths about this. A fifty-year-old relative of a patient in need of a kidney transplant informed me that they had been told at the dialysis station that she was too old to be a living kidney donor. Meanwhile, there is no age limit. It is the donor screening test that shows whether the donor can donate a kidney.
How long does it take to transplant a kidney from a deceased person?
The average waiting time is around 11 months.
So maybe the sick person is thinking – I will wait 11 months on dialysis and I will not deprive my loved ones of their kidneys?
If dialysis stations directed at least 30% of patients for transplantation, the waiting time would be six times more, and therefore the waiting time several times longer. Meanwhile, half of the dialysis patients die after five years. It should also be remembered that each month of dialysis treatment shortens the working life of the kidney after transplantation. The average life span of a transplant when a kidney comes from a deceased donor is 9-12 years, and from a living kidney – 15 years.
Besides, it is necessary to change the systemic thinking, but also of doctors and patients. There is a belief in Poland that the first dialysis patient is sent, and when his condition worsens, he or she begins to consider transplantation. I have patients who have heard from doctors in dialysis centers that they should have dialysis for at least two years, and then think about a kidney transplant. Meanwhile, it is best to start thinking about kidney transplantation before starting dialysis treatment.
Dialysis centers, mostly private entities, probably have no interest in encouraging patients to transplant because they are losing patients?
In Poland, there are 16 dialyses annually. up to 20 thousand patients, and only 5% of them go to the waiting list for kidney transplantation. This means that dialysis stations do not direct patients for transplantation. Meanwhile, the best treatment for kidney failure is transplantation of this organ, preferably from a living donor.
In other European countries, the average percentage of dialysis patients eligible for transplantation is 30%.
Maybe the National Health Fund, which pays dialysis stations, should oblige them to inform patients about this possibility?
Certainly, because every year of life after kidney transplantation without dialysis is saving for the system. The annual cost of dialysis therapy is approximately PLN 70. PLN, meanwhile, care for a patient 12 months after transplantation amounts to slightly over PLN 20 thousand per year. zloty.
What is life like in a patient undergoing dialysis?
Hemodialysis, the most common in Poland, disrupts normal life. The patient has to come to the dialysis center for five hours three times a week, practically every other day. If we add the travel time, it is approximately 7 hours. Many patients feel very tired after this procedure and need a lot of time to regenerate. It is a huge burden for the cardiovascular system. In addition, connection to the so-called artificial kidney requires access to dialysis – a catheter or arteriovenous fistula, which is produced by surgery.
Peritoneal dialysis is more convenient for the patient. Then the patient is connected to a special device at home for the night or changes the fluid in the abdominal cavity several times a day. This involves adhering to strict sterility rules, even disinfecting the room, otherwise the risk of life-threatening peritonitis increases.
Maybe Poles do not trust our health care system and are afraid of such an operation?
In Poland, transplant procedures are performed at the highest European level, and long-term results – according to some publications – are even better than in the USA.
Who needs a kidney transplant the most? What diseases or injuries make it necessary?
The dominant cause of renal failure is diabetes mellitus, glomerulonephritis and untreated arterial hypertension. Age is also a risk factor. About 25% of patients starting dialysis are over the age of 65. In the youngest patients, transplantation is most often caused by defects in the urinary system.
Who is most likely to donate a kidney – parents to children, siblings, spouses?
Most often, the donor is a woman from whom her child or spouse receives the kidney. This does not mean, however, that women are more self-sacrificing. Often, when making such a decision, the family takes into account that the male is the main breadwinner. The point is not to generate his absences from work due to even the surgery itself.
How is an organ donation decision made? Does the patient ask relatives?
It is difficult for a sick person to ask their relatives for such a gift. Ideally, it should come from the family. That is why we wrote a letter to the dialysis center asking the patients to come to the qualification appointment with their relatives. We wanted the family to hear about such a possibility and hold such a meeting with their relatives.
In addition, a regular educational campaign is needed, both in schools and in the media.
What are the donor and recipient relationships after kidney transplantation?
Donors do not regret their decisions and often stress that if they made them a second time, they would do the same. Such a gift usually deepens and cemented relationships. One of my patients, who donated a kidney to her husband, jokes that if he wants to leave it, he must return the donated organ. Recipients, on the other hand, often say that the moment of transplantation is the next date of birth, that, having received such a gift, they will take care of themselves more and enjoy life.
What does a living donor kidney transplant look like? How long does such an operation take? How long do the donor and recipient recover?
Kidney transplantation from deceased and living donors is similar and usually takes about 2 hours. However, donating an organ from a living donor is an additional procedure. It is done through a standard incision or laparoscopically. First, the instrument is inserted through the small holes and the kidney is cut out and the vessels and ducts are closed, and then the retrieved organ is led out through a small incision. Donors prefer this minimally invasive method. After three days, the donor leaves the hospital and, in the event of postoperative pain, takes commonly available paracetamol. After 6 weeks it is fully functional. The recipient stays in the hospital a little longer as he begins to receive drugs to prevent transplant rejection.
In 2007, Przemysław Saleta donated his kidney to his daughter Nicole. After a few years, however, the kidney that the boxer gave to his daughter stopped working. Why is this sometimes the case?
It depends on the so-called the immune aggressiveness of the organism. It is usually stronger in younger people. If the transplanted organ stops working, that person is eligible for a re-transplant.
What does a kidney donor risk? Does life shorter than people with two kidneys?
Organ removal and implantation have been safe procedures performed in the world for over 60 years. Transplantation is therefore no longer an event like a medical experiment, but a routine operation with a risk that is close to zero. Our role is to prevent complications, primarily through diagnostics preceding the procedure in order to detect contraindications. Donors do not live shorter than people with two kidneys. And thanks to transplantation, they care more about their health and have better access to a doctor, because the living donor care program includes an annual medical check-up. Even if they have other health problems, we can advise them where to look for help.
What is life like after a kidney donation? Przemysław Saleta claims that his has not changed.
The donor remains a healthy person and can lead a normal life. He must avoid drugs that damage the kidneys and inform about the procedure performed during imaging tests with contrast. In addition, donors emphasize that their mental condition is improving. They live with the belief that they have done something good in feeling satisfied with it.
The recipient’s life changes dramatically, because giving up dialysis allows you to return to professional activity. Many people start traveling abroad. The comfort of life really increases.
From time to time there are voices that the sale of organs should be legalized. What do you think about it?
Most doctors are against it for fear of illegal organ trafficking. Opinions are divided among ethicists and philosophers. I believe that you should not pay for an organ, but that a donor should receive other gratuities in return. Currently, in Poland, for absenteeism due to illness, he receives 100% of his salary, and not 80%, as is the case with other employees. He also gets a card authorizing him to use health services without queuing. However, I think the system should offer more incentives, such as reimbursement of travel expenses for research or tax credits.
Is altruistic donation possible in Poland, i.e. a gift from a person unrelated to the sick person?
Under Polish law, live organ donation is possible for genetically related people, i.e. parents, children, grandparents, grandchildren and siblings, and for emotionally related people, i.e. spouses. Court approval is required for distant relatives or an emotional relationship (such as a friend or partner). If the recipient has a blood group other than the donor, or produces antibodies against the donor’s cells, the law permits contacting such a pair with another, also biologically incompatible. Then the pairs can exchange the organ and the kidney is given to the unrelated recipient. I think Poland is ready to introduce altruistic anonymous kidney donation. A person declaring a wish to donate their own organ only needs to undergo psychiatric examinations to exclude insanity. In this way, thanks to altruists, many kidney transplants are performed in the USA.
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