Passing on a kidney transplant

By Michael Fraase

Saturday, 21 August 2004 07:35PM CDT

Section: ESRD

I thought it would be more difficult, or maybe more complicated, but it was neither. A transplant surgeon called from the University of Minnesota this morning to tell me they had a cadaver kidney for me (I’ve been on the transplant list for four-and-a-half years). “I’ll pass,” I said in a quiet but steady voice. “Call the next person on the list.” The physician wanted a reason. “I’m still working out some ethical issues with the whole transplant business.” There. It was out before I had a chance to even think about censoring myself.

That was pretty much a lie. I mostly worked out transplant ethics for myself within six months of my diagnosis. But it’s easier than telling the whole story. Or maybe more convenient. The short version of the whole story is that I feel very strongly that corporations should not profit from the misfortune of the chronically ill. It would be hypocritical for me to hold that position and then turn around and benefit from someone else’s misfortune. In order for me to receive a cadaveric kidney transplant, there has to be a cadaver. Get it?

I’ll be 50 next month, God willing, and I have a vague gnawing in my gut—nothing clear enough or strong enough to call a belief—that everything happens for a reason, my kidney failure included. We’re supposed to learn from things that happen to us; that much I know for dead certain. Where I am is partly a result of some things I haven’t learned yet. And here’s the really difficult part: I may never learn them.

At my age there are certainly better transplant candidates who are confident that a transplant is the best treatment option for them. That’s right, transplantation is a treatment for end-stage renal disease (permanent kidney failure); it’s not a cure.

Then there’s the whole problem of paying for the anti-rejection drugs for the rest of my life. These drugs are expensive—several thousand dollars each month—and not covered by Medicare. I’m not currently a Medicare patient—I pay for my own private insurance—but I hope to live long enough to be a Medicare enrollee in about fifteen years. Most kidney failure patients are on Medicare because since 1972, end-stage renal disease patients are eligible for Medicare at any age. Medicare pays for the kidney transplant but only pays for the anti-rejection drugs for three years.

So, less than a half hour after the call, I’m sitting in my Chinese medicine practitioner’s office participating in my twice-weekly whacked-out old/new-agey electrical field experimental therapy that’s probably illegal because strangely enough it’s actually working, mulling all of this over. You know the drill: ten thousand different ways to second-guess whether this was the right decision or not. For months I’ve been hearing male cardinal song outside his office, but he never showed himself, flying away whenever I’d arrive and leave. Suddenly, there he was: just as big, bright, and bold as I’d imagined, perfectly framed in the office window, perched on a low branch, singing for all he was worth. A creature so unmistakable was surely an answer of some kind of question. Or at least that’s how I took it. That, and the synchronicity that my wife had just finished doing a dialysis advocacy show on Baltimore’s WEAA.

Here’s hoping that whoever received the kidney receives it in the spirit with which it was given by the donor and goes on to do good work.

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