While organ transplant has become a staple of the medical world, it is kidney transplant that has gradually come to dwarf all other organs in its prevalence among organ transfer. Since J. Hartwell Harrison and Joseph Murray made history by mastering the first ever successful transfer of an organ from a deceased patient to a living one in 1954, by transferring a kidney between identical twins (which was a simple way to ensure a match as well as willingness to donate), kidney transplants have held a significant role in the world of organ transplant. Now both organ transplant in general and kidney transplants in particular have shown no signs of abating. The discovered usefulness of kidney transfer has placed many on the waiting list, which in the United States made up a total of 93,000 patients in 2010, and is growing by 3,000 to 4,000 each year according to the United Network for Organ Sharing (UNOS); the disparity with the number of donated kidneys may suggest that kidney transfers are diminishing, when in fact the number of living kidney donors more than doubled over the advent of the new millennium, going from 3,009 in 1994 to 6,467 in 2003. Perhaps even more significantly, the number of living donors with no emotional attachment to the patient jumped over this same time period from 2.5 per cent in 1994 to 21.4 per cent in 2004, according to the United States Department of Health and Human Resources’ 2004 annual report.
It is likely this facility for transfer from a living donor that is largely responsible for making kidney transplants predominate the world of organ transplants. While the Organ Procurement and Transplantation Network (OPTN) lists 115,015 candidates on the waiting list for organ transplants as of August 2012, the vast majority (93,018) of those candidates are awaiting kidneys. After kidneys, the next most common organ to be sought after is livers, with 15,968 candidates on the same waiting list. The next most common in turn after livers are hearts, with 3,243 candidates waiting. What seems to distinguish kidneys then, and, to a lesser degree, livers, is the ability of donors to donate and still live their lives relatively unimpaired. The average person possesses two kidneys, and is able to live on one, while a liver is the only internal organ able to regenerate into full capacity if as much as 75 per cent of the tissue is donated. This is in sharp contrast to organs such as hearts or lungs, for example, the donations of which will either prove inevitably fatal or severely impair the donor. And indeed, the statistical difference between a deceased donor and a living one is crucial, just as is the difference between an emotionally attached donor and an unemotionally attached one, with the numbers dramatically reducing respectively according to these categories. The innovation, then, by Murray and Harrison of allowing deceased patients to donate their organs cannot be understated, any more than the kidney’s role therein.
Besides the inherent correspondence between the most survivable organ transfer process and its being the most prevalent, there are, however, no less direct reasons for the crucial role of the kidney in the world of organ transplantation. Perhaps chief amongst these is the widespread nature of the disease which kidney transfer is most often a measure against; namely, chronic renal failure, one of the most prevalent diseases in the world, with the Kidney Trust estimating that 1 in 9 of all Americans (26 million people) suffer from chronic kidney disease, most of them without even being aware of it, and approximately 485,000 of which have progressed to the end stage of renal disease (ESRD), which requires a kidney transplant (or a similar alternative) merely to stay alive. The wide need for kidney transplants can therefore also be traced to the large proportion of patients suffering from a directly pertinent disease. And indeed, the number of patients is spread across a wide demographic, while other diseases can largely be limited to one group of people or another. Even if chronic kidney disease fails to discriminate between such categories as race or socioeconomic status, the allotment of kidneys does not always do the same, meaning that some communities are in even greater pursuit of the organ than the standard, albeit extremely high, demand. The Journal of the National Medical Association has reported some disturbing findings along these lines, such as that men are far more likely to receive kidney transplants than women, or that Caucasians are more likely to receive kidney transplants than all other races; older age groups were found to have a lesser chance of attaining a kidney, while those living in more prosperous communities had a greater chance.
While such findings may sadly seem to confirm what many have already suspected, it also confirms that the need for kidney donation crosses all boundaries, with the people most in need also often being the people with the least access. And it is this widespread need that has led to the implementation of diverse (and increasing amounts of) alternatives to actual organ transfer. Dialysis, for example, has long been the only viable option for the great number of people unable to procure a replacement kidney. However, even such a widely used alternative is not sufficient, with dialysis rendering the patient immobile for the many hours which the treatment requires. Furthermore, the expense of such an alternative is a severe economic burden, both on the patients themselves and the public at large, with the Kidney Alliance estimating that in the United Kingdom, the cost-benefit for kidney transfer over dialysis is £241,000 over a period of ten years. Other alternatives, such as portable dialysis machines or artificial kidneys, are all still in the experimental stages, but that they are being developed (or, in the case of dialysis, already exist on such a wide scale) reflects on an even greater need for kidneys than is suggested by the already eloquent numbers on the donors list.
Alex Levin is a writer for Seeger Weiss LLP, a top ranking Plaintiff’s law firm specializing in consumer protection, commercial disputes, and injuries from defective drugs and medical products such and defective hip implants.
