The Ballad of Billy The Kidney

Another transplant tourism story with an unhappy ending

This blog has been consistently opposed to the practice of organs-for-sale.  It is a dangerous, foolish, and unsafe practice.

Probable outcomes of transplant tourism include:

• Decisions based on commercial imperatives rather than best medical practice

• Compromised screenings that might allow unsuitable donors - possibly spreading tumours, hepatitis B, and HIV

• Transplant imperialism, dazzling prospective donors with fistfuls of dollars and continuing the impression that many Westerners promote of having more dollars than sense

• Breaking the law, here in Australia and in many other nations

• Sending people to penury as life savings are destroyed and family homes are sold off

Indeed, one of the reasons that I moderate comments on this blog is to prevent the occasional appeals to buy  (or offers to sell) organs that would otherwise be instantly published.

Thus I was interested to read about the experience of Tony & Saide Haddad of Sydney, who lost their life savings over an unsuccessful transplant-tourism kidney.

Arising from the surgery, Mrs Haddad developed aspergillosis. The treatment for this life-threatening condition involved the rejection of her transplanted kidney.

Mrs Haddade's Sydney doctor, Yvonne Shen, notes that

The outcomes are often terrible for people who go abroad. I've seen patients … come back and test positive for HIV or hepatitis B. The level of screening and monitoring that is done … is very much less than would be carried out here.

The article notes that long-term survival rates for transplant tourists tend to be lower than those treated in Australia, where 98% or patients survive at least 5 years.

Folks - dialysis and kidney disease is tough. But transplant tourism is just not worth it.

Some folk might think that I do not have the right to make such pronouncements. In response, I would point out that I was on dialysis for 5 years whilst waiting for a kidney transplant.

• The picture of Tony & Saide Haddad is from: Tom Reilly, Kidney trade comes at a high price, Sydney Morning Herald, 3rd March 2010.

Dialysis in the Australian outback - part 2

In a previous post, I discussed the situation of dialysis for the people of Central Australia - mostly indigenous peoples.

As it so happens, state boundaries happen to run through the middle of Australia, and this is causing one of those administrative-cum-financial muck-ups.

The South Australian Government is apparently refusing to contribute to the cost of dialysis in Alice Springs (in the Northern Territory) - so people who happen to live on the wrong side of the border but close to Alice Springs still have to travel or move many hours away to get treatment.

People who happen to live in the State of Western Australia have no such problem, with that Government contributing to the Alice Springs dialysis centre.

So now we have a situation in Australia where your quality of life is directly affected by where you happen to live - and just a few kilometres here or there makes a big difference.

In the ABC News article I noted two particular statements:

• The South Australian Government is commited to establishing dialysis units in the Outback Lands of that State, but "...it is in the early stages and no decision or funding commitment has been made."

• The Opposition parties in South Australia are pessimistic of the success of the plan, and "...declined to give a Liberal [Party] funding pledge to have patients treated in Alice Springs."

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• Deal reached on dialysis treatment, ABC [Australia] News, 23rd February 2010 - regarding the Western Australia deal for the Alice Springs centre

• Jano Gibson, "I'm crying": Dialysis patient forced interstate, ABC [Australia] News, 24th February 2010

• Natasha Robinson, Elder may die for lack of dialysis, The Australian [newspaper], 24th February 2010

• Dialysis treatment hope for APY Lands, ABC [Australia] News, 24th February 2010

Image credit:  NPY Womens' Council, reproduced by ABC News

medical_imperialism

Further to my post introducing research on Good Samaritan websites comes this article from the Melbourne Herald Sun concerning an Australian woman paying a Filipino man AUD $65,000 for his kidney.

Dialysis is a tough road to travel.  My wife and i did it for 5 years, and I, like all other renal transplant patients, still have it hovering over our heads (at least in the background, if I might mix my metaphors).

Different people react to this situation in different ways, and its not for me to judge the opinions of others and the actions of others (unless these actions are wrong).

But I sincerely believe, in my humble opinion, that this lady has this wrong.

This belief comes from the following:

• It is the worst type of medical imperialism to wave a roll of cash before a person in exchange for their kidney.  This is not an equal power relationship.  The bloke would no doubt do anything to put food on his family's table, to the point of doing this.

• Judgements about suitability of donation should be made purely on the basis of medical reasons, entirely free of other considerations - such as ability to buy or ability to sell.  This is why I have such an issue with the current form of health insurance in the USA - apart from it being so utterly unjust to so many people, it also interferes with the purely medical decisions needed to allocate donor organs.

In justifying this position, this lady is also inadvertently sprerading misconceptions about dialysis.

The article states that her "... health has deteriorated after three years of gruelling dialysis."  (I assume the article refers to haemo-dialysis, but it is not clear.)  If this is so, then she should be talking closely to her doctors because usually a person can go along quite well on dialysis. 

And Australia has a very low mortality rate for dialysis patients.

And quite apart from this, the last thing a prospective dialysis patient needs is to be told inaccurate stories of "slow death" on dialysis.

Finally the lady is quoted in the article as saying

[...] you have to understand you can't judge me because if you were in my situation you would do exactly what I am doing.

Well, my wife and I are 2 people who had 5 years to do what she is doing and we chose not to do so.

• Disclaimer

• Image credit:  picture of donor Alex Sarip by Michael Sarini, published in HeraldSun.com.au on 2nd March 2008

Priorities: digital television vs universal health insurance

Let me state up front that usually I am reluctant to publicly comment on the affairs of another nation;  indeed, whilst I was in local government service, I never even commented on the affairs of another local government authority.

But I sincerely believe that I can claim an exemption with the USA.

The reasons I seek this exemption are:

• My wife is an Australian graduate of Berkeley and lived for some years there whilst studying.
• Her work brings her to the USA frequently, and I have been fortunate to accompany her on these trips since our marriage.
• We continue to maintain friendships in the USA, especially around the San Francisco / East Bay area.
• We have indeed lived in the USA, albeit for short periods of time (up to 3 months at a stretch).
• And of course the position of the USA in world affairs means that this position affects those outside the USA.

Having declared this, I now feel OK about making the following observation.

After hearing and reading about the horror stories about medical and insurance funding for health services in the USA (a cursory read of Dialysis from the Sharp End of the Needle shows this), and after following the agonising ongoing debate as to whether there should be a universal health insurance scheme in the USA, I was amazed to learn this week discover the following.

The US Government is offering subsidies to entice people to buy those set-top boxes as part of the switch to digital television.

The subsidy amounts to USD $40 per box.

This certainly shows where national priorities are.

• This YouTube clip shows an interview on WBAL TV Baltimore in which Commissioner Michael J Copps, of the Federal Communications Commission, explains digital television.  He is interviewed by Sarah Caldwell.

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World Kidney Day and dialysis costs

Today is World Kidney Day.  This is an appropriate time to note the "Every Other Day Dialysis" petition as described in a post by Rich Berkowitz et al in the blog Dialysis from the sharp end of the needle. 

Whilst the actual petition would, I imagine, only be signable by US citizens, it is nonetheless a very noteworthy and laudable aim. 

Success in dialysis is directly related to length and frequency of treatment.  This is also related to affordability, which for most people is related to one's level of health insurance - provided for either by the individual, the employer (if you're lucky enough to have a job) or by the state. 

The USA, of course, is inexplicably very bad at this health insurance question.  The lobbying for this dialysis issue will, it to be hoped, provide another bit of push towards the new President's pledge to fix this failing of public policy once and for all.

Great figures in Transplant / Non-transplant History: Victor Trumper

The next post in this fortnightly series looks at the Australian 1st-class cricketer Victor Trumper (1877-1915).

Victor Trumper was noted for his swashbuckling batting style.  He was the first Australian cricketer to score 300 in England, against Sussex in 1898.

Victor Trumper played cricket as a representative of

• Australia
• New South Wales
• in his home town of Sydney, the Gordon District Cricket Club.

This was in a career that extended from the late 19th century to 1914. 

By rather long co-incidence the venue of his final cricket match (Gordon v Petersham at Chatswood Oval, October 1914) was also one of the Sydney venues where my cricket umpiring career took me.

He was also a noted player and administrator in a range of other sports - rugby (rugby union), rugby league, and Australian football.

He was the first treasurer of the New South Wales Rugby League, and helped organise the first game of this competition in Sydney (Eastern Suburbs vs South Sydney) in 1908.

He became affected with illness at the young-ish age of 38, and eventually succumbed to Bright's disease - the old name for glomerulo-nephritis.

This, again, was at a time long before the advent of dialysis and transplantation.  Chronic kidney disease at that time had no other outcome for the unfortunate patient as there were simply no means to manage this.

Its a bit sad that his estate amounted to only £5 - a sum equalling 2 or 3 weeks' wages for the average worker at that time, but still not a huge amount for your life savings.

And he left a young family.

This was a reflection on the position of elite sportsmen (and they were almost all men) at that time.  They either had to hold down a normal job as well, or be independently wealthy.  This situation existed in cricket until the late 1970s when Kerry Packer introduced professionalism and salaries to the elite level of this sport.

Unfortunately, Victor Trumper was in neither situation.

There was a plaque to Trumper's memory at the back of the Sheridan Stand at the Sydney Cricket Ground.  I remember looking at this plaque as a kid.

Unfortunately the plaque disappeared in the 1980s when the stand was demolished for re-development.

However, Trumper's name will be honoured again at the SCG with the naming of a new stand in his memory.

Websites about Victor Trumper include:

• Australian Dictionary of Biography > article on Victor Trumper
• Official website of Victor Trumper
• CricInfoAustralia > Player profiles > Victor Trumper
• Items on Victor Trumper in the State Library of New South Wales.
• Information on the Life & Career of Victor Trumper as discussed on The Einstein Factor (panel game on ABC1 [Australia])

• "The last innings of Victor Trumper": newsreel footage of his funeral, held in the National Film & Sound Archive [of Australia]. (High-speed broadband connection needed to view video.)

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• The picture at the top of this post is from BBC Sport
  
• Disclaimer.

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Walking to work

This post also appears in my official sponsorship weblog.

Work started again this week, so my exercise consists mainly of

• walking between home and the local railway station
• Walking between my destination station and my workplace

This still gives me up to about 70 minutes' worth of brisk walking each day, depending on whether its raining (theres a lot of this about at the moment) and whether i sleep in past the alarm (especially at 5am).

Initially I was dismayed about missing more structured exercise at the local gym.  But this is a reasonable alternative.

And my legs are doing a lot of "happy aching" (as distinct from the "bad ache" of illness), so something must be right!

Catching the train to work is also inspired by the fact that petrol at the moment is hovering just under the AUD $1.70 per litre mark.  It costs me about $100 to completely refuel the car, as against $56 per week on the train (plus the odd $5 taxi fare if its raining heavily).

And to catch the train means I have to brave the fearsomely bad reputation of our regional public transport provider, CityRail (satirical site).  But so far, the walking and the $$$ saving outweighs this.