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Kidney Transplant

Treatment

Treatment 1996

During 1996 Sam's kidney function deteriorated rapidly. From March to June of that year creatinine in the blood increased from 4.2 to 6.1 despite all the efforts to prolong kidney function. Sam was becoming anemic; hematocrit and hemoglobin were falling, and he was complaining of fatigue and depression. He was placed on Prozac® for depression to help him cope better. Appointments were changed from quarterly to monthly.

By June, 1996 Sam was started on Tums with his meals to absorb excess phosphorus that he could not excrete. High potassium was a continued threat and he was advised to avoid high potassium foods, a special concern during summer months with abundant fresh produce.

By late 1996, Sam was running low on energy and options for extending his own kidney function much longer. His creatinine had risen to 8.6, his BUN was 83 and his hematocrit was down to 26%. Work and other activities became increasingly difficult. Sam and his wife were told that they must begin to prepare for eventual initiation of dialysis and consideration for transplant. A tired Sam came to see a predialysis educator at a dialysis facility upon referral from his nephrologist in January, 1997.

When the educator began working with this family, she first assessed the possibility of a transplant from a living donor since Sam was young, active and in good physical health with the exception of his renal condition. Both mothers appeared interested in being tested to see if they could donate a kidney to Sam.

Sam's brother had already offered to see if he could donate a kidney to Sam, but the boys' mother very much wanted to be the donor to spare her other son from going through surgery and being off work. The educator assessed the medical situation as well as Sam's family, employment and lifestyle situation. Sam was interested in transplantation and wanted to avoid dialysis if possible. He was cautioned that dialysis might be necessary before all testing could be completed prior to a transplant or if a suitable match could not be found.

The educator provided information on:

• transplantation,
• available centers,
• insurance coverage,
• evaluation steps for recipient and potential donors,
• living and cadaveric transplant options,
• surgical procedures,
• follow-up,
• the need for numerous medications to prevent rejection, and
• initial overview of advantages and disadvantages of transplant.

She then referred the patient to a transplant program at a hospital and emphasized the importance of speed with the evaluation, hoping that it might be possible to avoid long-term dialysis and to go straight to transplantation. Another hope was to provide a more cost-effective treatment, although it can take two years for transplantation to be cost effective compared to dialysis as a treatment option to lower costs. Medicare can help with some costs.