Chapter 6 - End Goal—Kidney Transplant

Summary

Throughout everything that I have described so far, my end goal has been kidney transplantation. Without it, my survival depends on dialysis. And, while peritoneal dialysis provides a certain degree of control and convenience well beyond the burden of thrice weekly hemodialysis, it is by no means easy. It is only a substitute for a well-functioning kidney, and while it enables me to approach a sense of normalcy, I remain some distance from it. My ability to travel, to go swimming, or to even take a bath (I can only shower) is either impossible or extremely challenging now. And, of course, there are the many dietary restrictions by which I must abide.

The amyloidosis and multiple myeloma will continue to exist as simmering threats that will in the best-case scenario remain at undetectable levels. Whether this will require regular “maintenance” (i.e., infusion) remains to be seen, but the doctors treating this are confident about the current pharmaceutical cocktail’s efficacy. They support and have encouraged me to pursue kidney transplantation.

In the United States, kidney transplantation was the first of the organ transplant procedures to be developed because of the availability of live donors and the critical technique of dialysis. In 1990, the American researcher and surgeon Joseph Murray received the Nobel Prize in Medicine for his pioneering work in kidney transplantation and the development of many new immunosuppressive agents, including drugs and monoclonal antibodies.

Since that time, transplantation has become the treatment of choice for those with end-stage renal disease (ESRD), and at the same time, an understanding of the molecular and cellular events associated with the transplant has expanded considerably.

Today, kidney transplantation is a therapy for ESRD with benefits that go well beyond dialysis treatment. Kidney transplant not only provides a longer and better quality of life for ESRD patients, but it is also less expensive in the long run. The current estimate for the complete cost of a kidney transplant is approximately $450,000. This includes physician fees, drugs, as well as hospital admission, procurement, and post-transplant costs, and while this fee of nearly half a million dollars seems expensive when one considers the accumulated costs for dialysis, it is clearly the less expensive option.