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 “Get out of here and go home,” Richard Herrick wrote.
“I am here, and I am going to stay,” Ronald Herrick responded.
The exchange between the twins culminated in the first successful
long-term transplant of a human organ in 1954. Although the surgery
happened 60 years ago, a new study shows that the same concerns that
likely prompted Richard Herrick to tell his brother to leave the
hospital still trouble kidney recipients today.
Patients with chronic kidney disease worry about the long-term
consequences for potential donors and frequently feel unworthy of
such a self-sacrificing gift, Camilla Hanson and her colleagues
reported online December 1 in Transplantation.
“Some people don’t like to be on the receiving end and don’t like to
ask favors,” she told Reuters Health.
“Our study really shows that there’s a whole host of emotional
barriers, mainly guilt, that stop someone from asking for, and
perhaps accepting, a kidney,” said Hanson, a public health doctoral
student at the University of Sydney in Australia.
She examined 39 studies from 13 countries with nearly 1,800 patients
suffering from chronic kidney disease and identified themes that
present barriers to finding living kidney donors.
In addition to guilt, patients’ worries about jeopardizing donor
health, about causing donor inconvenience, about donor regret and
about unrelenting indebtedness ran through the literature.
Another thread in the studies - and one that resonated with
nephrologists Hanson interviewed for a separate study - was that
patients with chronic kidney disease did not know how to approach
relatives or friends to ask for one of their two kidneys.
One American patient said, “I would step up like that to give
anybody else a kidney, but for me to ask somebody, I couldn’t do
that.”
“Rather than ask and get my feelings hurt, I didn’t even ask,”
another said.
Organ transplant surgeon Dr. John Roberts told Reuters Health that
his patients often hesitate to ask relatives who may want to donate.
“It’s a difficult question to pose to say, ‘Hey, do you want to
donate your kidney to me?’” said Roberts, chief of the University of
California, San Francisco, Medical Center Transplant Service. He was
not involved with the current study.
Kidney transplants from living donors offer optimal recipient
survival outcomes, the study says. In addition, shortages of
deceased donor kidneys lead to long wait times.
Patients on the waiting list for a deceased donor kidney have only a
one in five chance of surviving long enough to get a transplant,
Roberts said. The chance for patients with diabetes shrinks to one
in 10, he said.
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“Without a living donor, your chances of getting a transplant are
pretty slim,” he said.
“Frequently the children want to donate, and the parents don’t want
the children to donate, and their parents end up dying on dialysis,”
Roberts said. “I think it’s really the parents’ fear of their
children having a complication, not being able to work and not
having health insurance.”
Roberts believes the government should offer lifetime health
insurance to kidney donors as an incentive.
Transplant nephrologist Dr. Peter Reese told Reuters Health he also
believes lifetime health insurance would provide a fair incentive to
living kidney donors.
“I think that would be a good idea from a justice point of view,”
said Reese, a professor of medicine and epidemiology at the
University of Pennsylvania School of Medicine in Philadelphia. He
was not involved with the current study.
In 1954, when Ronald Herrick was preparing to donate his kidney, he
asked the doctors if they would assume responsibility for his health
care for the rest of his life.
One of the doctors replied that he would not. But then he assured
Herrick that the medical team would feel a professional
responsibility to care for him.
Reese, who evaluates potential kidney donors, is not in a position
to make similar promises.
Today, not only would Ronald Herrick have to figure out his own
health insurance, he would not be considered an ideal donor, Reese
said. At 23, he was too young in Reese’s opinion to have established
life habits that could foretell his ability to withstand losing a
kidney, and he shared the same genetic predisposition for kidney
disease as his twin.
Richard Herrick lived eight years with his brother’s kidney. Ronald
Herrick died in 2010 at 79 years old.
(The story of the Herrick twins is told by Dr. Joseph Murray, the
surgeon who performed the transplant, in an article on the Harvard
Medical School website, here: http://bit.ly/1Afnvql.)
SOURCE: http://bit.ly/1BbAf0F
Transplantation 2014.
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