Why is a Significant Portion of the Dialysis Patient Community Refusing Kidney Transplantation?

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Over 500,000 people are on dialysis in the United States, but only approximately 100,000 individuals choose to be listed on the US Kidney Transplant Waiting List. Thus, only one-third of dialysis patients are on the waiting list in the USA. But why?

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Many End Stage Renal Disease (ESRD) patients believe that a kidney transplant will solve all of their issues and provide them with a completely "normal" life. This is not true.  A successful kidney transplant can improve your quality of life, because you will not have to undergo hours of dialysis treatment, and it reduces your statistical risk of dying from kidney disease. However, kidney transplantation is a major surgical procedure that has risks both during and after the surgery. The risks of the surgery include infection, bleeding, and damage to the surrounding organs. Even death can occur in extreme cases.

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Dialysis only performs about 10% of the work a functioning kidney does. Also, dialysis is known to cause other health problems such as anemia, bone disease, high blood pressure, heart disease, and infection.  Yet, after kidney transplantation, you will be required to take medications and have frequent monitoring to minimize the chance of organ rejection; this must continue for your entire life. The medications can have significant and bothersome side effects and can be very costly after your three year subsidization from Medicare ends.

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Although you will not likely experience any pain during the actual surgery, it is very common to experience pain and discomfort immediately following the procedure. Pain killers are often given to help minimize the after-effects. Some may experience visual cataracts, arthritis, and even skin cancer (usually easily treatable) with prescribed medication.

As a result of immunosuppressive drugs your body may lose the ability to fight off certain infections, some of which may be life threatening. This is why, it will be critical to make frequent visits to your physician as a means to catch any issue early in its development. Again, necessary post transplant medication can be very expensive. Although in the U.S., Medicare will cover the cost of anti-rejection drugs for the first thirty-six (36) months after your transplant, the lifetime cost can be financially crippling, forcing you to find employment simply to pay for your medication.   

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Even after all of the risk involved, there is no way to 100% guarantee that a transplanted kidney will take and that your body will accept it for the long-term. Hence, some have decided against receiving a kidney donation to avoid the stress and pressure that comes along with it. KidneyBuzz.com refers to this as the "Devil I know" mentality. It is quite common for kidney transplant patients to experience ongoing anxiety, mostly rooted in the fear of losing function of the newly transplanted kidney and having to then return to dialysis or depression and guilt from losing a transplant.

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However, a kidney from a living donor functions, on average, 12 to 20 years, while a deceased donor kidney is somewhat less, 8 to 12 years. If you receive a kidney transplant before you are required to begin dialysis then you will live 10 to 15 years longer than if you stayed on dialysis, on average. So, even though a kidney transplant involves major surgery and requires some risk, in comparison it offers you a longer life. Most patients who have been on dialysis before their transplant report having more energy, less restricted diet, and less complications with a kidney transplant than if they had stayed on dialysis.

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Recent advancements have made rejections less likely than they have ever been in the past and allow kidneys to last longer. Statistics suggest that the average life expectancy for an individual that receives a kidney is longer than one who does not. The fact that a kidney transplant may potentially save your life by considerably restoring kidney function is obviously something to consider when weighing the pros and the cons of having a transplant. However, KidneyBuzz.com recommends that you discuss all aspects of this matter thoroughly with your healthcare team, Specialists, and loved ones, to make the decision for the treatment option that best suits your life.

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Reference: "Kidney Function." Kidney Transplant Disadvantages.