Your kidneys are critically important organs that clear toxic substances from the body and regulate your fluid balance. Kidney disease is very common, affecting millions of Americans. So-called “end-stage” kidney disease is kidney disease so advanced that without treatment, death is imminent. Presently, over 800,000 Americans are affected by this advanced stage of the disease.
It is very rare that kidney disease can be cured surgically or medically. Instead, you must either get a new kidney from a donor or go on dialysis. Dialysis is a technique in which the blood is filtered by a complex machine that tries to do what the kidneys are no longer capable of doing. The technique was developed in the 1940s but only became widely used in the 1970s.
Dialysis, to be blunt, is no fun. You have to be connected to the machine 3 times a week and stay at the center for 3 to 4 hours each visit. About 1 in 7 dialysis patients, who have good home support, can do the procedure at home. While it is life-saving, patients on dialysis rarely feel really well.
A breakthrough in the treatment of kidney failure came in 1954 with the first transplantation of a kidney from a human donor to a patient with end-stage kidney disease. This was done by Dr. Joe Murray at the Brigham, and the donor was the recipient’s identical twin. The first transplant from an unrelated donor came 8 years later, in 1962.
Any time an organ is transplanted from anyone but an identical twin, the body recognizes the transplanted organ as foreign and tries to eliminate it the way it tries to eliminate bacteria. To prevent rejection of the new kidney, the body’s immune system must be suppressed, leaving the recipient at higher risk of infection.
When transplantation is successful, the recipient of the new kidney feels much better, physically and emotionally, as they can now lead a normal life rather than being tied to a dialysis center.
Why don’t all patients with end-stage kidney disease get a transplant? Simple: There are not enough organs available. Of the 800,000 with the condition, over 2/3 are on dialysis and fewer than 1 in 3 have had a transplant.
If the recent transplant, from a pig that was genetically engineered to have kidneys that were closer to human genes is successful, the huge bottleneck that is availability of kidneys for transplant would be removed.
Can we declare success? Not yet. The two men who had pig hearts transplanted both died soon after the surgery. We hope the Boston man who got the recent transplant does well, but only time will tell. There are too many unknowns to predict the outcome. In addition to the problem of rejection of the new organ, pigs carry many viruses that humans do not, and one or more of these may cause problems.
If this volunteer is alive and with a functioning kidney in several years, a giant step will have been achieved.
The number-one cause of chronic kidney failure is poorly controlled, high blood pressure, so if you have hypertension, be sure to have it controlled with medication.
Dr. Ed Hoffer is the chairman of the Marion Board of Health, a graduate of MIT and Harvard Medical School. He is Associate Professor of Medicine, part-time, at Harvard and a Senior Scientist at the Massachusetts General Hospital.
What Does The Doctor Say?
By Dr. Ed Hoffer
Thank you for this interesting article. I heard a report about this on NPR and had lots of questions. Your article answered many of them. I also saw a clip on the TV news showing the labs where the organ donor pigs are raised. It was extremely sanitary! I wonder how much these pigs suffer and about the ethical issues. Maybe the wonderful human benefits are enough to outweigh the sad life for these pigs. Maybe not. Perhaps that is an individual choice.