Artificial kidneys and miniaturized dialysis could save millions of lives | Hacker News Reader

Artificial kidneys and miniaturized dialysis could save millions of lives

nature.com

82 pointssohkamyung30 comments

My older sister had end-stage renal failure (from IgA nephropathy [0]) and was on dialysis, so I donated my kidney to her. If you want to make an incredible difference in someone's life, I can't recommend it enough!

There are cool computer science problems involved: imagine person A1 wants to donate their kidney to their partner A2 but they aren't a match. Now imagine many such pairs exist (B1/B2, C1/C2, D1/D2 etc.) and you start noticing that while A1 can't donate to A2, they can donate to B2, and B1 can donate to C2, and so on! Thus the kidney chain is born. You get everyone together and have them agree that if their partner gets a kidney donation, they'll pass on the favor to someone else. All that's needed is a single purely-altruistic donor to start the fire. The longest such chain has reached over 100 people! [1]

Anyway, the surgery is laparoscopic and has an extremely low fatality rate: around 1/10,000, which is an order of magnitude lower than the all-cause mortality rate for living a single year of your 20s. The kidney is a fairly isolated organ, basically only attached to you via the renal artery/vein, the ureter (which carries urine to your bladder), and some fascia (internal connective tissue). You can see a full video of the surgery at [2] (if you're into that kind of thing). I was walking within hours of the surgery, discharged within two days, and back in the gym within 5 weeks. My life is not any different than pre-donation, and if anything goes wrong with my remaining kidney I go to the top of the donation wait-list! If you're interested, you can see more info at [3].

[0] https://en.wikipedia.org/wiki/IgA_nephropathy

[1] https://www.beckershospitalreview.com/quality/nation-s-longe...

[2] https://www.youtube.com/watch?v=x8-YhyYrMsc

[3] https://www.kidneyfund.org/kidney-disease/kidney-donation.ht...

Kidney donation may be one of the most admirable and heroic things many people can do for another. I too have had family with renal failure (though I was not a match), and the potential to simply fix it with a match is wonderful. But anyone considering it should internalize upfront that there are potential real long term risks, and a surprising paucity of data since long term outcomes are apparently not rigorously followed. See for example "At 18 years old, he donated a kidney. Now, he regrets it"[0]. It's very much not to discourage anyone, but it'd be a shame to not go in with eyes wide open and have what should be something to be proud of marred by any feelings of deception. I have definitely seen the lack of hard long term data on real risks of kidney donation downplayed, it's not fair to portray "we don't see high risks" when that's because we just don't see much period. "Going to the top of the donation wait-list" for example is good, but there is in fact still a wait list.

All that said, the positive vs negative ratio certainly still appears high depending on the situation. And developments like the one in this article could also reasonably factor into an individuals analysis, after all in 20-30 years it may be a solved problem with high quality synthetic organs, so a young person giving a kidney now is more helping to bridge the gap, and by the time they themselves might have an issue they'll have saved a life yet not have the same trouble. Even so, donators should fully recognize that, all of them should absolutely feel as good about it as you clearly do.

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0: https://www.washingtonpost.com/national/health-science/at-18...

As for the guy regretting it, the only real issue is the possibility of getting kidney disease going up from 0.1% to 1.0%. He is greatly over exaggerating the risk. You are screened for potential kidney risk factors before donating.

Your life expectancy is not affected.

a USA Registered Nurse colleague casually mentioned while we were driving past one of the many, many chain store dialysis locations, that the service is inefficient and literally unsafe for many patients, and generally is over-prescribed. I assume because the drive-through model of the service, and the chain store, franchise-type setup, and reducing face-time with MDs, that this factory-like practice fits more to billing models and automation, so is chosen in a pseudo-market evolution. disclosure- I have no direct experience with kidney dialysis, nor known anyone who goes there.

I was on dialysis in the UK - Um not sure what you mean though the US has less home dialysis and prefers Hemo vs CPD

Dialysis helps you both stay alive and also helps extend the life of the failing kidneys - and a better outcome for a trasplant

Normally based on my experience you are prescribed your dialysis based on your remaing kidney function.

Dialysis is ideally a long process starting years before you start, combined with going on the transplant list (ideally you get the call before you go on dialysis)

I was doing home CPD dialysis BTW

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