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A kidney donor at 18 now regrets it

washingtonpost.com

11–20 of 143 posts

Re: A kidney donor at 18 now regrets it

#11
I admire the author's selflessness. At the same time, it seemed easier to be selfless as a teenager, probably for similar reasons for why it's easier to draft 18-year-olds than it is 28-year-olds. Given young persons willingness to sacrifice for the greater cause without realizing that life extends well past your 30s and 40s, I wonder if more shouldn't be done to let young donors think of the risks, so that their naïveté isn't something that the system takes advantage of.

The author's right to ask for better data and tracking of donors. That said, his current worries are likely to be heavily informed by selection bias:

> Five years after the surgery, when I was 23 and getting ready to go to medical school, I began working in a research lab that was looking at kidney donors who had gone on to develop kidney failure. For that research, I talked to more than 100 such donors. In some cases, the remaining kidneys failed; in others, the organ became injured or developed cancer. The more I learned, the more nervous I became about the logic of my decision at age 18 to donate.

If you spend a lot of time talking only to donors where things have gone wrong, yeah, you'll be paranoid. Reminds me of being a cops reporter in which you strongly associate certain neighborhoods with shootings and murders because, professionally, those incidents are the only times you ever visit those neighborhoods.

Re: A kidney donor at 18 now regrets it

#12
To be fair, there's lots of other organs in your body that are already single points of failure. Regardless, there's probably a reason we evolved with two kidneys. My personal theory (i.e. I have no idea if there's any actual research on this hypothesis) is that before humans discovered cooking, agriculture, sanitation, etc., there were a lot more diseases and toxins and such in the food we ate, so the organs responsible for handling them were much more active than they are now. This is why you can get rid of your tonsils, appendix, a large fraction of your liver, and one of your kidneys and still be "fine".

(To reiterate, though, I don't know how much research there is to support this theory.)

Re: A kidney donor at 18 now regrets it

#13
post #8

Earlier quoted context omitted.

Also, our worthless medical system doesn't do even the most basic data analysis to answer basic questions for common procedures and runs on half-truths and inertia.

is that true ?, I thought there were stats on the outcomes of a lot of procedures.

According to the author:

> The truth is, it is hard to get good numbers about what happens to donors. Hospitals are required to follow them for only two years post-donation, which does not catch such long-term complications as chronic kidney disease, cardiovascular issues or psychiatric issues. There is no national registry for kidney donors or other large-scale means of tracking long-term outcomes.

That's surprising to me. Seems like it's one of the easier things to track. Though what is the status quo for health tracking beyond chronic diseases?

Re: A kidney donor at 18 now regrets it

#14
There are real risks in the actual donation, of course. And some lifelong things you need to worry about. It does affect treatment of other things. For example, if you happen to have a rotator cuff injury, you can't just take high doses of anti-inflammatory meds for a month. You have to do physical therapy and steroid injections. And, in our wonderful US healthcare system, you'll get near-zero aftercare beyond a few months worth of checkups. You'll have to advocate for yourself for later extra checks on your remaining kidney's health and often have to foot the bill yourself because your overpriced insurance will refuse to pay for it.

Source: Am a kidney donor living in the US that has experienced both of the above and several similar issues

Re: A kidney donor at 18 now regrets it

#15
My physiology professor told our class to never donate, especially at our age group (18-23). His presentation included some of the complications listed in the article. However, his reasoning was straightforward: Assuming a long lifespan, if you are in the position with your only kidney failing, you're screwed.

He was speaking generally of course. Not every situation has an easy solution and Poulson took a noble route, albeit when he was young and not fully informed. I have heard med students suffering from slight paranoia because they learn all kinds of diseases and their symptoms (as another comment has stated). I wish all the best to Poulson.

Re: A kidney donor at 18 now regrets it

#16
post #11

I admire the author's selflessness. At the same time, it seemed easier to be selfless as a teenager, probably for similar reasons for why it's easier to draft 18-year-olds than it is 28-year-olds. Given young persons willingness to sacrifice for the greater cause without realizing that life extends well past your 30s and 40s, I wonder if more shouldn't be done to let young donors think of the risks, so that their naï…

>At the same time, it seemed easier to be selfless as a teenager, probably for similar reasons for why it's easier to draft 18-year-olds than it is 28-year-olds. Given young persons willingness to sacrifice for the greater cause without realizing that life extends well past your 30s and 40s

I totally agree, the biological basis of this is Pre-frontal Cortex development.

"The [prefrontal cortex] isn't fully developed and won't be until the person is 25 years old or so." https://www.urmc.rochester.edu/encyclopedia/content.aspx?Con...

"This brain region has been implicated in planning complex cognitive behavior, personality expression, decision making, and moderating social behaviour. The basic activity of this brain region is considered to be orchestration of thoughts and actions in accordance with internal goals." https://en.wikipedia.org/wiki/Prefrontal_cortex

I can't understand any other context for drafting 18 year olds other than taking advantage of their youth and incomplete development, but avoiding Presentism and the comfort of Mutually Assured Destruction / Pax Americana, I can understand why when the cards are on the table and your entire society is at risk, why you must call all hands, young and old, into Total War a la WW1 or WW2.

As far as donations go, that's got to be a morally gray area as well for all the reasons you mention.

Re: A kidney donor at 18 now regrets it

#17
post #9

TL,DR: author voluntarily donated a kidney to his stepfather's brother, against the advice of much of his family. Years later, the recipient is doing fine but the author (on his way to becoming a doctor), has reviewed the risks of being a donor and now is nervous about the whole thing.

This is an accurate summary. One thing I'd like to add is that there was nothing that the receiver did that provoked the regret. I read this assuming that something happened that caused it to not be worth it. While this is a good view on this situation, the article is basically a guy saying that his comfort and security to have a long life is more important than the other guy's life. So I assumed that the other guy h…

"...the article is basically a guy saying that his comfort and security to have a long life is more important than the other guy's life. So I assumed that the other guy had done something to bring this to light but that is not the case."

This is how I went into the article as well. I expected seeing something about the recipient being a substance abuser or otherwise not careful with his gift, or some related drama. But it's really some light hypochondria and the recklessness of youth on display.

I don't begrudge his regret; I don't know if I would have donated in the first place if I had been in his shoes. I'm just not entirely convinced of the overall worth of the article.

Re: A kidney donor at 18 now regrets it

#18

My physiology professor told our class to never donate, especially at our age group (18-23). His presentation included some of the complications listed in the article. However, his reasoning was straightforward: Assuming a long lifespan, if you are in the position with your only kidney failing, you're screwed. He was speaking generally of course. Not every situation has an easy solution and Poulson took a noble route…

Assuming a long lifespan, if you are in the position with your only heart failing, you're screwed.

Re: A kidney donor at 18 now regrets it

#19
post #16
post #11

I admire the author's selflessness. At the same time, it seemed easier to be selfless as a teenager, probably for similar reasons for why it's easier to draft 18-year-olds than it is 28-year-olds. Given young persons willingness to sacrifice for the greater cause without realizing that life extends well past your 30s and 40s, I wonder if more shouldn't be done to let young donors think of the risks, so that their naï…

>At the same time, it seemed easier to be selfless as a teenager, probably for similar reasons for why it's easier to draft 18-year-olds than it is 28-year-olds. Given young persons willingness to sacrifice for the greater cause without realizing that life extends well past your 30s and 40s I totally agree, the biological basis of this is Pre-frontal Cortex development. "The [prefrontal cortex] isn't fully developed…

> I can't understand any other context for drafting 18 year olds other than taking advantage of their youth and incomplete development

18-year-olds have been volunteer recruited and drafted for perhaps the entire history of organized armies. Child soldiers also have (and in some countries still are) enlisted also. I suspect this is only out of extreme necessity, as the moral and practical drawbacks are overwhelming.

When the United States has instituted the draft, it has encompassed 18-to-45 year-olds for immediate enlistment. 18-25 year-olds comprise the largest age group of new volunteer enlistees in the US. The largest barriers to military service qualification are health reasons and family situations. It would follow that younger enlistees would have lower likelihood of physical injuries and being the sole caretaker of a dependent.

Your post made sense until your bizarre digression to armed service being linked to incomplete prefrontal cortex development. It can be appealing to find sinister motivations behind institutions you dislike, but there isn't a basis in fact here. The explanation is tradition, health, and lack of obligations.

Re: A kidney donor at 18 now regrets it

#20
post #16

Earlier quoted context omitted.

>At the same time, it seemed easier to be selfless as a teenager, probably for similar reasons for why it's easier to draft 18-year-olds than it is 28-year-olds. Given young persons willingness to sacrifice for the greater cause without realizing that life extends well past your 30s and 40s I totally agree, the biological basis of this is Pre-frontal Cortex development. "The [prefrontal cortex] isn't fully developed…

> I can't understand any other context for drafting 18 year olds other than taking advantage of their youth and incomplete development 18-year-olds have been volunteer recruited and drafted for perhaps the entire history of organized armies. Child soldiers also have (and in some countries still are) enlisted also. I suspect this is only out of extreme necessity, as the moral and practical drawbacks are overwhelming.…

It's hardly bizarre, but it's not put in terms of cortical development either. It is however a bit of, "Give me a girl at an impressionable age, and she will be mine for life."

Ignoring that reality, and why 12 year olds are more likely to pick up a machete than a 30 year old, is what's bizarre.

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