The healthcare system is still in crisis: many areas have medical deserts, hospitals are in dire straits due in part to staff shortages… These difficulties can also have consequences for patient care. Example: living donor kidney transplant (an alternative to deceased donor transplantation, which can take several years to wait). This type of surgery, which must be planned and performed at a university hospital center, is sometimes delayed.
They are sitting very close to each other in the waiting room of the CHU (University Hospital Center) of Poitiers. Jackie, 75, has a catheter in his arm to facilitate the collection of blood samples this morning; In a few months, he will donate a kidney to his 73-year-old wife Nadya, who suffers from end-stage chronic renal failure. ” It was as soon as we knew that we could “,” he explains modestly. ” After 54 years of marriage, he still gives me a wonderful gift. “,” Nadya jokes. ” This is a wonderful gift of love. There are two of us in this fight against the disease. “,” she adds gratefully.
Harvesting and replanting should take place in June, not earlier. Their journey was complicated by the difficulties of the healthcare system. ” Our only regret about this adventure was the wait time for tests due to the medical desert: more than six months. It’s huge. The last one, kidney scan: there are two and a half months left until this appointment, although in the city… “,” she explains. And these exams are fundamental.
” Our priority is not to harm the donor ” Natalie Charge, nurse coordinator for the kidney transplant unit, tells us. ” If we take a kidney from a living donor, it is because he is completely healthy and we are confident that by removing the kidney we will not put his future life in danger. This is the whole purpose of the examinations, which, due to a lack of human resources, can last several months, whether in a hospital or in the city. »
Access to the block is difficult
Another challenge that sometimes arises is finding available space in the operating room to schedule collection and transplantation on the same day. According to Professor Antoine Thierry, nephrologist and head of the kidney transplant program at the University Hospital of Poitiers: “ The hospital crisis is manifested in difficulties with hospital staff, especially in the areas of anesthesia and operating room nurses. The absence of these personnel complicates access to the operating room and delays planning time for living donor transplants. »
However, delaying a transplant can pose a risk to a patient, even if they are on dialysis, a heavy treatment designed to supplement kidney function. ” The main consequence is the risk that if the living donor appointment time is increased, the recipient’s health status will deteriorate, even if he or she is on dialysis. However, during dialysis you may encounter a certain number of complications and therefore especiallyloss of chance: you may develop cardiovascular disease, infectious problems that will complicate, prolong, and make this transplant more risky,” recalls Professor Thierry.
Health care system problems also sometimes interfere with the monitoring of transplant patients. Nearly twenty years ago, after several difficult years on dialysis, Eric, now 57, received a kidney from a deceased donor. Then, when the transplant stopped working, his brother gave him a kidney in 2017. ” Every year we have to take stock.” he explains. ” We have dermatological, dental, cardiac examinations, we have Doppler ultrasound of the graft, which is an ultrasound to check if the graft is well irrigated, if it is in good shape, etc. We also have x-rays of the lungs. ” According to him, ” It’s becoming increasingly difficult to get an appointment for all these exams. »
Alain, four years older, explains his approach to us: “ Eric, I already proposed to him the first time because it’s hard to see your brother on dialysis and not in good shape. And so I didn’t want him to go back to dialysis. In a way, it is also an opportunity to give because we are in good health and meet the criteria… Since we can live with only one kidney, this is not a problem. » « I have to admit, it’s a wonderful gift…Plus, since Christmas was approaching, he was now my Santa. It was December 14, 2017. This is one of the dates that we remember, this is the new birth. “Adds, touched, his younger brother.
Transplantation is the best treatment for end-stage renal disease for the patient. And the cheapest for society.
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