Kidney Diseases and Transplants: Challenges and Progress

Priority #2: TRANSFORM TRANSPLANT and increase access to donor kidneys. If patients understood the benefits of transplantation and the process involved, more would likely accept the opportunity and pursue transplant listing.

The lack of public awareness of kidney diseases, especially compared to other serious health conditions, is both a challenge and opportunity. It is probably the same in every part of the world: people know a lot about other diseases (for example, heart disease), but little about kidney diseases. Kidney diseases are a huge public health burden and source of morbidity, mortality, and health care expense.

In addition to a lack of awareness, there are misconceptions. When some people are asked about kidneys, they confuse them with other organs (such as the liver). There is also a reluctance to discuss the topic. Kidney diseases are generally not on people’s priority list. But if you are thinking about your health, kidney diseases deserve your full attention.

While there are many great options to treat kidney diseases, I’d like to talk about what to do when your kidneys fail. The best option is a kidney transplant, which is a daunting prospect for many people. Often when a patient is on dialysis, the kidney transplant option is not part of the discussion between the patient and their physician. I work at a center where transplantation is openly discussed with our patients, and if it qualifies as a viable option, it is pursued. We see many patients on dialysis and often suggest that a transplant might provide better health outcomes and lifestyle.

But even after suggesting transplantation to those patients who would greatly benefit from the procedure, we run into obstacles. The patient may feel strongly that a transplant is not for them for a wide variety of reasons. They may resist being put on the transplant list because it feels like a major step medically, emotionally, or physically. However, if patients understood the benefits of transplantation and the process involved in getting to transplantation, more would likely accept the opportunity and pursue transplant listing.

ASN’s campaign, " We’re United 4 Kidney Health, ” invites kidney health professionals to be part of a movement to shift our focus from kidney failure to kidney health. This campaign is unified by four priorities, one of which includes transforming transplantation and increasing access to donor kidneys: 

We can certainly understand why the word “transplant” of any body organ would sound scary to a patient. There are probably situations when patients do not ask about transplantation due to fear. Or maybe because before they start on dialysis, they think it is too early, or once they are on dialysis, they think it is too late. So, I think the onus is on the nephrologist to clearly explain the advantages of kidney transplantation. It is entirely possible for a transplant to be performed even before starting on dialysis; in fact, this is the optimal situation. Having early conversations with your nephrologist about transplantation rather than waiting is a good idea. It could take the worry out of the equation and help drive a more productive discussion. 

There is a perception that a lot of work is required to get on to the transplant list, in terms of getting tests performed and multiple visits to the transplant center. This puts people off. There are many professionals involved in the process of getting patients onto the transplant list. This is to help make the process smooth and efficient. However, there is more that we can do to help people navigate this big step in their lives. This includes involving loved ones and other health professionals to work as a team to ensure that patients have support while they navigate the road to transplant.

There is another important issue in transplantation. The odds are that before you get a kidney transplant, you are probably going to need to start on dialysis. The waiting list for a transplant is long because there are many more potential recipients on the list than there are donor kidneys available. 

Personally, despite some of the obstacles I have mentioned, the field of nephrology is one of the most satisfying and rewarding in medicine. As a nephrologist, your work spans many different disciplines of medicine and you work daily with a wide range of fellow physicians, including surgeons, cardiologists, infectious disease doctors, immunologists, endocrinologists, pharmacists, and many others. The breadth of exposure to medical care is wide, and the many health professionals involved in the care of our patients highlights the complexity of kidney disease management. 

I have been lucky to have trained with inspiring teachers and mentors in nephrology. They taught me important lessons that have helped me deliver better care to my patients. I have also learned the importance of good and compassionate communication with my patients and their families. Good communication helps increase awareness of the options available (including transplantation) to our patients with kidney diseases. 

This awareness campaign, " We’re United 4 Kidney Health ," is just what our profession needs right now to ensure we take the important steps necessary to shift the conversation from kidney diseases to kidney health.