HemoDoc, From Doctor to Patient

Will the Renal Community Stand Tall with Shad Ireland?

By Peter Laird, MD

Shad Ireland saved his life through living his dream of becoming an Ironman, but his dream is not yet finished. Shad is the one and only dialysis patient who has ever completed a full Ironman competition. At the age of 40 and after 30 years in need of dialysis, Shad has once again set his goal on Kona. Over 30 years ago, Shad saw a TV program broadcasting the Kona World Championship and as he lay in his bed waiting to die, he dreamed of becoming an athlete and competing in Kona. Today, Shad is in the fight of his life as he competes against other competitors just to earn a spot through Kona Inspired.

Sadly, Shad is not getting the support he needs and now he is in 3rd place in his division. Only the top two vote getters move into Kona. The combined power of all of the active renal organizations could easily place Shad in first place with only a few minutes time from all of their members.  Taking only two minutes a day to vote for Shad from all those that have heard of Shad would be enough.

If Shad does not make it to Kona, next year will be one more year of dialysis and one more year of potential injuries to a body ravaged by renal disease for thirty years. With only a couple of days remaining on the Kona Inspired contest, the only question that remains is whether the renal community as a whole will stand tall with Shad and support our own dialysis champion who has and continues to give so much of himself to all of us.

To date, the renal corporations are not standing together with Shad and say he is all washed up. Shad continues to defy that logic through the daily pain and suffering he submits his body. We will never know if the power of a dream can be fulfilled if we don't stand together with Shad. If you haven't voted for Shad and given him a few minutes of your time, then who then shall we support and choose to represent all dialysis patients who never had a chance to dream a dream? Sadly, the renal community is known mainly for apathy and greed filled corporations. One man can and has made a difference.

You can make a difference for Shad and I urge all to vote at Kona Inspired for the next three days and show him that we do care and wish him to fulfill his dream. Shad deserves no less.

Shad Ireland: Pledging His Trust to the Renal Community

By Peter Laird, MD

Shad Ireland has devoted his life to promoting exercise and an independent life for all dialysis patients. Today, Shad seeks the dream that opened his life and saved him from a sure death at an early age. Shad was inspired by watching the Kona Ironman competition when he had been given only months to live. He saw himself one day competing at Kona and that inspired him.

Shad is now forty years old with over thirty years of renal replacement yet he is seeking his dream. He is in training for his most important Ironman competition to date. However, Shad cannot complete his lifelong dream without help from the community that he has devoted his entire adult life inspiring people to live a better life. I have pledged to give back to this man that has given so much to us. My pledge is to vote at least 100 times every day for the next two weeks and bring Shad to Kona and fulfill his lifelong dream. It is Shad's story, but it is also our story.

Shad faces his biggest challenge since he will need at least 2000 people who likewise pledge to vote 10 times a day for the next two weeks. The system is quick, simple and easy to vote. 10 votes will only cost you a few minutes a day, but it will mean much more to Shad and allow him to continue revealing the plight of his fellow patients to the world. He needs over 200,000 votes before midnight July 3rd. I pledge to do my part as Shad has pledged to do his best to represent the 400,000 ESRD patients in America. Only one vote from each patient would place Shad at the top of the list.

Please do your part and send Shad to Kona. He deserves our support and he has already given to the renal community over and over again. Make your pledge today and vote and vote again, there is not penalty to voting over and over again. Indeed, Shad deserves a few minutes of your time
the next two weeks.

Go to Kona Inspired and pledge your votes to Shad. Thank you. 

Pushing Organ Procurement Ethics Over the Slippery Slope

By Peter Laird, MD

The dead donor rule serves organ donors protecting those that can no longer speak for themselves. Tragic cases of death by organ donation are not talked about especially in the renal community yet they are documented and continue to occur in large part due to the lack of uniform brain death criteria throughout the US. Though fortunately rare in occurrence, anyone that has seen the NBC news report on the Zack Dunlap case should seek legislation assuring that no one would ever die as a result of death by organ donation. (here)

Unfortunately, coupled with paradoxical outrage at a Wall Street Journal article documenting the rare cases of death by organ donation, medical ethicists recently turned the discussion to procuring organs prior to the death of the donor. Although there were some ethicists who spoke against this newly proposed donation policy, many supported this new medical ethics paradigm.

The Case for Kidney Donation Before End-of-Life Care

Donation after cardiac death (DCD) is associated with many problems, including ischemic injury, high rates of delayed allograft function, and frequent organ discard. Furthermore, many potential DCD donors fail to progress to asystole in a manner that would enable safe organ transplantation and no organs are recovered. DCD protocols are based upon the principle that the donor must be declared dead prior to organ recovery. A new protocol is proposed whereby after a donor family agrees to withdrawal of life-sustaining treatments, premortem nephrectomy is performed in advance of end-of-life management. Since nephrectomy should not cause the donor's death, this approach satisfies the dead donor rule. The donor family's wishes are best met by organ donation, successful outcomes for the recipients, and a dignified death for the deceased. This proposal improves the likelihood of achieving these objectives.

As a renal disease sufferer, I initially considered pre-emptive renal transplant with donation from my wife. However, after considering both my prior history of cancer and risk of cancer recurrence after renal transplant and the risks entailed for my wife, I declined to pursue that option and then focused on optimal dialysis considerations. After all, renal disease is my disease and my responsibility. I do regret the loss of the kidneys that God granted to me, but I do not believe I have any right to another persons kidney whether dead or alive. It is a gift, it is not a right of any person with renal disease. 

It appears to me that in many ways, the renal community has transformed renal donation into a right over the last two decades. Presumed consent at its heart gives ownership of vital organs by the state for all those that don't opt out of this system utilized in Spain and other nations. While I value the gift of organ donation, I still cherish my civil liberties and I would hope that the demand for renal donation would never preclude our right to liberty and self determination. Once again, it is my disease, not someone else who is a complete stranger to me who has their own right to life, liberty and the pursuit of happiness.  In many ways, I personally would much rather die from my renal disease than see my renal disease used as a means of of encroaching another man's civil liberties.

I fear that I am in the minority opinion among my friends and colleagues in the renal community. It appears that just about any means of increasing renal donation no matter what the ethical implications of those policies and procedures is gladly welcomed by the renal community at large. Presumed consent, abandonment of the dead donor rule, donation by cardiac death and now kidney donation before end of life care infringe civil liberties for society in general and push the organ procurement ethical framework over the slippery slope endangering individual societal rights.

While I am sure that I will likely be in the minority opinion on this issue among the renal community, I must still question whether there are limits we should not cross in providing all available ethical renal donations? Changing the definition of what is ethical is a dangerous slippery slope that poses risks to society at large. Should we not who are most at risk in this society from our own renal disease support the protection of others who can no longer speak for themselves in their own tragic circumstances and forgo our greed for their organs by ever changing medical ethics?

American society decades ago saw the dangers of euthanizing anencephalic children and harvesting their organs recognizing the sanctity of person-hood in these children doomed to a sure death shortly after birth. I suspect our current modern society will re-evaluate that decision as well one day. I don't see these changes in our medical ethics as a positive change in any manner. I believe it shows a callous disregard of our human condition and respect and dignity for the individual and life in general.

We in the renal community must consider that same callous disregard for individual lives could in the end be the same sort of justification given to terminate treatment of those with renal disease as well. We are on the high price, low benefit scale according to many medical ethicists with some questioning how we perform dialysis in America. (here)  The renal community needs to be very careful what we ask for as there are always consequences of seemingly small decisions. 

Donation prior to death should never be the standard for organ procurement. I would hope that the renal community would understand this better than the general population since it was the respect for individual life that spurred the 1973 ESRD program funding in the first place. Losing this fundamental ethical paradigm could have untoward outcomes on continued ESRD funding in the future. The demand for kidneys today should not subvert the ethical foundations that secure our future especially in a time of limited resources.

I personally call upon the renal community to stand up and firmly disengage from the pursuit of renal donors at any cost through alteration of long held ethical paradigms. I would hope that the renal community will instead reaffirm the dead donor rule and set limits on the ethics of organ procurement. Respect for all life begins by recognizing the importance of the individual no matter what circumstances they encounter. Is that not the story of the ESRD program in 1973? If we won't stand up for those at risk of death from trauma and other illnesses, who will stand up for us in our time of need that the future shall surely bring.