By Dr. K. Javeed Nayeem
It is a well-known fact that Chronic Kidney Disease (CKD) that results in a near total or total shutdown of kidney function is becoming exceedingly common in our country. Although there are many factors responsible for this very distressing but largely preventable problem, improperly controlled Diabetes and Blood Pressure happen to be the two main culprits. The injudicious use of pain-killers coming under the category of Non Steroidal Anti-inflammatory Drugs (NSAID’s) is another significant cause of kidney damage which is very common in our country as we do not have laws that prohibit the sale of this class of drugs across the counter.
All grocery shops and tiny petty shops selling beedies and cigarettes across the length and breadth of our country dispense these drugs and our village folk who are tormented by aches and pains of more than one kind, buy and use them rampantly without the slightest knowledge of their lethal side-effects. Even educated people dwelling in towns and cities indulge in this kind of pill-popping without the slightest thought to the harm that they may be doing to themselves.
Incidentally, these are the very same people who ask their family doctors at least three times whether they have taken into consideration all the side-effects before prescribing the drugs for their problems! Unfortunately, unlike some other organs like the liver that can regenerate their cells when damaged and thus regain their function with treatment, the nephrons which are the basic functional units of our kidneys are simply unable to do this. Thus when they get damaged due to any cause their function is lost forever. And, whenever our kidneys lose about seventy to eighty percent of their nephrons their function becomes inadequate to support and sustain life.
As things stand now, patients afflicted by this problem have only two options before them; spending the rest of their life on regular dialysis or going in for a kidney transplant. Life on dialysis is not easy or comfortable considering the fact that it has to be done at least twice a week for most patients who will end up being tied to the place of their treatment without being able to travel. Dialysis is beleaguered with other technical problems like frequent infections, electrolyte imbalances and shunt failure, all of which are more than just minor nuisances. Added to this is the recurring and life-long cost of the procedure. On the whole it is not a comfortable experience and it is usually accepted by patients and their relatives alike only as an inevitable means of extending life.
While kidney transplantation can obviate the need for regular medical intervention and the need for the recipients to be tied down to the places of their treatment like patients on dialysis, this option too has its drawbacks like the recurring cost of protecting the transplanted kidneys from being rejected by the recipients’ bodies. Even for the patients who can well afford the cost of these medications they have to be on constant guard to ward off infections as their immunity gets compromised greatly by these drugs. But all said and done transplantation is certainly a better way of dealing with failed kidneys and so many patients on dialysis would certainly opt for it if given a choice.
But unfortunately although it is a better option it is not an easy one to avail especially in our country because of the very strict and to some extent irrational laws that govern it. This has no doubt has been done with good intentions to curb the trade and trafficking in human organs which had become a thriving business for some time soon after transplantations started taking place in our country. Simply speaking, the law says that only very close blood relatives of the patient can donate kidneys to their kith and kin. Very specifically, it says that they have to be the father, mother, son, daughter, wife, husband, brother or sister of the patient. So other close relatives like cousins, aunts, or uncles are out of this group. And when this is so, anyone from among the infamous in-laws circle is also naturally outlawed!
A close friend or well-wisher too cannot donate a kidney even if he or she wishes to do it as a very voluntary act of goodwill and magnanimity. This very strict stipulation and its equally strict implementation has meant that lakhs of kidney failure patients in our country who are consigned to a life on dialysis and who wish to break free from it and who can afford to do it too are completely helpless in procuring kidneys even from willing donors.
Well known to all of us, this scenario seems to be completely different for anyone who happens to be a VIP in our country. We have seen a good many high-profile personalities undergoing transplants with the kidneys coming from completely unrelated donors let alone from their close relatives. A notable example is Sushma Swaraj, our External Affairs Minister who underwent a transplant recently with the kidney coming from an unrelated donor. The propriety of this act was questioned albeit briefly in the social media although the mainstream media very conveniently preferred not to embarrass our laws, lawmakers and political big-wigs.
Arun Jaitley, our Union Finance Minister, was all poised to undergo a transplant last fortnight with the identity of the unrelated donor remaining a closely guarded secret. It was reportedly postponed just because of a mismatch problem although there are strong rumours that the transplant has indeed already taken place with secrecy being maintained to prevent a public outcry. Many patients of kidney failure, presently on dialysis, have formed a group on the social media that has been questioning the sanctity of such transplant operations. That is why perhaps we have noticed that news about Jaitley’s medical condition has been so conspicuous by its absence over the last two weeks. Or do we have a set of completely different rules that are meant to make our VIPs immortal while other ordinary mortals wait painfully for merciful death to end their misery?