An Essay on developments in Medicine.
In the history of human development, great minds are noted for their contributions to advancing mankind. Today researchers are making further headway to answer the alarming numbers of men, women and children across the glo
be with chronic renal failure. After several years of development, the artificial and “bioartificial” replacement organs researchers have developed are moving forward in to an encouraging future. Many therapies such as “dialysis and apheresis, cardiac assist devices, insulin pumps, and advanced limb prostheses arose to the center of medicine” (ESAO-IFAO 2017 Congress, 2017). Particularly for the chronic renal failure patient, dialysis must be met with dietary changes and great care to sustenance and receiving a kidney transplant is the best chance for a normal life today. A wearable artificial kidney (WAK,) would exceedingly improve quality of life for patients for normalizing their daily activities, “while undergoing dialysis, as well as by loosening dietary and fluid restrictions and reducing pill burden” (Davenport, 2015). A compelling solution for patients on long waiting lists, the artificial kidney could be the life changing breakthrough to the traumatic changes chronic renal failure has on patients and their families.
Chronic Renal Failure and the waiting lists
The United Network for Organ Sharing (UNOS) serves as the United States’ organ transplant organization. On their website one will find a large banner at the center of the page which displays a counter with the current number of people whom need a lifesaving organ transplant (total waiting list candidates) which at the time of this writing was 114,605 people at 8:48pm EDT (UNOS, 2018). The National Kidney foundation details the causes of the rising numbers which will be addressed further into this essay. In 1988, there were less than 14,000 patients waiting for a kidney transplant, today the waiting list has multiplied (largely due to rising numbers of diabetes) (Meckler, 2007). Early detection is key, but the numbers suggest a growing number of Americans living with renal disease, estimated to be over 650,00 Americans today. As regulated by UNOS, patients who need a kidney transplant are added to the national waiting list for kidneys from donors, which are distributed based on “geography, waiting time and various medical factors” (Meckler, 2007). Patients waiting for an available donor kidney must endure dialysis for survival, less than 35% survive on hemodialysis after 5 years, clearly one must consider that a prevention campaign will be essential to reduce the number of people whom are diagnosed with renal disease.
Causes of the problem
It is likely that all Americans today have been touched by life threatening illness in their family such as chronic renal failure. Chronic renal failure (CRF) is defined as “progressive and irreversible loss of renal functions that gradually progress to end-stage renal disease” (Sajid, Ahmad, Sarwar, 2014). Over the counter drugs like pain relievers and prescribed drugs can cause kidney disease, a simple urine test can determine if one is at risk. Abuse of drugs, prescription drugs and alcohol abuse can all cause renal disease. “Congenital malformations stricture and renal calculi are the most common cause of chronic renal failure in children” (Sajid, Ahmad, Sarwar, 2014), and the effects of treatment and dialysis are compounded for children. “1 in 3 American adults is at risk for kidney disease, major risk factors include diabetes, high blood pressure, a family history of kidney failure and being age 60 or older” (National Kidney Foundation, 2017). The symptoms are not always detectable before it is too late, testing and early detection is a must for reducing chronic renal disease. The number of patients waiting for a transplant now being over 114, 000, the current donor/transplant system fails to meet the demand. As a result, some families will turn to illegal means which further enables the black market and human trafficking element, a new solution must be researched and realized.
The effects of the problem-Dialysis/mortality
Chronic renal failure (CRF) will eventually lead to dialysis once a patient’s kidneys can no longer perform at above 10% functionality. It is likely that a patient receiving treatment for CRF has already changed their diet, dialysis as a treatment is intrusive and time-consuming while being unequivocally vital to survival. “Dialysis is the life-sustaining treatment for patients with end-stage kidney disease, for many patients this treatment is the focal point around which their life revolves, not only due to the time spent travelling to and from treatment sessions and the time dedicated to the dialysis treatment itself, but also due to the accompanying dietary and fluid restrictions and medication burden” (Davenport, 2015). CRF tremendously compromises an individual’s health and lifestyle; the conditions of dialysis treatment and scheduling and medicinal treatment is expressly more difficult on children with CRF. Dialysis is an “efficient treatment for removing small water-soluble solutes, but trials have consistently shown that simply increasing urea clearance does not lead to improved patient survival for patients with both acute and chronic kidney failure” suggests Davenport, “their extracorporeal clearance is more dependent on time than modality” (2015). For growing children, growth and health can hinge on more frequent hemodialysis treatment, it is questionable if dialysis centers can increase scheduling and whether families can commit to increases in treatments.
The proposed solution-Artificial organs, specifically artificial kidney.
A realistic solution for patients on long waiting lists are the rapid developments in artificial organs technology to answer the needs of many. Medical research and development have made advances in prosthetics and cardiac assist devices, leading to a new school of medicine. Organizations of top researchers and surgeons have developed to meet the demand for new concepts. Today there is organized global support for the development of artificial organs with the European Society of Artificial Organs (ESAO), the Japanese Society (JSAO), the American Society (ASAIO) and the IFAO (International Federation of Artificial Organs) (ESAO-IFAO 2017 Congress, 2017). These advances in medicine have improved quality of life and today we see athletes with highly advanced prosthesis performing in world class sports events today. These are advances in technology that produce results in a quality of life one could not have imagined 30 years ago for people whom have lost limbs. “The advent of nanotechnology manufacturing techniques coupled with miniaturization and computer technology has allowed the development of experimental wearable HD devices” (Davenport, 2015). Late in 2015, the Food and Drug Administration (FDA) awarded the Expedited Access Pathway award to the wearable artificial kidney (WAK,) “invented by UCLA/Cedars Sinai Nephrologist Dr. Victor Gura; The EAP designation signals FDA support for expediting the availability of this device” (MDT Online, 2015). The FDA approval and support puts the WAK on a fast track to availability, and Dr. Gura is actively testing the device on human patients on hemodialysis today. “The Kidney Project national research team, led by Shuvo Roy, PhD, a bioengineer and faculty member in the Department of Bioengineering and Therapeutic Sciences, are developing a surgically implanted, free-standing bioartificial kidney” (USRDS, 2013). The bio kidney would perform the biological functions of the natural kidney. The Kidney project has also received the EAP and are in the second stage in testing, doctors’ Gura and Roy are forging the way to developing the artificial and bioartificial kidneys. While the idea of an artificial kidney solving the long waiting lists and ending the black market may seem implausible to some, the concept is being made reality by the world’s leading specialists in surgical medicine.
Justification for the solution
The layman, politician and clergy can agree that man’s purpose should focus on caring for those in need. On a global scale, the development of the black markets and the staggering numbers of citizens whom die waiting for a kidney calls for action. A wearable dialysis device could be the solution aimed at extended treatment for patients while significantly reducing travel to and treatment at dialysis centers (Davenport, 2015). As proficient and effective the transplant system is, there is still margin for improvement. The artificial kidney would alleviate the mandates on transplant centers and hemodialysis centers, and along with legislation and educational programs could remedy to a degree the cultural blight of the black market, human trafficking and mortality of patients. All legislation must meet the standards of acceptability, the issues of illegal organ harvesting and the long waiting lists for an organ donor must be met on different stages. The artificial kidney offers an acceptable solution and has been met with resounding global support of physicians, surgeons, medical researchers and legislators alike. The artificial kidney’s first purpose is the improvement of quality of life for patients, but theoretically it could take medical science to eradicate the temptations of the black market organ trade.
Benefits of the solution-benefits to dialysis patients
The artificial kidney as a concept alone is much favorable to hemodialysis, this would considerably improve the life of children whom are at high risk for mortality at the end stage of renal disease. “Much like a normal kidney, the wearable artificial kidney (WAK) removes excess fluids and toxins from the blood at a natural rate and provides patients with continuous treatment (as opposed to intermittent) allowing them to achieve a quality of life closer to that of a healthy person” (MDT Online, 2015). For children and adults, the psychological effects of hemodialysis are devastating, the artificial kidney as a solution would be an improvement mentally as well as physically for patients. Children will be able to attend school, with some maintenance and the alleviation of dietary restrictions would help patients thrive and live normal lives. The National Kidney foundation offers these statistics in favor of the development of the artificial and bioartificial kidney (implant):
“The 650,000-plus people who live with ESRD are 1% of the U.S. Medicare population but account for roughly 7% of the Medicare budget” (USRDS, 2013). Dialysis treatment costs an average of roughly $89,000 per patient annually in the U.S., a total annual cost of $42 billion; “$34 billion of this is absorbed through the Medicare budget” (USRDS, 2013). The rest is either covered by Medicaid, insurance, or paid otherwise. The cost of a kidney transplant is $32,000 for surgery and $25,000 a year after surgery care for prevention of the rejection of the transplanted kidney. 53% of the annual transplant cost in the United States is covered through the Medicare budget. “The Kidney Project will save the Medicare budget $15 billion annually once the bioartificial kidney is available to eligible patients who are on dialysis or unable to get a transplant” (USRDS, 2013). The Kidney Foundation encourages Americans to donate to the development of the artificial kidney’s research and development for The Kidney Project by contributing at the website for The Kidney Foundation.
Conclusion
Hemodialysis was first used during the second world war, and by the sixties was developed to treat acute kidney injuries and is the only treatment for chronic renal disease short of a kidney transplant. As technology progresses with scientific and research development, the wearable artificial kidney and the implantable artificial kidney are being realized. Support of the FDA and the development of the IFAO (International Federation of Artificial Organs) and similar organizations in the US, Japan and Europe give strength to the idea that the artificial kidney is an exciting and optimistic solution with realistic possibilities. Donorship awareness as well as renal disease prevention should also be addressed to aid in reducing the numbers of patients on waiting lists. It is more likely that the implementing of legislation to improve health care in the United States is a far more realistic goal than supporting a campaign to legalize organ sales. As individuals we should aid in spreading awareness and a conscientious culture must be cultivated in the United States and abroad. The Kidney Foundation calls for Americans to donate to funding research such as The Kidney Project. Great minds are developing solutions thru research on an artificial kidney, awareness and improved healthcare for all will change the conversation. Learn more here.
References
Davenport, A. (2015). Portable and wearable dialysis devices for the treatment of patients with end-stage kidney failure: Wishful thinking or just over the horizon? Pediatric Nephrology, 30(12), 2053–2060.
Ferreira, J. P., Duarte, K., Graves, T. L., Zile, M. R., Abraham, W. T., Weaver, F. A., Zannad, F. (2016). Natriuretic Peptides, 6-Min Walk Test, and Quality-of-Life Questionnaires as Clinically Meaningful Endpoints in HF Trials. Journal of the American College of Cardiology (JACC), 68(24), 2690–2707.
MDT Online. (2015). Medical Design Technology, 19(8), 8. (June 2015).
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Meckler, L. (2007, Nov 13). Medical marketplace: Kidney shortage inspires A radical idea: Organ sales; as waiting list grows, some seek to lift ban; exploiting the poor? Wall Street Journal
National Kidney Foundation, Inc., (2017). National Kidney Foundation website. Retrieved from: https://www.kidney.org/prevention
Sajid, N. K., Ahmad, S., & Sarwar, I. (2014). Chronic Renal Failure in Children; Etiology and Clinical Presentation. Professional Medical Journal, 21(2), 280-289.
UNOS, (2018). United Network for Organ Sharing, a non-profit 501(c)(3) organization. Retrieved from: https://unos.org/
UNOS Announces Efforts to Increase the Number of Transplants. (2016). Targeted News Service (TNS).
U.S. Renal Data System, USRDS (2013). Annual Data Report: Atlas of End-Stage Renal Disease in the United States, Natio,nal Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2014.
Welcome to the World Meeting on Artificial Organs: ESAO-IFAO 2017 Congress. (2017). Artificial Organs, 41(9), 797–799.
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