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HAPPILY EVER AFTER FOR THE PRINCE WITH A KIDNEY TRANSPLANT

A fascinating story has just been brought to light by the local Swedish business newspaper, Dagens industri. The Swedish royal family includes an organ transplant recipient! Prince Daniel, the husband of Crown Princess Victoria, acknowledged undergoing a live donor kidney transplant in 2009 as treatment for congenital kidney disease just three months following his engagement to the Princess. His father was his donor. While other medical details were not shared, his photo suggests that he is doing quite well. And he has met the basic American measures of successful transplantation by surviving more than three years with the transplant. It appears that he is now six years out from the transplant and presumably still counting. And happily living the life of a royal.

The matter-of-fact way the issue seems to have been approached by the royal family into which he married, and by the Swedish population who appears to adore the now married couple, is extraordinary. This is hardly the first time that transplantation has touched the life of a person in the public eye. It is also not an unusual illustration of the magnificent way transplantation permits rehabilitation to a full level of function, whether royal (Prince Daniel), presidential (Ferdinand Marcos), athletic (Alonzo Mourning), musical (Charity Sunshine Tillemann-Dick), thespian (Larry Hagman), retired (Dick Cheney), or more ordinary (half a million transplants). Indeed, it is just another example of the full potential that awaits those in need of organ transplants. Meaningful, high quality life is widely achievable.

While some might be inclined to conclude that the transplant was performed simply because Daniel was soon to be a Prince, the more appropriate observation is that his own parent was the organ’s source. No other connection than family was required. And such a source is just as likely to be available to any of us, as to a Prince-to-be.

For the transplant to continue functioning as well as it appears to be, the Prince must be taking immunosuppressive medications to prevent rejection of that kidney. Years ago, there were few choices about which medications to use. Often, undesirable cosmetic consequences of those medications such as a very rounded face or exuberant facial hair growth were readily apparent. Today, however, such a broad choice of drugs is available that those undesirable outcomes are quite rare. They do not appear to be complicating Prince Daniel’s life.

The take home message from this “ordinary” royal news is that transplantation has evolved into a standard therapy with excellent results that is widely available in developed countries served by mature medical and social infrastructures. The limitations to even broader access include the woefully inadequate availability of organs (overcome through live kidney donation in Prince Daniel’s case) and the relatively high costs of surgery (in the first year) and maintenance medications (lifelong).

Half A Million – What An Accomplishment!

Survey

More than 500,000 organ transplants have been performed in the United States since October 1987, according to the United Network for Organ Sharing (UNOS) website on May 19, 2015. To put this bland statistic into perspective, there are only 34 cities in the U.S. with larger populations! And 5 entire states have no cities with even 20% (100,000) of this number of people. A mind numbing number of people who have, thus far, benefited from transplantation. But, so many more might have been saved if there had been more organs.

Transplant technologies have become such a significant component of the standard of care in medicine that the general public may no longer be amazed by transplantation, instead, simply taking it for granted. And, perhaps a sense of entitlement to having a transplant also contributes to the generally lackadaisical attitude many seem to have. Such a lack of awe is dangerous for multiple reasons. To begin, transplantation remains technically, medically and emotionally challenging. Even under the best circumstances, problems can pop up. For example, every transplant is performed under general anesthesia, an approach which has small but significant risk. And the patients undergoing transplantation are older and sicker than ever before. Why? Because medical care has become so good, because so many effective anti-rejection medications are available, and because people are living longer than ever before. All of these factors contribute to a surging group of transplant candidates who might benefit from kidney, liver, heart, lung, pancreas, intestine transplants. The U.S. list has topped 123,000 people who are currently waiting. At the current rate, 18 are dying every day. If we only had enough organs to be able to perform these transplants!

These huge numbers should help everyone to understand how important donation is.  These procedures have become so commonly needed, that at least 1/3 of people in the U.S. have a personal connection to someone who has undergone, has died waiting for, or is in need of a transplant. Beyond the ties to transplant recipients that so many of us have, it is well known that the majority of Americans are in favor of organ donation. In a 2012 government survey, 95% were strongly in support, or in support (see below)! Now it is time to make the connection between thought and action.