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What is the future of kidney transplants?

Q: I am a renal patient. I like to be informed of the following:

  1. The following extract of therapeutic cloning relating to kidneys which is self-explanatory, from The Hindu dated 23rd January 2003, citing the success of different types of cloning - therapeutic cloning - he said this technology could be used successfully for cloning organs such as kidneys, hearts and lungs to facilitate their transplant in human beings. The chairman of Indo-American millennium foundation for improving bilateral relations said India should give a boost to therapeutic cloning and a thrust to research on stem cells. It has been done successfully in the US and Europe. India could also create kidney and heart bank to transplant the organs like eye banks to transplant the organs to give new life to many.
  2. Bone protein can reverse kidney failure – Investigation at Beth Israel Deaconess Medical Center has shown that a protein called Bone morphogenic protein (BMP-7) used to heal fractured bones is effective in repairing and reversing chronic renal disease. It is understood that production & application of this protein is being done in U.S.A.
  3. Due to paucity of cadaver/related donors, many renal patients wait for a certain death in this country. Other countries also face similar problems. It is understood that Israel has formulated a law giving legal sanction to willing living donors to donate their organs. Will our government / medical association think in that direction?

A:I must commend you for putting forth these excellent questions. The issue of shortage of human organs is becoming more severe with each passing day. This problem not only plagues countries like India but nations like United States are increasingly feeling the brunt of it. It has been estimated that in U.S. alone every 14 seconds a new person gets added to the waiting list for organ transplantation. I must point out that U.S, over a number of years, has developed a highly efficient network of organ sharing from deceased donors (as they are respectfully called rather than cadavers). But this was possible only largely due to political motivation and state funding. Despite this, U.S. and other countries are desperately looking towards alternate sources of organs since human pool of organs has failed to meet the demand. Possible approaches include transplanting organs from animals (xenotransplantation), cloning organs using sophisticated gene technologies or expanding human pool (as in case of Israel and other countries). Humans have been successfully able to clone certain animals and now using stem cells are trying to clone organs. This approach remains purely experimental and is in its rudimentary stages. Risks are just beginning to be realised and long term benefits are unknown but is extremely promising. According to some, it will be another several decades before it finds its way to clinical trials. Xenotransplantation seems promising and has its own risks (known and unknown). It has already been performed in humans with varying success and may become available earlier than cloning. Yet again it may bring with it a totally new patterns of diseases which we never knew because the diseases known to animals may become transmitted to humans. Thus, it has to stand the test of time. As far as Bone Morphogeneic Protein-7 (BMP-7) goes, there are several types of BMP as indicated by the suffix. Only one particular type has been approved by U.S. Food and Drug Administration (FDA) for the treatment of certain types of fractures. It is exciting to learn that BMP-7 helps revert some of the damage done to kidneys in animals. It remains to be seen whether it does same in humans and if yes, to what extent. In other words, there are lots of questions to be answered but it may prove revolutionary as far as treating kidney failure is concerned but it will be years (many) before something becomes available for testing in humans. Simply stated, it is just what appears to be a light at the end of tunnel. We don't know whether it is really a light and how long is the tunnel! Regarding living organ donation, unfortunately, India has earned itself an embarrassing and bad international reputation after series of scandals involving organ bazaar. Part of the blame is to be borne by the laxity of legal system which had left too many loop holes only to be manipulated by certain individuals and lack of enforcement of those meagre laws prior to the revision of Organ Transplantation Act. On the same note, to make an efficient infrastructure available for organ sharing (living and deceased), it needs great deal of political will, motivation and funding. Public platforms like NDTV and others (including all forms of media) have a definite role to play by increasing the awareness and igniting the public debate on this issue.

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