Kidney transplant as an option

It’s been almost three years now since 48-year-old Julian Concepcion was wheeled into the operating room of St. Vincent Hospital in Los Angeles, California to have a kidney transplant.

Concepcion, who underwent four delicate operations in three months which included his heart and brain, remembers his trip to different hospitals for treatment and being attended to by about 25 doctors for his various sickness.

“At one point, I told the doctor already to let go but he simply said don’t worry, we’ll fix you up,” Concepcion said. He was on dialysis treatment for four years before the operation.

While some people wait for two to five years to get a kidney donor, Concepcion was very lucky to find one at a time when he needed it most. “We were not informed about the identity of the person, except that the kidney came from a 19-year-old who died of gunshot wounds,” said his wife Vicky. Their medical insurance paid for the cost of all the four operations of Julian which amounted to close to $3 million.

Option With the growing number of patients undergoing dialysis at the Commonwealth Health Center, kidney transplant is one option being made available to them by the government.

Public Health Secretary Joseph Kevin Villagomez recently signed an agreement with San Francisco-based California Pacific Medical Center to provide medical care to patients from the CNMI who would be sent there for kidney transplant.

Last week, Dr. Sharon Inokuchi, a transplant nephrologist and vice chairman of the department of transplantation at the California Medical Center, examined the patients who are on dialysis treatment at CHC to find out the possible candidates for a kidney transplant.

Unfortunately, only one-third of the patients are healthy enough to undergo kidney operation. Inokuchi was assisted by Dr. Hilmer Negrete, director of hemodialysis unit of CHC, in discussing the kidney transplant with the patients.

“Every patient must be informed of the different choices available,” said Inokuchi who last came here in 1996. In meeting the patients, Inokuchi said they are informed of the consequences of not following the doctor’s advise while they are on treatment. “You may be a candidate today but if you don’t follow the instructions, it is possible that you will be removed from the waiting list,” she said.

Three years ago, there were only 44 patients in the hemodialysis unit of CHC. The number shot up to 71 in 1999, an alarming increase for an island with a small population.

Process While the option for a kidney transplant is being offered, not all could qualify, said Inokuchi. “Once we decide that the person is a candidate for a kidney transplant, we register the patient to a transplant waiting list,” she said.

A month or two before the operation, the patient will be flown to San Francisco. For a patient to qualify for transplant, he must show commitment to health care such as maintaining proper diet and medication.

The California Pacific Medical Center is committed to helping people from far places, promoting aggressively its outreach program.

It does not matter whether a person lives in San Francisco, Saipan or Hawaii, Inokuchi said the medical center gives equal treatment to all of its patients.

“There’s not just many donors so the patient will have to wait. There’s just many people in line,” said Inokuchi. And the waiting can take two to five years.

A living donor who is either a relative or a friend of the patient cuts down the waiting time for the available kidney. “In fact, we have patients who have living donors and they are doing very well,” said Inokuchi.

However, a potential living donor must also be perfectly healthy — not diabetic, no hypertension and obesity problems — common diseases in the CNMI.

Even if patients were sent home after a successful kidney operation, Inokuchi said they make sure they keep in touch to monitor the progress. She is all praises for the team of doctors at CHC whom she believes would be able to help the patient sent home after the transplant.

Support Based on the agreement with Pacific Medical Center, the CNMI the government’s medical referral program will support the patient while waiting for the transplant in San Francisco, including a stipend for the companion.

Government support will continue even after the operation or until it is safe enough for the patient to go home. “But nobody can just go there without being told to go ahead,” said Villagomez. The funding must be programmed because a patient may have other complications while in California.

“We are happy to sign a contract with California Pacific because it is one of the best in the U.S. and we have a lot of people here with various medical problems. We want to send them to a place that can handle the risks,” said Villagomez.

Moving to San Francisco immediately before the doctors advise the patients to do so does not mean that they will be placed on top of the list.

Although $500,000 has been made available for a kidney transplant this year, Rep. Heinz Hofschneider said the legislature will help the department find funding when more patients need to have kidney operation.

Hofschneider said the government will save more money to help the person get out of dialysis treatment and have a kidney operation in the long run. The Health, Education and Welfare Committee of the House of Representatives met with Inokuchi to explain to members of the Legislature the kidney transplant program of the medical center.

Dialysis treatment costs a patient $7,000 a month. A kidney operation can cost between $50,000 to $70,000 and can even go higher for more complicated cases.

“It is not just the cost that we’re after, the patient’s quality of life improves and they can go back to work immediately,” said Negrete.

Villagomez said the transplant program is one way of helping the people to lead a productive life again. Due to the high cost, no family can really afford it on their own, he said.