Patients with end-stage renal disease (ESRD) are given a new lease on life with kidney transplantation. However, the search for a donor is challenging. Maria Anna Zaguirre-Cortes tells the story of her unconditional love and sacrifice by donating one of her kidneys to her husband
By Mylene C. Orillo
When then 45-year-old Maria Anna Zaguirre-Cortes found out that her then 44-year-old husband, Arnaldo or Arnie had end-stage renal disease (ESRD) and needed to undergo dialysis, she offered herself up for compatibility test without hesitation.
Born and raised in the Philippines, Anna migrated to Australia in 1980 at the age of 21 with her parents and siblings. She went back for a holiday after a year and married Arnie in a civil union so she can petition him easily. When Arnie migrated to Australia in 1984, the two got married the same year and they were blessed with four boys now with ages 34, 33, 22, and 20.
Arnie’s health condition took Anna by surprise as he showed no signs and symptoms of having a kidney problem. Her husband has never seen a doctor. In fact, it was a normal busy day for the two of them until one midnight in 2002.
Anna recalled the incident: “Arnie went to the toilet to pee. He didn’t know he already collapsed. He just saw himself lying down on the floor and saw the bathroom drawer broken. He said maybe he held on to it or hit it. He woke me up and told me what happened.”
The next day after attending Sunday mass, Arnie drove down to the nearest hospital by himself. Straight away, he was admitted to the hospital because his systolic blood pressure was over 200 mmHg. When the blood chemistry results came in, it was conformed that he had a serious kidney problem.
After a year, his kidney failure worsened, and his nephrologist referred him for the creation of a fistula on his hand in preparation for dialysis.
“His doctor said that his kidney was failing 90 percent and that he needed to undergo dialysis. That’s when I asked if we can bypass that and offered myself to be tested for compatibility without hesitation,” said Anna.
Anna had to go through many tests and psychiatric interviews to make sure she was really voluntarily doing the organ donation.
“My only concern at that moment was what if there’s a rejection after the operation all my sacrifices will be put to waste plus losing one kidney. I prayed to God to guide us through,” shared Anna.
The surgery was done on November 22, 2004 at the Prince Alfred Hospital, Camperdown in New Southwales, Australia. After about six to eight hours, Anna and Arnie were brought to separate recovery rooms. The doctors said they were not supposed to see each to avoid emotional tension and stress. They were also not allowed to entertain visitors to prevent infections.
Anna got home after three days while Arnie was left at the hospital for a week. After discharge, he was required to report back to the hospital every morning for a month or so to make sure there was no rejection of the kidney.
Life after kidney transplant
It’s been almost 15 years and Anna (now 60 years old) reported that Arnie (now 59 years old) has been normal and active ever since. As for her who has only one kidney left, nothing has changed as well. She feels normal like everyone else like. They attend regular Monday Zumba and Swing n’ Rock n’ Roll classes.
“We also did boxercise for a year, but stopped for the meantime because I have a neck and shoulder pain for a long time. Overall, we are okay. I’m perfectly healthy, except that I take a blood pressure maintenance tablet, since I only have one kidney, but it’s manageable so far,” said Anna.
Anna shared that she gave up working since 2010, while Arnie works only during weekends. They also manage their own shoe repair and key cutting business since 2004.
Aside from work, the two are also busy babysitting their two grandchildren.
“For potential kidney donors, do it as long as you are healthy you can make a lot of difference in the world. Don’t hesitate to donate your kidney. It’s the most incredible humane thing you can do to save one’s life,” said Anna.
Best option for kidney failure
Dr. Romina Danguilan, noted nephrologist and deputy executive director for medical education at the National Kidney and Transplant Institute (NKTI), emphasized that the best treatment for ESRD is kidney transplant.
“It’s the one that will give the patient the highest quality of life and the highest survival rate. Once you have a kidney disease, your risk for mortality or death is very high, much higher than the ordinary person. Once you are transplanted, the risk decreases a lot,” said Dr. Danguilan.
Although kidney transplant is the best management for ESRD, many financially challenged patients do not take this option. It costs about PhP 600,000 including the onemonth follow-up for the recipient.
However, the Philippine Health Insurance Corp. (PhilHealth) covers up to P600,000 for the kidney transplant procedure of every member and dependent suffering from end-stage renal disease. PhilHealth also subsidizes a maximum of 45 sessions per year of dialysis. But the patient would still need anti-rejection medicines which he/she has to take for life.
According to Dr. Danguilan, the leading causes of chronic kidney disease (CKD) that can lead to ESRD are diabetes, high blood pressure, or chronic glomerulonephritis (inflammation of the kidneys.
Experts at the NKTI note that the number of patients who are developing ESRD is rising. The youngest patient is less than 10 years old; while the oldest patient is in their 90s who are on dialysis.
“Our last data was in 2016 and there were more 20,000 new patients every year starting dialysis and it increases by 10-15 percent every year. The number of prevalent patients who are ongoing dialysis at any one time is already more than 30,000,” revealed Dr. Danguilan.
Finding a suitable kidney donor
Kidney donors actually live a normal life. Only he/she has to have a healthy lifestyle, needs to undergo regular checkups during the first year, and yearly checkups thereafter.
On the other hand, recipients of kidney organs can live normal lives even up to 20 years. In fact, some of them participate in transplant olympics showing they are strong and they can do sports. Women can have children as well. One-year survival is 98 percent. Five-year survival is 95 percent. We have very good survival rates, higher than patients on dialysis.
“Many donors disappear after because they feel well. They feel they shouldn’t see a doctor. But we really try to encourage them at least once a year to see their doctor,” said Dr. Danguilan.
Apart from the high cost, Dr. Danguilan revealed that one of the reasons also why many patients are not availing of kidney transplantation is that there’s not enough awareness about it, thus the lack of donors.
“Many people don’t know that we have NKTI; that we do more than 300 kidney transplants a year; that the survival on kidney transplantation is so much higher than the survival of patients on dialysis,” she said.
Dr. Danguilan mentioned earlier that the leading causes of kidney failures are diabetes and high blood pressure, but these diseases run in families. Once everyone in the family has hypertension and one of them develops a kidney problem, they cannot be kidney donors anymore.
The patient now has to look for an extended relative, maybe someone not related to him/her, or whom the patient has a social or emotional relationship with. Last option would be enlisting in the deceased donor organ program, which would take a lot of time.
“Unfortunately, NKTI’s deceased donor organ program has not been very successful despite social media campaigns and promotion. There are very few deceased organ donors. They won’t be needing their kidneys when they’re dead. Whereas if you donate all your organs, many patients with organ failure can still use your organs,” said Dr. Danguilan.
In two or three national surveys conducted by NKTI regarding organ donation, it found that if one asks a well person if he’s willing to give up his organs, he always answers ‘yes’, but during the actual point of a loved one dying, all of a sudden, he doesn’t like to give his consent.
“A lot of it is maybe because his families don’t know that the person or the family member who is dying wanted to be an organ donor. When you decide to become an organ donor, share this decision to your family. In case anything happens to you, your family knows that you’re a willing organ donor,” said Danguilan.
One of the popular misconceptions on organ donation is that the lives of sick patients who have agreed to become organ donors are being cut short on purpose to speed up the donation process.
“That’s not true! Doctors who are in charge of taking care of the patient and making sure that they’re going to be alive are a separate team who will procure the organs. It’s only at the point when the patient is brain dead that we will call the organ procurement team to assess the patient if he/she can be a donor. If I were the attending doctor of this patient, I’ll do my best to try make him live,” clarified Dr. Danguilan.
She explained that if the patient develops brain death, cardiac death will soon follow, and that’s only the time the attending doctor will talk to the family to ask for their consent to have his/her organs donated to those patients who have kidney failure. Once consent is given, that’s the only time the organ procurement team will come and get the organs for donation.
In 2007, there were reported abuses in organ donation wherein many foreigners were allegedly coming to the country for transplantation, and getting kidneys from willing Filipino donors in exchange of money. Since then, the Department of Health has issued an order such that foreigners cannot get Filipino living donors as organ donors.
“That’s a disadvantage to Filipino patients who have kidney failure,” said Dr. Danguilan. “Why are we donating kidneys to foreigners when we have our own countrymen who need donors?”
Early diagnosis is key
Apart from living a healthy lifestyle, eating the right food, Dr. Danguilan noted that it is important to have an early diagnosis, especially in high risk individuals. One is highrisk if he/she has relatives who are diabetic, hypertensive or on dialysis or who have CKD as these diseases run in the families, explained Dr. Danguilan.
“Once you become an adult, you have to undergo annual kidney checkup which includes creatinine, urinalysis, fasting blood sugar and blood pressure check,” Dr. Danguilan advised.
When one waits for symptoms, it might be too late already to stop progression of the disease.