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Susan Senator

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Everyone Deserves A New Kidney

Posted: 01/16/2012 8:52 am

Susan Senator is one of the most eloquent persuasive and knowledgeable voices out there right now on the subject of the realities of disability. She happened to pop up in my Facebook IM yesterday when I was struggling with this post about why I thought Amelia Rivera should not be put on the list to wait for a donated kidney. Susan argued with me, and asked to write what she believed in a separate post. She is right -- this is how the world SHOULD work. But it doesn't. Yet. Lisa Belkin, To Be Named By You Blog

It's the way of the world, people say. Limited resources. Bad laws. That's reality.

I guess I am not a realist. I believe that Amelia Rivera should get the kidney. Many will say I am not living in the real world. Okay, so welcome to my world. I am the mother of a deeply autistic young man, and so most of my adult life has been spent fighting the concept of That's the Way it Is, So Deal With It.

No, my child is not dying of kidney failure, thank God. But there is something in this debate over Amelia Rivera's worthiness of the kidney that feels familiar to me, and that is the idea that we have to live in the real world, with its harsh realities. In Amelia's case, the real world does not have enough kidneys, and so choices must be made. The choices are made based on odds of survival, quality of life after surgery, and perhaps even comparative to the others in need.

Yes, that is the reality: to think of the greater good. And yet, it also feels a bit like Social Darwinism, or even eugenics. Why does a team of doctors get to decide that Amelia is less deserving than someone else? Are doctors always right? History is full of mistakes in the medical profession. The story of the human race is one of trial and error. Evolution itself is trial and error. We all make mistakes because we are human. And that, perhaps, is what has me so upset over Amelia's doctors: the implication that some humans are better than others, when in fact, we are all a mess.

All of Nat's life I've been told to make him more like everyone else. Those who told me that were not completely wrong; I knew that Nat needed to learn as many skills as he possibly could so that he could eventually be as independent and productive an adult as possible. Nat's teachers and therapists spent years getting him to communicate, to deal with his overwhelming confusion and frustration with the world, to advocate for himself as best he could -- so that he could live a better life.

And yet at some point there are things I will not force on Nat in the name of getting to normal. I don't insist that he stops talking to himself. I don't make him stop flapping or walking in circuits endlessly around the house. If I did, I would be correcting him constantly, and what would that tell him, implicitly? That he is not good enough as he is.

Society is biased towards the mainstream, even with all the evidence that it is the oddballs, the aberrations, the mutations that give us our uniqueness, and help us progress as a species. And yet the mainstream, the normal, the cookie cutter: that is our standard, and all else needs work -- or worse. In Amelia Rivera's case, it seems that her body's problems don't even rate medical care. In a Saturday, January 14 blogpost from Notdeadyet.com, Disability Activist Stephen Drake points out that even Children's Hospital of Philadelphia's Patient Bill of Rights appears not to apply to Amelia: "Patients and Families have the right to: Receive care, treatment and services regardless of race, color, age, sex, national origin, religion, handicap, disability, sexual orientation, who pays for care or your ability to pay."

Why doesn't this policy apply to Amelia, a three year old with a serious disability? Isn't this hypocrisy? Veiled in calculations of life expectancy and quality of life projections is the underlying fact that organs in America are scarce, and that therefore there has to be some way to choose who lives and who dies. But next to that very same fact is the way our society is taken for granted that disability equals inferior. No matter what we say, this is how we act, for the most part. We have the Americans with Disabilities Act, yet employers continue to deny work to the disabled. According to an August 2011 article in Forbes, "Americans with disabilities are experiencing a jobless rate more than 80 percent higher than the rest of Americans, who are currently at 9.2 percent." We have the Individuals with Disabilities Education Act, and yet we have to drag Congress and state legislatures kicking and screaming to get the funding for special education programs. We say we want all people to be equal, but do we act that way when it comes to disability?

I don't think we do. All of my son Nat's life he has gotten the message that he is not good as he is. He is forced to socialize, to speak, to look people in the eye, to endure sensory overloads we can only imagine, all in the name of helping him be more normal. It's the way of the world, we say, and sigh. But what I want to know is, if we don't like the way of the world, why aren't we doing something to improve it, rather than going along and reinforcing it with bad decisions? Shouldn't we instead be investigating not only organ scarcity but our current way of looking at disability? I hope that the doctors at CHOP rethink their point of view, because a nation is watching, waiting to find out what Amelia's kidney can tell us about our country's heart.

 
 
 
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11:05 PM on 02/01/2012
Except you are all missing the point, you only have one side of the story, the mother's. And, she is going to tell the story in the way that is the most persuasive, of course. However, her daughter has a syndrome called Wolf-Hirschhorn which "can also cause abnormalities of the eyes, heart, genitourinary tract, and brain." We don't know why her doctor's advised her parents that she wouldn't be considered for transplant, just that severe mental disabilities were mentioned. A kidney is not being withheld, she was denied consideration for a transplant which the hospital has reconsidered. Children with her condition do not have a significantly shorter life expectancy, so while she is only 3 and has her parents to care for her now - what about 15 years from now? 20? 30? 50? So many factors go into deciding who is eligible for the shockingly few organs available for transplant and, while mental acuity (intelligence) is not (and should not be one of them), severe mental and physical disabilities that will inhibit the individual's potential success post-transplant should and does factor in. My advice to you who are shocked by the hospital's stance that they will simple consider her a transplant, but not guarantee acceptance or an organ? Become an organ donor - make more organs available thru living donation, agree to have your organs donated upon your death. The more organs that are available for donation, the more options hospitals and families like Mia's will have.
04:02 PM on 01/31/2012
And our country's heart says that it better to let someone else's child die, one who would live a long and productive life, so we can feel better about ourselves by giving an organ to a girl with mental and physical disabilities? That's what you truly feel is fair. Okay? I'd like you to go up to the parents whose child you think should be denied an organ, an organ that would otherwise die without, because it should be given to a girl who will NEVER have much of a life. Who will likely die prematurely, long before that child would with said organ.

You are naive if you think that these decisions, straight and without letting our own personal situations and ethics (as you've clearly done) cloud our judgment. I'm glad you're not anywhere near there committees because we'd have a large number of the VERY LIMITED amount of organs available for donation going to waste. These are hard decisions to make and I have a lot more respect for those who do make them, then those who have the nerve to criticize them for it.
08:06 AM on 02/15/2012
Well, since her parents are donating I don't think any of what you are saying makes any sense. And who are you to say she will "NEVER" have much of a life? do you know her? Do you know any children with her syndrome or are you getting your information from outdated sources on the internet?
nschomer
Scientifically Progressive Libertarian Socialist
01:48 PM on 01/20/2012
You claim an underlying hypocrisy, and yet display some pretty strong examples of your own, most notably "we have to drag Congress and state legislatures kicking and screaming to get the funding for special education programs. We say we want all people to be equal, but do we act that way when it comes to disability?"
Really? Is equality really what you're after? So you would be satisfied with your child being dumped into a 30 person classroom and told to sink or swim? No, what you are looking for is special treatment for your child, and the state to pay for the much greater cost of raising a child with special needs. I am sorry that you don't like the world the way it is, and would prefer an ideal one, but at some point you have to grow up and deal with reality.
photo
mikeholloway
support organ donation
12:15 PM on 01/20/2012
While I appreciate the use of this event as a teachable moment about the organ donation crisis, I'm very much afraid that ignoring the facts in favor of drama is preventing the public from understanding the real problems. What happened was that the surgeons initially denied them access to surgery using a family member as a live donor. At this point the waiting list for a donor kidney is just an academic debate. There are two problems with this. Most importantly, the public is being told that doctors are doing something unethical with donated organs. This type of news is always used as an excuse to not support donation. You'd hope that it would make people realize the importance of having more organs for transplant, but no, it never works that way. The other problem with this blurring of the actual events is that it has kept most of the public from realizing that the actual ethical question currently for this family isn't rationing of donor organs but surgeons rationing their time and refusing patients that might bring down their success rates.
Please, let's refocus the discussion on the actual events.
01:57 PM on 01/20/2012
Very well said. What I was trying to say in my comments below. Thanks!
08:09 AM on 02/15/2012
I agree that success rates have everything to do with the doctor denying the child the transplant in the first place.
07:31 PM on 01/19/2012
I didn't buy any of your arguments. The parents, understandably are understandably are fighting for their child, but the very sad reality is that, she likely will die even with the kidney. The difficulty in using immunosuppression (required after transplant) is a limiting factor. Another child who could use the kidney and have a good shot at living will die. Personally I am glad in this case it is the doctors making the call and not a paid insurance employee. I am a cancer survivor (for now) but can tell you doctors are not gods, they can't conjure cures and miracles. Guaranteeing care is not the same as guaranteeing life. And we haven't even been able to get to the guaranteeing care in this country. But you do have a point that is Amelia IS worth saving. Perhaps new kidneys could be grown or developed in labs....so those "pro lifers" out there who are opposed to stem cell research ....maybe you should rethink your opposition.
01:21 PM on 01/19/2012
To put this into the category of "social Darwinism" is ridiculous. The medical outcome for this child would be completely independent of the social status of the parents or the amount of money involved. It only depends on the medical condition of the child... unless, of course, you want to accuse the doctors of treating it differently from anybody else?

Indeed, if rich parents, or politically influential parents would manage to take a kidney from a much more deserving, but poor individual... now that would be social Darwinism.

As for "evolution making mistakes"... that's just poor thinking. Evolution is a process, not a person. Processes do not make mistakes, only people do.

This shows, again, that when emotions are involved, all logical thinking skills, even the most basic ones, are going out the window.
01:02 PM on 01/19/2012
I think a lot of people here do not realize that Amelia is not just being denied to be put on the waiting list, she is being denied the option to even have the surgery. Her parents and extended family are going to be be tested to be donors. This shouldn't be a debate about a kidney that could go to someone else, bc these people are not going to donate their kidney to someone else.
02:41 PM on 01/19/2012
I think those people do, in fact, realize what's going on in Amelia's case. It seems that *they* are able to recognize that there are many, many more factors that go into transplant surgery than simply finding a suitable organ. Producing that kidney may be the least of the issues in her case.
08:28 PM on 01/19/2012
Xtina724, the "they" I am referring to are many of the commenters on here, not Amelia's doctors. Your own comment referred to "how the very limited number of organs be distributed" and "everyone thinks their kid should be put at the top of the list." Since the donated kidney would not be available unless it went to Amelia, being on a list is a moot point. If the parents know the risks with surgery, the risks without the surgery, have a suitable organ donor, and are willing to pay for it, who are the doctors to deny them?
06:41 PM on 01/19/2012
The child may not survive the surgery. Her physical condition is poor.
12:40 AM on 01/19/2012
Amen. The world is what we make it, and if as it is today, not good enough, then we need to work for change.
02:42 PM on 01/19/2012
That would look great on a greeting card. As a philosophy regarding medical care? Not so much.
11:45 PM on 01/18/2012
There's a difference between denying someone treatment based on unfair discrimination and denying someone treatment because there's serious doubts that they can even survive the surgery, let alone recover.
07:02 PM on 01/18/2012
I have my doubts that this child is being denied a transplant simply because of mental defects. But rather her physical disabilities that negatively affect her health already. All of these people up in arms over this are only looking at two things here, she's a child and she's mentally handicapped. Would you be this upset if you knew that the elderly are denied transplants everyday simply because of their advanced age? None of you realize the fact Dr's have to consider many things (most of all a persons over all health) before deeming someone a viable candidate for a transplant. Or that there is a limited amount of transplantable organs to go around. And as cruel as it may seem the organs need to go to those who are going to benefit from it the most. I don't believe she should be put on the national transplant list. Reason being is that the wait time can be many yrs. I myself spent 6 yrs waiting for my kidney and the wait time is even longer now. So the chances that she recieves a transplant through the national list before she passes are very slim. But if her parents, relatives or even a total stranger are a match and want to donate I say go for it.
06:20 PM on 01/18/2012
"And yet, it also feels a bit like Social Darwinism, or even eugenics."

Y'know, it really doesn't. Approaching this dispassionately and realistically has nothing to do with social Darwinism, and isn't near the same ballpark as eugenics. When you're lobbing incendiary bombs like these, there is a responsibility to be accurate:

eugenics: noun ( used with a singular verb )
the study of or belief in the possibility of improving the qualities of the human species or a human population, especially by such means as discouraging reproduction by persons having genetic defects or presumed to have inheritable undesirable traits

"Why does a team of doctors get to decide that Amelia is less deserving than someone else? "

What would you like to do -- submit it to a vote? Is a popularity contest the best way to logically and without emotion determine how the very limited number of organs be distributed? A team of doctors gets to decide because they are the very best -- probably the only -- group adequately prepared to make this determination based on years of study, and all anecdotal and empirical evidence available. Everyone thinks their kid should be put on the top of the list when something like this happens. Allowing people without an emotional stake or vested interest in the outcome is the only acceptable process.
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Suzq0027
Micro Bio now full
05:49 AM on 01/18/2012
How is it that we are equating length of life with quality or value of life?

That seems to be the trend in all of the "against it" posts I read regarding this case. If the party isn't going to live a substantially longer life, then they don't deserve the physical relief that the transplant would provide, much less the time that it actually would add.

I submit that there are a good many jackasses who live long lives and don't add a lot of quality or value to the world. Number of years survived on this planet is not a good way of establishing what comprises a good life.
02:00 PM on 01/18/2012
If you can, Remove all emotion from this subject. People seem to use better judgment and be more humane to a suffering animal then with this child. No, I'm not calling this child an animal. I'm saying If people saw an animal suffering, and in spite of the great cost of getting everything it needed to be whole, It would still need a small pharmacy of pills and injections daily only to still be suffering everyday of it's shortened lifespan. There would be no question of what to do. Some would probably start calling for cruelty charges if that animal was pretty much in a vegetated state with all it's new parts. How could you not have, and feel the same compassion for a human? Frankly, I think the parents are being selfish and cruel and looking to make money off this kid anyway they can.
10:47 PM on 01/17/2012
A wonderful portrayal of most people's inability to make reasonable decisions because of some personal experience that has almost nothing to do with the matter at hand.
09:17 PM on 01/17/2012
So....what would people rather do?

Give kidneys to those who yell the loudest?

...who pay the most?

...who are first in line, regardless of any other factor?

...by throwing darts?

Go on...come up with a solution.