Reclast Class Actions : With today’s advances in removal and transfer of a kidney from a living person, most surgeons can remove a donor’s kidney laparo-scopically. In laparoscopic removal, the surgeon makes small incisions in the abdomen and then extracts the kidney through one of the incisions. The other incisions allow the surgeon to insert a video camera and surgical instruments. A minimally invasive laparoscopic operation means quicker recuperation for the donor than in traditional removal methods, which require an incision under the rib cage and which can cause greater discomfort and longer recovery times.
When you are ready for a transplant, the transplant team will organize a meeting with your donor, whom you may or may not have already met, to explain the process and to answer any questions about living donation, the surgical procedure, and the short-term and long-term risks associated with a donation. These meetings may include family and friends. AJ information gathered about the patients and the procedure is confidential. Your transplant team may separate you and your donor for counseling and examination. Your donor will be seen by a nephrologist different from yours for the workup. Your donor and you will also have different surgeons. Medicare now requires that every program have a living donor advocate who is available to talk to your donor about concerns or reservations. Medicare and most medical insurance plans cover the cost of testing the donor for compatibility.
Both you and your donor will undergo extensive physical examinations, be asked to provide your medical histories, and will undergo a battery of tests performed by your respective medical teams to ensure that your kidneys are compatible and that donating a kidney will not adversely affect the donor’s health. In addition, your donor’s nephrologist will make sure the donor does not have kidney disease and that he or she has two kidneys; the donor’s nephrologist will rule out any infectious disease or cancer risk that the donated kidney may pose to you. If there are warning signs of potential pitfalls at any point in the process, your donor can opt out.
The team will discuss with you, the recipient of a transplant, what’s involved in your surgery, what will take place during the hospitalization, and what you will need by way of follow-up care after you are discharged from the hospital. A crucial part of your aftercare is the medications you will need to take to help your body resist rejecting your new kidney and becoming infected by various microorganisms. Therefore, the transplant team will discuss your ability to pay for your medications, which can be very expensive, to make sure that you have adequate insurance or other financial means to cover their costs. Medicare will cover most of the costs of medications for three years after surgery, but for now (legislation is pending in Congress to remove the three-year limit) other health insurance policies or personal funds will be needed to covcr the rest of the cost for the first three years and most of the cost after that.
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In the future, doctors maybe able to predict how an individual will respond to treatment, resulting in individualized health care that is tailor-made to a person’s specific characteristics, not just to how people on average respond to a medication. In the future, health care treatments may be modified on the basis of a person’s genetically mediated responses to a number of medications, some of which may be effective and some not. This new approach to treatment is called pharmacogenetics. Depending on the condition, this promising future treatment could analyze a person’s genetic code to determine whether her genetic attributes support the use of a particular treatment.
Pharmacogenetics may also yield information about the target of the medication and how the body breaks down the drug. For example, the liver metabolizes drugs using enzymes, which have different activities, based on the variants of the genes involved. Identifying which genetic variants of liver enzymes a person has could help doctors prescribe drugs that are most likely to work according to that person’s genetic makeup.
Although in its infancy, pharmacogenetics has already led to the development of better treatments for some diseases. It has been known since the 1950s that certain genetic variants in a number of enzymes that metabolize drugs in the liver can enhance or reduce their effectiveness. More recently, the treatment of hepatitis C has been greatly improved by the observation that a protein known as artificial interferon is more effective in patients with a particular genetic variant than in people without it.
Whether a pharmacogenetic approach will yield improved treatments for kidney disease remains to be explored. A better understanding of the mechanisms underlying different diseases is more valuable for treating some illnesses, but not all. Because a specific disease can be associated with many va riations in the genetic code, as is the case with diabetes, any specific variation might contribute a great deal—or very little—to the expression of the disease. Thus, pharmacogenetics holds the most promise with diseases in which there is variation of only a few genes contributing to the expression of the disease.
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Individualized treatment based on a person’s genetic code is not a far-fetched idea. The cost of performing the sequencing has plummeted dramatically in recent years. Sequencing one persons complete genome will probably cost as little as $1,00 0 or possibly less in the future. In the future, too, sequencing a child’s entire genome at birth may become a routine procedure. Because a person’s genome does not change over time, it would be necessary to sequence each person’s genome only once, and therefore this would be a one-time expense. In the future, as we begin understanding how and when genes turn on and off, it may be possible to determine which genes are overactive or underactive in a disease state and to tailor the treatment to the process that a specific gene mediates. Currently it is possible in diseases like cancer to predict the response to a particular form of treatment based on a certain genetic characteristic of the patient.
There is a downside to genome sequencing and to knowing a person’s predispositions to specific diseases. For one thing, a predisposition to a disease does not necessarily mean a person will get the disease. Many diseases develop only when a person who has the genes that make him susceptible to the disease encounters something in the environment, like a virus, which turns the disease “on.” Some critics argue that genetic sequencing could cause people to worry needlessly, because they might never develop a disease, even though their genes indicate that they have the potential to develop the disease. There is also some concern that worried individuals will get unnecessary medical procedures to monitor for disease. Also, evidence that a person is at risk for a specific health condition might lead insurers or employers to discriminate against that person. In an effort to combat this concern, the Genetic Information Nondiscrimination Act was signed into law in 2008; this Act specifically forbids such discrimination on the basis of genetic information. In addition, the passage of the Patient Protection and Affordable Care Act in 2010 will prohibit this type of discrimination beginning in 2014.
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