The gift of life

Living with kidney disease requires special attention to diet as well as a number of other factors. The lack of a waste removal system makes managing diet all the more important for patients with kidney failure relying on dialysis. Protein, phosphorous and potassium need to be reduced while water intake should also be monitored.

"Things that are otherwise considered healthy foods - like tomatoes and bananas - could have a detrimental effect on a patient with kidney failure so being aware of what to eat and what to avoid can make life a lot more manageable," Muscat said.

Muscat met up with Vivian Corporation's Hannah Cremona last November when an idea to launch a cookbook for kidney patients was born.

"The cookbook is part of a series of activities put together to celebrate World Kidney Day on 8 March and aims to provide kidney patients with recipes that are easy to prepare and also take these special dietary requirements into consideration."

On advice from dietician Mario Caruana, the booklet was launched on 8 March at Mater Dei Hospital.

Muscat has had a personal interest in kidney disease as Malta's first living, unrelated donor. He has been involved with the Transplant Support Group for the past eight years and acts as the group's vice president.

He became aware of plight of people with kidney disease when his brother-in-law, David Vella, was diagnosed with kidney failure, resulting from diabetes and other complications in 2002. While waiting for a donor match, Vella was put on dialysis to keep him alive.

"I made the decision to donate my kidney to David the first time I saw him hooked up to the dialysis machine where he had to undergo treatment for several hours on alternate days."

When Muscat returned home that night he hinted to his wife and three sons that he was going to see if he was a match for Vella.

"My family reacted positively and with a huge amount of support, without which I would have never gone ahead with the procedure.

"We made the announcement over Christmas in 2002. It was my gift of life, not only to David but to his three daughters too, who were in their early teens at the time."

Though Vella is part of Muscat's family, being married to his sister, he is not directly related to Muscat, and, as there had never before been an unrelated donation in Malta, an ethical panel had to be set up to establish genuine altruism of the gesture.

The transplant eventually took place on 25 February 2004, 15 months after Muscat had made his decision.

"The long delay was frustrating, and made even worse by David's worsening condition. Although I was not advised to stick to any sort of diet or take any kind of exercise, I took that opportunity to get myself as healthy as possible in preparation for the transplant.

"Even after I was approved by the ethical board and a candidate, I still had to undergo vigorous testing to make sure that I was a match for David and he would not reject my kidney.

"By the time I got to that stage I had made up my mind to donate a kidney. Had I not been a match for David I was willing to make a Samaritan donation - donating a kidney to anyone that needed it - a stranger."

Muscat brushed off the risk factor in donating a kidney saying that the altruistic nature of a decision to save someone's life downsizes the risk in the operation itself.

"The ethical board ensures that there is very little risk to the health of both donor and recipient and will only approve a transplant if risk is minimal, though any major operation poses certain risks as well as the risk of living the rest of your life with only one kidney. However I cannot say that the risk factor has ever rattled the sense of determination that I had to go through with this."

Muscat was the first of just three unrelated kidney donors in Malta to date, however he emphasised that there are many living kidney donors that come from the same family, with an average of three to four successful transplants every year and a record six last year.

Though donating an organ while still alive is a huge gift that many would not feel comfortable with, donating organs after death is much more manageable. Becoming an organ donor is a simple procedure. An application form can be filled either online from www.transplantsupport.com.mt or by requesting a form by phone on 21 223026, 21 826718 or 21 696383 in Malta or 21 565604 in Gozo or by e-mail at [email protected]. All requests will be put on the ITU register, though it is best to inform your next of kin of your decision, as the final authorisation must come from relatives. 

In the event that you change your mind, it is possible to have your name removed from the register at any time.

Organ donation - separating fact from fiction

Myth: Family can refuse to have my organs donated even if I have a donor card.

Fact: That is true, in the sense that the final authorisation comes from the donor's next of kin. However in reality very few relatives of persons who wished to donate organs have interfered in Malta. Be sure to inform your next of kin of your wishes.

Myth: If I agree to donate my organs doctors won't work as hard to save my life.

Fact: The doctor dealing with a patient in an emergency has nothing to do with the transplantation and will fight to save the life of the donor. It is every doctor's duty to fight to preserve life till the very end. 

Myth: I might not really be dead when doctors sign my death certificate.

Fact: Doctors distinguish between being 'brain dead' and being in a coma. A coma is reversible and the patient may come out of the coma even after a number of years. When a patient is 'brain dead' the life support machine slows the process of deterioration of the organs but deterioration is already taking place. The patient is not going to recuperate. Only then will doctors recommend harvesting of organs.

Myth: My corpse will be maltreated while harvesting organs.

Fact: Specialised medical officers operate on the body to harvest the organs exercising utmost caution and ensuring the dignity of the deceased. After the organs have been removed there will be no visible signs to the body.

Myth: Organ donation is against my religion.

Fact: Organ donation is consistent with most religious beliefs including Catholicism. The Catholic Church encourages the donation of organs calling it "an act of love and a gift of life". If you are unsure of your faith's position contact a member of your clergy.

Myth: I am under 18 and too young to make that kind of decision.

Fact: Parents can make that decision for you if you wish to donate. Children also need organ transplants and often require smaller organs than an adult can provide.

Myth: I'm too old to donate organs

Fact: There is not cut off age for donating organs. Organs have been successfully transplanted from donors in their 70s and 80s. Decisions to use organs are based on strict medical criteria. Allow the doctors to decide whether your organs are suitable for transplantation.

Myth: I'm not in the best of health.

Fact: Very few medical conditions automatically disqualify you from donating organs. It may also be that some organs are not suitable for organ donation but other organs and tissues may be fine. Again, allow medical experts to determine suitability of your organs.