Confused

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65 year old male who came to OPD couple of days back was found to anemic and hypertensive and an evaluation revealed that he had an ESRD – (End Stage Renal Disease – Chronic Renal Failure.) He had just recovered from a Cerebro-vascular accident couple of months back. He was from a lower middle class socio-economic back ground.

As we started preparing the family for Renal replacement therapy (Dialysis/Transplantation) Vs Palliative care, to our surprise the relatives seemed to be - too keen and proactive for a transplant! Within 24 hours they had found a donor and was asking to be referred for further management. Such a response seemed too good to be true and so I called the younger brother over to talk. And the story came out.

The patient has been married for more than 30 to 40 years but had no children. 2 years back, with the aim of having a child he (? with consent of the first wife) took a second wife. This wife is only 14 years old! (One is never sure about age in these communities). And since she could not become pregnant – in a large hospital in the city they got her pregnant through injections – spending about 100,000/- Rs. (IVF probably.) And she bore him a girl child who is now 16 months old (Though the desire was for a male!).

Since the child is only 16 months old and the “Shame of not having a father” is not acceptable in their culture, they are willing to spend any amount of money to keep him alive! And his first wife is willing to donate her kidney for the same reason. The 2nd wife (14 year old young mother) is nowhere in the picture or discussions. Decisions are taken by the first wife and the husband’s brother. The patient has not been told about his illness and the first wife and brother in law is taking all efforts to see that he gets a transplant done, to save the honor of the family.

And here were we, referring a 65 year old man for a transplant without understanding the dynamics of the family, the reasons of their pro activity.

Are we right in referring such a patient, who will need to spend about 5 to 8 Lacs to get his kidney replaced, and will be impoverished for life after this "lifesaving treatment." Saving life at what cost? Even if he goes through a successful transplant – 65 years old with a recent CVA – how long a life will he have…? When do we say no? What about the future of the 14 year old second wife? Doctors role in thinking through these complex issues? What about the ethics of doing an IVF on a 14 year old…?Ethical practice? 

Questions which confuse us….this is the context of our Nation….How long will it take…for Kingdom to come….?

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