Living with a Spinal Injury
When someone comes to us with compromised kidney function, one of the first things we will look at is whether dialysis will be required and, if so, when and for how long. We will also look at what form the dialysis will take and where, and what impact this will have on daily life. There are different regimes for dialysis whether it be daily, several times a week or overnight and there is some patient choice in this. In some circumstances, home dialysis is an option and for this it is important to take account of any additional space requirements needed and whether a house move or adaption is required. Crucially, the right sort of support needs to be in place to ensure both patient safety and, as far as possible, minimum disruption bearing in mind the particular circumstances and wishes of the individual.
As well as the physical impact of long term dialysis, there may also be a psychological toll, and it is important to make sure that this is addressed too and appropriate support given.
Patients will, of course, look to move on from dialysis and the key to this, where the injury is permanent, is transplantation. Whilst kidney transplantation can be done privately, NHS Services are still often preferred not least because of the infrastructure and expertise which surround NHS kidney transplant units. Many will look to close relatives to find a match; and some will strike lucky. Others join the waiting list for a deceased kidney donor. It is hoped that the recent changes to deceased donation, whereby there is now a presumption in favour of donation, will result in greater availability of donor kidneys. There are also living kidney sharing schemes which match living donor/recipient in pairs who are willing but incompatible with other, compatible transplant pairs.
With all transplantation comes the question of graft life expectancy – how long will the new kidney last? There will be many variables to this, but prognosis going forward will still need to be looked at in the context of a claim. So too will the question of overall life expectancy and what the options will be should the graft be expected to fail during the recipient’s lifetime. Where, sadly, a second graft is not likely then it is important to include a regime for appropriately supported dialysis, potentially at home, as well as end of life care.
All graft recipients will require immune-suppressant medication for life and this brings with it increased risk of a number of medical conditions. For this reason it is not unusual for kidney claims to be dealt with on a provisional basis.
Kidney transplant patients will need to be followed up for life, and some will opt for private outpatient care to be able to access the physician of their choosing at the time of their choosing.
In terms of the bigger picture, it is also important to consider the effect of kidney injury on employment and family life. For some, work will be relatively unaffected, but for others there will be a significant negative effect; whether a period of time out of work with loss of earnings and career advancement, or a change of direction altogether. There is also the impact on work with the time consuming nature of dialysis and the lack of stamina which this may bring.
In relation to family planning, there can be an issue for women in particular where a kidney injury has resulted in delay in starting a family. For some, IVF treatment may need to be considered. Family planning at the right time for those who wish to have children can be particularly important.
There are many aspects to a kidney injury and whilst some are generic it is also important to consider the circumstances of the individual in terms of both what the future holds and what can be done to mitigate the effects of their injury and to improve the quality of life.
For further information on the issues raised in this blog, please contact a member of our Clinical Negligence and Personal Injury Team.
Bridget Hughes is a Senior Associate Solicitor in the Clinical Negligence and Personal Injury Team at Kingsley Napley LLP. If you have been affected by any of the issues discussed in this blog you can contact her on 020 7814 1214 or at firstname.lastname@example.org
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