Full Description
The last 20 years has seen an enormous increase in our knowledge about the management of patients with terminal renal failure. Despite this, even the most successful dialysis and transplant patients require long term specialist supervision so that renal units will have an incremental work load until the death rate of patients undergoing treatment equals the rate of intake of new patients. Furthermore, innumerable conditions which were once regarded as contraindications to therapy may no longer be seen in this light, so that the number of new patients coming forward for treatment each year is increasing rapidly. Dialysis and transplantation are expensive forms of treatment, in terms of staff, facilities and consumables, and it is therefore inevitable that there will be problems in providing treatment for all who need it. These will be particularly acute in times of economic crisis. This book contains the proceedings of a conference which was set up to explore the difference between the supply and the demand for treatment in the United Kingdom, to compare the situation with that in other countries, to explore possible solutions and possibly assign responsibility for the shortfall and to examine the practical and moral implications of our failure to treat the treatable.
Contents
Session One A Fact Base: Current Requirements in the United Kingdom.- 1 Five years since Stirling — a progress review.- 2 Comparison of facilities in the United Kingdom and in Europe for dialysis and transplantation.- 3 The costs of treating chronic renal failure.- 4 Chronic renal failure in the United Kingdom: referral, funding and staffing.- 5 The selection and de-selection of patients for dialysis and transplantation.- Discussion.- Session Two An International Perspective.- 6 Should we let them die?.- 7 Dialysis and transplantation in the United States and the impact of continuous ambulatory peritoneal dialysis.- 8 Treating end-stage renal failure in Italy.- 9 Politics, morality and economics — are there choices?.- Discussion.- Session Three The State of the Art in the United Kingdom.- 10 The current United Kingdom transplant situation.- 11 Haemodialysis: the current situation in the United Kingdom.- 12 Continuous ambulatory peritoneal dialysis (CAPD) — current state in the United Kingdom.- 13 Future developments in renal transplantation.- 14 The application of computers to haemodialysis.- 15 The morphology of the peritoneum with special reference to peritoneal dialysis.- Discussion.- Session Four Psychological, Social and Ethical Aspects.- 16 Social and psychological issues of end-stage renal failure.- 17 Stress amongst staff in the renal unit.- 18 The patient's viewpoint.- 19 The ethics of tension.- Discussion.
