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Howard et al present valuable information in their rebuttal to my brief discussion of dialysis vs transplant as modes of treatment of endstage renal disease. They state several physiological disadvantages of dialysis but merely mention in passing that transplant patients trade restored "normal renal function" for "some degree of Cushing's syndrome." To some persons the change in body contour and facies is not acceptable. Frequently this fact as well as the expected physiologically traumatic and psychologically frightening episodes of rejection are often not dwelt on sufficiently by transplant teams for the patient to clearly understand the prolonged, eventually downhill course of treatment on which he is embarking. Most transplant patients carry false hopes with them largely out of their own need but partially because transplant teams do not persist with accurate, realistic descriptions of the course of the transplant when the patient does not wish to hear this.
Kemph JP. Dialysis vs Transplant-Reply. JAMA. 1978;239(9):830–831. doi:10.1001/jama.1978.03280360026005
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