Last week the veterinary profession’s governing body the Royal College of Veterinary Surgeons (RCVS) gave the go ahead to allow vets in this country to perform kidney transplants in cats. However, don’t go running down to your local practice asking for the operation next time your Tiddles develops a kidney problem. There are an awful lot of restrictions as to who can do the procedure but probably it is the ethics that surround the whole idea that gives the most pause for thought.
Unlike humans, cats can’t tell us that they would like to donate a kidney to their best friend and are happy to go through the major operation and prolonged aftercare associated with the procedure. Nor is it feasible to have transplant teams on standby ready to harvest kidneys from animals killed in road traffic accidents – unfortunately many cats die very quickly after being hit by a car, or even if they survive until they reach the vets, the vast majority of practices don’t have the ventilators and monitoring equipment to keep brain-dead animals alive.
Obviously there are many stray cats in rescue centres around the country, who could provide a source of kidneys. In the USA there are schemes where owners of cats undergoing transplants will adopt a rescued donor cat and look after it for the rest of its life. The problem is that many potential donor cats may have to be tested before a tissue match is found, putting a lot of cats through unnecessary tests. In addition, as kidney disease is very common in older cats, there is a reasonable chance that the donor cat may die prematurely as it struggles to cope with one kidney – it seems to me that we are putting one cat’s life over another without their consent. In fact the RSPCA feels that removing any major organ from a living animal, where there is no benefit to the animal, probably constitutes an offence under the Protection of Animals Act 1911, so they may prosecute anyone performing such an operation.
The next question is who will do the procedure. In order to safeguard the well being of the donor and recipient cat, the RCVS has advised that the transplant team should have Diploma Status (the top UK qualification) in medicine, soft tissue surgery, anaesthesia and microvasular surgery. One of the team must also have had first hand experience of the procedure at another centre over a long period of time. This means that only a couple of referral centres would be suitable at present. There would be a lot of aftercare for the cats so the owners own veterinary practice would have to be able to cope with this side of the treatment.
Another point to consider is which kidney patients would be suitable for the procedure. The majority of cats that develop kidney failure do so in their old age. Personally, I would find it debatable as to whether it is fair to put an old cat through such a massive procedure, even if the rest of its body could cope with the stress. Some cats suffer with congenital kidney conditions and develop problems at any age from 6 months to 8 years old. Polycystic Kidney Disease of Persians is probably the commonest of these, and potentially a transplant could allow them to live an extra ten years or so. However, to stop the body rejecting the new kidney, they would require immunosuppressive treatment for the rest of their lives, which in itself can cause serious side effects, or at least mean regular monitoring blood tests – quite a commitment both for cat and owner.
The final question is the cost of the procedure. As none have been carried
out in this country yet, it is very difficult to give an accurate idea
of the fees. However, with all the tissue matching, the actual operations
and the follow up care, you might not get much change out of £ 6
– 7,000. Insurance may help, although no insurance companies have
mentioned whether they would be prepared to cover this sort of treatment.
Kidney transplants have been available in the USA for around 20 years
now, and only 250 have so far been carried out successfully. The threat
of prosecution from the RSPCA and the lack of vets with experience in
this field, means it may be sometimes before we see our first transplant
in this country, and even then I wouldn’t expect the flood gates
to open – I think the British love of ALL animals will make us think
twice about depriving a cat of a kidney.