The Battered Child

The Battered Child

It was another busy day at the clinic. One of the patients being seen is an HIV patient in his late twenties. I had first seen him several years ago. At that time he was not doing well. He was first diagnosed with HIV at age 17, but because of multiple reasons, did not start treatment.


Five years later he was admitted to the local hospital. The HIV had destroyed his kidneys and he was put on dialysis. His immune system was destroyed to the point that he had no detectable T cells (normal is greater than 1,000).


I did an HIV resistance test on him and with the help of our HIV pharmacist, came up with a regimen of medications that was not only effective, but was also dosed appropriately for his renal failure.


He made steady progress, and within a few months his T cells had recovered to well above the 200 AIDS threshold. During this time, he continued on dialysis and was generally doing quite well. 


A few months ago he told me that he was on the waiting list for a renal transplant. I subsequently got a call from a doctor at our nearby teaching hospital, that he had received his kidney transplant. 


His entire regimen had to be changed as he was on anti rejection medications which interact with a lot of HIV medications. The dosages also needed to be adjusted as his new kidneys started functioning. Of course we would also have to keep in mind his original resistance test.


He did very well. His new kidneys started working and his new HIV regimen kept his virus undetectable and also his T cells remained good, despite the anti rejection drugs that can reduce the T cell counts. He is now in college and working part time as well.


At his appointment, I asked him if he knew where his kidneys came from.  ‘It was a baby’ he said. I was taken aback!


It was a battered baby he explained further. Her parents had battered her so badly as to cause brain death. Her grandparents had then made the painful decision to donate her organs. 


Her kidneys came to my patient. Her heart went to someone else as did her corneas and so on. Because she was an 18 month old baby, it took some time for those kidneys to grow in my patient until they became fully functional.


As this information sunk in, I asked my patient how he felt about this. He said when he first found out about the baby, he cried. He has talked to the grandparents via teleconference arranged by the hospital, and he told me that they are happy to see him doing well.


After the visit, I felt incredibly sad that this child’s life was ended so soon, in such a sad way, and yet feel a sense of gratitude to her for making such a difference to so many people.

Kidney ready for transplant