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by Abigail Van Buren

Youngster's Kidney Disease Is Topic for Open Discussion

DEAR ABBY: I have two sons, 19 and 12. My younger boy has a rare form of kidney disease. His kidney function is currently normal, but his doctor says that in the future he may need a new kidney. At that point, his brother would be high on the list for compatibility and availability. I, sadly, would not.

How does one mention the possibility of being a donor to his older brother? Is it even fair to ask? If he doesn't offer, would I always resent it? Should we wait until there is a real need before asking? -- PLANNING AHEAD IN CALIFORNIA

DEAR PLANNING AHEAD: All families are different, and it's a credit to yours that you're thinking ahead regarding some of the difficult aspects related to donation. This subject can sometimes be fraught with the potential for perceived coercion. It can be offset by not framing it as a "request" from one family member, but as a general family discussion about the loved one's health situation.

Among the issues that should be raised: What does it mean for your younger son to have this rare kidney disease? What's the survival rate for an adolescent who receives a living donor transplant? What is involved in the donation process?

These questions should be raised as a family in conversation with a physician or other members of the kidney care team. Family members can then talk about how they feel about the issue, not as a response to a direct question. This provides a chance for better education about the condition as well as the process, and reduces fear.

The decision to be a living donor is a voluntary one and should be entered into free of pressure. Some people may not want to take the risk -- and their rights should be respected. The evaluation process is very thorough. It's designed to minimize risk and also can uncover unexpected conditions in the potential donor that are important.

The National Kidney Foundation provides information on its website regarding this subject. Visit kidney.org to learn more.