Survivability in Kidney Transfer as Becoming: Embodiment, Materiality, and Time in Kidney Failure and Transplant

Abstract

This paper explores embodied experiences of survivability in kidney transfer. By drawing on interviews with, and photography produced by, people on dialysis or with a kidney transplant, this paper counters biomedical approaches to survival by examining the fluid, dynamic, and shifting relations and affects of living on and with kidney transfer. Through an engagement with vitalist thinking, it is argued that kidney transfer is an ongoing process of becoming. In doing so, three characteristics of becoming in kidney transfer are identified: first, becoming in kidney transfer is characterized by material embodied experiences, which occur across and between the intersecting registers of the bodily interior, exterior, and body-in-space; second, experiences of survivability in kidney transfer are shaped through highly relational and dynamic engagements with other people, the more-than-human, and place; and third, becoming in kidney transfer involves developing new relationships to time and temporality.

本文探讨了移植肾存活性的具体经历。基于对透析患者或肾移植患者的采访和摄影，本文研究了透析和肾移植患者的流动性、动态性和变化的关系及其影响，反驳了生物医学对生存的研究方法。结合活力主义者的思维，本文认为，肾移植是一个持续的“形成“过程。为此，本文探讨了肾移植的三种“形成“。第一，肾转移的形成是以物质体验为特征的，这些体验发生在身体内部、外部和空间的各个部位及其相互作用第二，肾移植的存活性经历，受制于高度关联和互动的人、超人类、位置第三，肾移植的形成，需要建立与时间和时间性的新关系。

Este trabajo explora las experiencias de sobrevivencia que se viven en la transferencia de riñón. Apoyándose en entrevistas y fotografías captadas por gente sometida a diálisis o que han tenido un trasplante de riñón, este escrito va contra los enfoques biomédicos de supervivencia examinando las relaciones y afectos fluidos, dinámicos y cambiantes de quienes siguen vivos gracias a un riñón trasplantado. A través de un debate con el modo de pensar vitalista, se arguye que el trasplante de riñón es un proceso en desarrollo que apunta a una transformación. Al plantear eso, se identifican tres características del cambio durante el proceso de trasplante de riñón: primero, el transformarse en el trasplante de riñón se caracteriza por experiencias materiales personalizadas, que ocurren a través y entre los registros entrecruzados del interior corpóreo, el exterior y el cuerpo en el espacio; segundo, las experiencias de supervivencia con el trasplante de riñón se configuran a través de compromisos altamente relacionales y dinámicos con otra gente, con lo más-que-humano, y con el lugar; y tercero, el volver a ser con el trasplante de riñón implica el desarrollo de nuevas relaciones con el tiempo y con la temporalidad.

Key Words:

• becoming
• dialysis
• health geography
• kidney transplant
• survivability

Key Words:

• 形成，透析，健康地理，肾移植，存活性

Key Words:

• diálisis
• geografía de la salud
• trasplante de riñón
• supervivencia
• transformación

Acknowledgments

Thank you to the participants who took part in this research and to the charities and organizations that assisted in participant recruitment. I would also like to thank Clare Madge, Gavin Brown and Jen Dickinson for their insightful feedback on earlier drafts of this paper and the two anonymous reviewers for their helpful comments and suggestions.

Notes

1. Chronic kidney disease (CKD) is a general term that refers to kidneys that gradually lose function over time and become less effective at filtering waste products from blood (NHS Kidney Care 2012).

2. Dialysis is a process that duplicates some of the functions of the kidney through blood filtering (removing waste products and excess fluids) (NHS 2015).

3. For example, between 2017-2018 the rate of graft survival in the UK for kidney transplants from deceased donors was 86% 5 years post-transplantation (NHSBT 2018).

4. The term minded-body acknowledges the interconnections between thinking and being and works toward overcoming socio-material dualisms (Hayes‐Conroy and Martin 2010).

5. During hemodialysis, blood is removed from the body and passes through a hemodialysis machine, which filters the blood and returns it to the body. Hemodialysis is usually carried out 3 days a week, each session lasting approximately 4 hours and can be performed at home or in a dialysis clinic.

6. Peritoneal dialysis uses the inside lining of the abdomen (the peritoneum) as the filter for dialysis, rather than a machine. The peritoneum has thousands of small blood vessels, which make it a useful filtering device (NHS 2018). During peritoneal dialysis, fluid is pumped into the peritoneal cavity through the catheter. As blood moves through the blood vessels lining the peritoneal cavity, waste products and excess fluid are drawn out of the blood and into the dialysis fluid (NHS 2018). Peritoneal dialysis can be carried out manually through continuous ambulatory peritoneal dialysis (CAPD) or by a machine in automated peritoneal dialysis (APD), both of which are carried out daily.

7. A fistula is created by connecting an artery to a vein, making the blood vessel larger and stronger, ensuring the efficient transfer of blood between the dialysis machine and the body. A fistula may appear as a “bulge” or “lump” in the arm, which usually becomes larger as it is used more over time. During hemodialysis two needles are placed on the fistula, which are then attached to tubes connected to the dialysis machine. Blood flows out of the fistula through one needle, into the machine and then back to the fistula through the other tube and needle. Most participants interviewed in this research that chose hemodialysis as a treatment used a fistula to dialyze.

Additional information

Funding

This work was supported by a University of Leicester PhD studentship.

Notes on contributors

Hannah Smith

HANNAH SMITH is a postdoctoral researcher at the School of Geography, Geology and the Environment, Keele University, Newcastle, ST5 5BG, UK (she was previously a doctoral researcher at the University of Leicester, where the research for this article was conducted). E-mail: [email protected]. Her research is situated within health geography, and research interests include the geographies of survivability in kidney transfer and nicotine and tobacco product use.