Dear Editor:

I have read the articles "To Give or Not to Give" and "When Kidneys Go Bad" in your May edition and would like to offer my opinions on them from the standpoint of a medical specialist on kidneys.

First off, I would like to make one thing clear: Though hemodialysis and kidney transplants are both methods that uremia patients can take to extend their lives, up to the present there have been no studies attesting to their relative efficacy.

Because of advances in technique, chronic complications will appear now only 14 years after hemodialysis, and thus several years ago the University of Pittsburgh in the United States (the U.S. medical center that has performed the greatest number of transplant operations), turned from recommending that relatives of patients not donate kidneys to recommending that transplant procedures be taken after long-term chronic complications have appeared.

Currently more than 70 percent of long-term hemodialysis patients can all return to their jobs, making a contribution to society while enjoying the pleasures of family and life. Hence, hemodialysis patients are relatively active. Correspondingly, among kidney transplant patients, nearly 20 percent cannot go back to work (mostly stemming from insufficient pre-transplant psychological evaluation and guidance). In addition, after the procedure, the patients must use anti-rejection drugs for the rest of their lives. Even a common cold can put them in the hospital. If the procedure is taken without careful consideration, not only is it a waste of social resources, it can do irretrievable harm to the patients.

Promoting the donating of organs in the R.O.C. is worthy of our support, but establishing an excellent investigatory and supervisory system is also needed--so that once the number of donated organs has grown it does not result in excessive use of the transplant procedures. Currently there are more than 100 cases of kidney transplant each year in the R.O.C., with 15 hospitals handling the transplants. There ought to be a much stricter process under which hospitals can qualify for handling transplants. Not only would this make it easier for hospitals to cooperate by establishing data banks about receivers that would make cooperation easier and lead to increased survival rates; it would also add to the preoperation choices of kidney receivers and strengthen the clinical experience about transplant procedures and the use of anti-rejection drugs afterwards. Only if the medical establishment discards its prejudices and holds a strictly guarded attitude of professionalism can patients obtain truly top-quality medical care.

In a nutshell, hemodialysis not only extends the lives of uremia patients, but the vast majority of patients so treated can go back to their jobs as well, living active lives. While it's worth affirming efforts to promote the giving of organs, at the same time it is necessary to establish a complete supervisory system to bring about the best results.

Li Cheng-min

R.O.C. Kidney Fund Medical Consultant

R.O.C. Kidney Internist

Dear Editor:

The recent publication in your esteemed periodical of the story on overseas Chinese in Korea in April, "The Story of a Returned Child Emigrant" in May, and the letters to the editor in June have triggered many feelings in me.

The previous generation of overseas Chinese went abroad to struggle for a living because they had no choice, and in their hearts they hoped to return to their native land. They did not forget that they were Chinese. But now, many emigrants go just because the environment is better abroad than here. Given the difference in motives, is it any wonder that people have their doubts about the purpose of overseas Chinese in coming back?

Again in reference to the second generation overseas Chinese, it seems they are not as loving of their country as their predecessors. "China" is perhaps just an impression in their memories. It is of course fine that they fit in with the local people in their adopted lands, and are accepted by the local people, and in fact even better if they are completely assimilated. It doesn't matter where their roots are. But is it that Taiwan is just the place they take refuge when they are disappointed or rejected? I don't know.

We have no right to ask overseas Chinese to be from any particular country; that's their own free choice. But if overseas Chinese come back to Taiwan and have no sense of identification with Chinese culture or Chinese people, and yet want to be accepted by the people of Taiwan, that's not going to be very easy.

Hou Ching-yang

Taipei