In March 2007 Mark Tarica was given between a year and 18-months before he would face complete renal failure. The doctor was right. Within a year, his kidneys had failed and only the generosity of his best friend gave him a second chance at life.

Just over a month after his operation, he's still confined to house rest, but when I arrive at his Milnerton home, he's relaxing next to the pool, wrapping up a casual business meeting.

As we begin to chat I get the impression of an easy-going, enthusiastic man whose passion for life, work, friends and now the cause of kidney transplantation is not easily dampened. Being positive, Mark insists, is imperative if you hope to get through kidney failure and transplantation.

He suffers from a hereditary disease known as Polycystic Kidney Disease (PKD). The disease is characterised by the growth of numerous fluid-filled cysts in the kidneys. These cysts can fill up the kidneys, reducing their function and leading to kidney failure. Because the cysts are not necessarily painful, they are often only discovered when the symptoms of kidney malfunctioning become apparent.

Mark went to the doctor in 2007 when he noticed that he was always tired and felt as if he had a constant hangover. By the time he had his operation a year later, he was almost completely debilitated, suffering from deteriorated eyesight, hearing problems, an inability to focus, weakened muscles and uncomfortable fluid retention.

Some kidney basics

The kidneys act as a cleansing system for your blood by filtering it and getting rid of all the toxins. They also control blood pressure, the production of red blood cells, the concentration of electrolytes (such as potassium and sodium) and the retention of fluid.

Obviously, if your kidneys are not functioning properly, all these functions will be thrown out of whack, and there will be a build-up of toxins in your blood. Your body's metabolism also generates waste products which are cleared out by your kidneys. To measure kidney failure, you can test for the build up of these waste products — blood urea nitrogen (BUN) and creatinine — in your blood.

Mark's creatinine count is currently sitting around 100. Prior to his operation it was over 500 — a state he describes as a creatinine fog.

The difficulties of dialysis

Once your kidneys fail you have a choice between dialysis and transplantation. There are two forms of dialysis — haemodialysis and peritoneal dialysis.

In the former, your blood is purified by being circulated through an external filtering apparatus. In the latter, your abdominal cavity is flushed with a dilute salt solution.

"Dialysis centres are the most depressing places to go to," says Mark. "And when you are on dialysis you have to go for a few hours every two days."

You also have to limit your fluid intake and follow a very strict potassium and sodium free diet. And this is if you can afford it. Mark's medical aid covered the R1000/session cost, but not everyone has the luxury of medical aid.

But, Mark emphasises, you can still live a very full and functional life on dialysis.

The ultimate gift

Things become a little more complicated if you decide that you want to get a new kidney.

"It is generally accepted that live donors are better than cadaver donors in terms of the outcome of the kidney transplant," says Alexia Michaelides, the transplant co-ordinator at Chris Barnard Memorial Hospital. "But this is not written in stone. There is also no guarantee that a live donor kidney will not reject."

It is not a simple matter of signing up on a kidney list either. Over and above the availability of suitable kidneys, the patient also has to meet certain criteria.

"The patient has to meet certain criteria, both medically and from a psycho-social aspect. Age also plays a role, as does lifestyle, but this would depend on the individual as well. However, current medical condition and co-morbidities play a greater role."

When he was told he needed to find a new kidney in October 2007, Mark had nine volunteers within a week. His two sons were immediately discounted as they too are carriers of PKD, but his best friend Alan Meyers was a match.

"He is a real South African hero," says Mark. "He is so generous. And he didn't want any kind of compensation."

The decision to part with one of your kidneys can't be an easy one and Michaelides emphasises that donating a kidney should seen as the 'ultimate gift' and not a sacrifice.

"Often I feel that we don't make as big a fuss of our donors as we should… Some want no fuss at all, some see it as something that 'anyone would do' and some enjoy the extra attention. The bottom line is that not everyone would do it, and those that do deserve every attention and praise."

Getting past the red tape

Compensation is a serious issue when it comes to organ donation. According to South African laws, 'organ trading' (receiving any kind of compensation for organs) is regarded as illegal and unethical.

In an attempt to prevent organ trading in South Africa, the government has laid down certain stipulations around live organ donations.

According to Dr Derek Miller, a nephrologist at Constantiaberg Medi-Clinic, these stipulations vary depending on whether or not the donor is a family member.

In the case of the donor being a close blood relative (parent, child or sibling), the unit doing the transplant is able to proceed without any intervention from the Department of Health.

If however, the donor is not a close blood relative, a dossier needs to be prepared and submitted to the Department of Health in Pretoria for authorisation.

There is a two-person Ministerial Advisory Committee which assesses the information and makes recommendations regarding the clinical and ethical appropriateness of the transplant. Once they are happy, the unit may proceed with the transplant. This process usually takes between two and three months to complete.

"Kidney failure patients become very agitated and concerned when there is a delay in the process for various reasons," says Miller.

"In general we would not submit a dossier to the Department of Health until we were happy that it fulfils all their requirements but occasionally they request more information and this can delay the process.

"There are numerous concerns regarding the makeup of the ministerial advisory committee and the way that the system is currently set up and functions, which the Transplantation Society of South Africa is attempting to address."

Mark, for one, is very frustrated with the system. Not only did he have to wait months to get approval for his operation, he had to wait until the very day of his operation.

"I was booked to go for the operation at 4pm on Monday 6 March," says Mark. "But the fax of approval from the minister of health only came through at 11am that morning."

His operation had already been postponed five times.

The fact that you are not allowed to buy organs does not mean that organ transplantation is not expensive. While Mark’s medical aid (the best package on offer) paid for the actual transplantation it did not cover the costs of the donor operation and the pre-operation blood tests and bills (R60 000).

Luckily Mark could afford the costs, but for someone without his income, the chance at a new life would simply have been unaffordable.

"I now have a 50-year plan," jokes Mark. "I intend to live to over 100 — I've discovered the world of body parts."

Mark Tarica is writing a layman's guide to kidney failure in which he hopes to share his experiences and help others in a similar situation. He also plans to set up a hotline for patients and the families of patients who are struggling to cope. If you would like to talk to Mark about kidney transplantation you can contact him at mark@maestrosgroup.co.za or on +27 82 573 4455.