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Dialysis on Shabbos

Question:
Kvod haRav,
I have been dealing with a rare blood lymphoma since 2009. LCDD (light Chain Deposition Disease) affects kidneys, heart or lungs. In my case, my kidneys were effected. After testing At a moderately high level of 1530 light chains, my doctor eventually decided to give me “light chemo” for ten months. Light chains went down to 49. (Ratio to heavy chains was 1.5/1 or normal) Baruch HaShem, my oncologist says that, although my light chains have crept up a bit in the last four years, I was still considered to be “in remission.” Even though the ratio is now 9/1, as of March.
throughout this time my kidney function, measured primarily by GFR (glomerular Filtration Rate) and Creatine clearance (how much protein remains in the blood) was worsening. GFR went from 19% to 13%. Creatine clearance which should be under 2 went steadily from 2.9 to 5.1.
In May it jumped to 10.3 which was a sign of imminent kidney failure. Over yomtov I experienced the first noticeable symptoms (besides proteinuria and a few rare muscle cramps) that is, serious nausea, difficulty eating, etc
When I went to the hospital, my creatinine was15 and GFR was 3%.
I received an emergency catheter and have been on hemodialysis since then for 6 months.
For dialysis, I go to a dialysis center and (non jewish) technicians prepare all tubes, connects all dialysis tea and enters all information, the only issue of chillul Shabbos that I need to do is to go on an electronic scale to weigh myself after the treatment on Friday evening. The scale works on digital led display. Also it prints out the weight.
Now the dialysis nurse and doctor would like me to remove the catheter and install either a fistula (which joins a vein to an artery in my arm after which the vein “matures” in a month or 2, and then the fistula is used to dialyze my blood
Or they install a different catheter in my belly which allows home dialysis. In this process, called PD (peritoneal dialysis) the dialysate liquid is pumped into my belly and, after 4 to 6 hours, I would have to drain the dialysate by myself and reintroduce new dialysate into my belly again. (As the dialysate lays against the peritoneum, it does the dialysis by using the peritoneum to filter. Then draining gets the bad dialysate mixed with poisons out of the body)
The Huge Plus in this method is that I would be able to travel to be with my children and grandchildren, some of whom are in Eretz Yisroel. ( although it is difficult, it is still possible to arrange for dialysis with enough lead time and space, if and when available, to get dialysis in a different city in the U.S. because my medical insurance would cover. But it will not cover dialysis in Eretz Yisroel.
The PD can be done in 2 ways. One way is automatic, overnight, with an electric machine that must be pressed on and off at least once. The other way is doing it manually. It seems but I am not sure, that it would be possible to do the machine only on weekdays. But even if I do it manually on Shabbos, I need to perform many many things which seem problematic: 1) hands and pd catheter must be washed for 1 full minute with sterile pads which cannot be pre opened- before and after the procedure. 2) the bags must be punctured. 3) the connector must be removed after each flushing and replaced onto the PD catheter (seems like Tikkun maneh) 4) it must be done at least 3 times each and every day.
Although they say that when people are asked if they prefer PD to clinic, 80% prefer home PD dialysis, and that it is supposedly healthier to do it Every day (in Europe it is done more frequently even in clinics but American insurance will only pay for 3 days) halchically, it seems much more “invasive” to kedushas Shabbos than 3x weekly. I havecread that either way, in clinic or PD, it is approximately equal to a 10% GFR, even though they claim “daily is better.”
Is iq wise or permissible for me to get a PD catheter to allow my travel if it will cause me to involve myself in chill up Shabbos issues as mentioned? Would I need to find a no hew to help perform these connections and sterilizations?
Thank you.

Answer:

The procedures you describe, seem to involve only Rabbinic prohibitions at worst. Tearing open sterile pads, puncturing a bag which is only used once, removing/replacing a tube which is meant to come on and off, all may in fact be permissible. For activating a machine you should try to arrange for a non Jew, but if unavailable and necessary you would be permitted to activate the machine. Ultimately whatever necessary must be done due to the severity of this condition.

In the clinic you have to activate a scale, and I presume the entire Shabbos must be spent in the confines of the clinic or transportation must be provided by a non Jew. There is no clear advantage of one procedure as far as Shabbos is concerned. So then you and family need to decide which treatment suits you best and will be most comfortable and keep you in a good state of mind which is crucial.

Best Wishes for a Refuah Shleimah!

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