Poor guidelines, long waiting lists slow transplants

At least 200 patients are on Kenyatta National Hospital’s kidney transplant waiting list, and the number is growing.

And, with an estimated four million (10 per cent of the population) Kenyans projected to develop some form of kidney disease in their lifetime, experts are calling on the government to increase the capacity of the country’s referral hospitals.

The congestion at KNH, they say, is piling pressure on the number of organ transplants the hospital can perform, resulting to the long waiting list that goes all the way to 2018.

This, they say, is what is pushing almost 100 patients to India annually. Topping this up is lack of awareness about the available local capacity.

Often, patients with chronic kidney illnesses are put on dialysis at least twice a week, at a cost of Sh2,500 per session, which is catered for by the National Hospital Insurance Fund (private insurance coversdo not cover dialysis).

But even this is not a permanent solution. “Before, many lacked access to machines because the only available ones were at KNH. If we currently have 3,600 patients on dialysis yet we say that about 6,000 will need dialysis, then the number of those accessing treatment is still not enough,” explains Dr Ahmed Twahir, a kidney specialist.

While kidney transplantation is the only solution for patients with end-stage (chronic) kidney failure, specialists say that lack of proper laws hinders the practice of advanced options of organ donation.

The prohibitive cost of medical care, the problem of finding a suitable donor, the lack of capacity among medical institutions, and policy-related issues are some of the challenges that patients with organ failure face while seeking treatment, therefore resorting to dialysis.

VOLUNTARY DONATION

A dialysis machine mixes and monitors the dialysate, a fluid that helps to remove unwanted waste products from the blood. It also helps to get an individual’s electrolytes and minerals to their proper level.

Dr John Ngigi, who heads KNH’s renal unit, says health workers insist on donors being immediate family relatives because the likelihood of finding a match is higher.

“The further you move away from the bloodline, the less likely you are to find a donor; but some patients are unable to get organs from their relatives due to medical reasons such as a history of diabetes or non-matching blood groups,” he says.

Under special circumstances, an exception is made on the donor, such as for married couples, as long as there is proof that they are legally married, or when tissues from close relatives do not match those of recipients.

But even before one is certified as a suitable donor, Dr Ngigi says, rigorous background checks that sometimes run up to three months must be conducted.

“These ensure that the donor is giving the organ voluntarily without any expectations of favours from the recipient. We need to ascertain that it is purely out of altruism.”

However, even though the background checks help to prevent illegal practices, including organ harvesting and trade, some potential donors give up along the way because the process is tedious.

Sometimes they are expected to seek approval from authorities such as chiefs, police officers and the Ministry of Health.

If successful, kidney transplantation improves the patient’s rate of survival and quality of life, and saves a substantial amount in costs compared with dialysis.

In high-income countries, for example, the current annual cost of maintaining a functioning transplant is approximately one-third to one-quarter that of dialysis, according to the World Health Organisation.

In low- to middle-income countries, transplantation is rare due to lack of infrastructure. Many patients rely on dialysis to survive.

“There is no law that clearly guides the transplant specialisation. But we have to carry out these procedures to save lives. That said, we need the legislation to be covered in the constitution so that we can even have deceased organ donors,” says Dr Twahir.

LAST WILL

Organ transplants have been hailed as an effective therapy for end-stage organ failure, and are widely carried out around the world.

Dr Ngigi says the existing Human Tissue Act, under which the surgeries take place, does not clearly state how the practice should be conducted.

“The law is silent on many things, such as how to treat the body organs of a person upon their death,” he says.

If assented to, the Health Bill, 2014 will allow a person who is competent to make a Will to donate his or her body or any specified tissue to a person or institution of his or her choice after death.

“Such consent can also be given by a spouse, parent, guardian or older brother or sister in the event the person dies without leaving a will,” the Bill states.

In the event that the relatives of a deceased person cannot be traced and no Will is left behind, the Bill gives powers to the Health Cabinet Secretary to donate the body or its parts.

Shortage of organs is a universal problem and living donors should be genetically, legally or emotionally related to their recipients, the WHO states.

It notes further that “no cells, tissues or organs should be removed from the body of a living minor for the purpose of transplants other than narrow exceptions allowed under national law”.