Dying for organs: A case for transplants

If Dr Anthony Were had a kidney bank, he could save patients who seek dialysis services at Kenyatta National Hospital a lot of money and pain.

Dr Were, the facility’s renal unit head, says one source of organs could be Kenyans who consent to donate their kidneys, and other organs, when they die — a donation termed cadaveric. But it is forbidden by Kenyan law.

He told the Sunday Nation: “There are athletic people who do not suffer from major infections. When they die, they are buried with healthy lungs, liver, kidneys, bones, eyes and intestines which could save many lives.”

Currently, only blood relatives and spouses can donate organs to patients.

The shortage of body organs remains a global challenge, one that could be solved through, among other ways, encouraging healthy people to pledge to donate their organs when they die.

While doctors and the society appreciate the challenges and associated benefits of organ transplant, legal and cultural impediments stand in the way of allowing Kenyans to give away their organs when they die.

Lion’s SightFirst Eye Hospital’s website says there are 50,000 Kenyans suffering from corneal blindness whose sight could be saved through transplantation.

To this figure reported in 2011, add about 5,000 cases every year.

UNWILLING TO DONATE

Even were the law to allow such donations, most Kenyans are unwilling to donate their organs.

Professor Omar Egesa, a medical anthropologist and lecturer at Moi University, says: “Cultural background and beliefs still hold the dead in respect, and they would want the deceased buried whole.”

Prof Egesa adds that “deceased organ donation” — as it is termed by the World Health Organisation — is a fairly strange Western practice.

Many Kenyans will react to it with opposition, as they would to any idea they had only cursory knowledge of.

It is the same reason very few people write wills to divide their estate and to specify whether they prefer burial or cremation.

When asked whether he would donate his organs to save another person’s life, Malcolm, a private gym instructor, said: “No. I know someone may need my lungs, but I don’t want to hang death over my head. I want to be buried whole”.

Like Malcom, business woman Terry Mwangi says she would not donate her organs. “That is witchcraft,” she told the Sunday Nation.

On the legal reasons for donating organs, Professor Kiama Wangai, a doctor-lawyer, says there is the Anatomy Act of 1967 which allows donation of bodies to medical training institutions for purposes of research.

Should the legislative hurdle be jumped, Prof Wangai sees another challenge: “We are at a level of development with cultural and historical issues that have not created room for that, no matter how practical it looks medically”.

Deceased organ donation would have salvaged the situation in many developing countries such as Kenya where from 2009 to April 2013, road accidents alone have claimed 14,600 lives.

Cruel as it may sound, these fatalities, and the others that occur in bathrooms and on building sites, are potential donors.

Studies have shown that Africans are three to four times more likely to develop organ malfunction, such as kidney illness.

Also, data from WHO lists sub-Saharan Africa as the largest contributor to the disease burden in the developing world that accounts for 80 per cent of the global disease burden.

WHO reported that one per cent of deaths in 2012 (there were 187,811 deaths that year, as recorded in the department of civil registration) were due to diabetes.

The figure could be underestimated, owing to poor data capture techniques in Kenya’s healthcare system.

Some of these problems could have been solved with kidney transplants. Besides saving lives, deceased donors would unburden live donors of inherent dangers associated with surgery, such as 29-year-old Rehema Kanini who died in Apollo Hospital in India in August 2014 after donating a kidney to her ailing uncle.

A post mortem on Kanini showed a blood clot had blocked her main artery to the kidney and suffocated other main organs such as the brain, heart and lungs.

Dr Were lists the costs incurred by patients who have not found a donor and rely on weekly dialysis to survive.

“Dialysis at Kenyatta costs Sh5,000, and may be conducted twice a week. After that, there are drugs to be bought to control the patient’s blood pressure, anaemia and other side-effects of dialysis.”

The costs in private hospitals are higher.

“A transplant costs about Sh300,000. The patient heals in about a month,” says Dr Were.

Dr Were says he has met Kenyans who are willing to donate their organs upon death, but they are unaware of how to go about it.