Deceased Owner Kidney Transplant:

Gift of life for the dying

by Carol Aloysius

Last year the Traffic Police unveiled some startling facts: Deaths from road accidents across the island recorded a chilling 2,400. That is not all. Traffic sources estimate the death rates could go up to 2,800 or more, taking into consideration the increasing number of vehicles that are crowding the roads day by day. They say 60 percent of the victims of these accidents usually die on the spot, their bodies smashed beyond repair.

So where do the rest end up? "At Intensive Care Units in various State hospitals, where they are more often 'Brain Dead," say hospital sources.

"If we can get the relatives of these persons to consent to donate the organs of these brain dead persons, we can save the lives of hundreds of patients whose lives are running out as they wait in long queues lists for a kidney transplant," says Consultant Nephrologists, Kandy General Hospital, Dr Anura Abeysinghe, who is also the Project Co-ordinator of an innovative pilot project aimed at doing just that.

"At present there is a huge waiting list for kidney transplants from patients whose lives depend on getting a new kidney. Since kidney donations are not allowed except from a living close relative (to prevent illegal trafficking of kidneys), their chances of obtaining a matching kidney from a close relative is usually remote. Their only hope for living is the frequent dialysis they undergo," he points out.

Project 'Deceased Owner Kidney Transplant', recently launched on the instructions of the Health Ministry at the Kandy General Hospital, however will change this negative scenario, he believes.

Not all 'brain dead 'persons brought into the hospital however are victims of road accidents.

Explaining the kind of 'brain dead' persons who are usually rushed to the ICU, he says, "We have categorised them in the following manner: those who have met with road accidents; those who have attempted suicide; and those who have had spontaneous bleeding into the brain due to hypertension and malfunction of the brain. All of them are kept in the ICU, where the rest of their organs are kept alive and working on ventilators. These machine driven organs will stay alive for a short period of 3-4 days, until they are taken off the machine. This tiny period of time between the diagnosis of 'brain dead' and the total cessation of all organs , offers a tiny window of opportunity for the relatives of the brain dead person to agree to give their consent for us to retrieve his/her kidney and transplant it to save the life of a person in need of a healthy kidney.." .

Since most people have two kidneys, retrieving two kidneys from one 'brain dead' person can save two lives since you can live with one kidney, he adds.

Experience

Kidney Transplant using donors from brain dead is by no means a new procedure. In the US, UK, and other western countries, it is now an accepted practice where living donors have their consent stamped on their driving licences, passports and other identification forms,.

In the event of an accident, authorities in any hospital to where they are taken to are expected to respect the wishes of the donees if they are brought in 'brain dead'. In some hospitals abroad, even helicopters and ambulances are lined up to transport a newly retrieved kidney to a patient in a hospital in some other state, with trained health workers accompanying the carefully packed kidney to its final destination.

Health staff in these hospitals are also given extra training to deal with such patients.

For the skilled operating surgeons at the Kandy General Hospital too this is not the first time they have carried out this relatively new procedure. As Dr Abeysinghe points out, "Our initial two Deceased Donor transplants were performed in 2004. Since then we have notched up 70 such surgeries. What's more, all of the patients are still alive."

The hospital has in addition also performed Living donor Transplants on 900 patients.

"What our Project has in mind is to streamline these operations and increase the number of surgeries we can do every year. At present we have been able to do less than ten per year. But under the new project, we can do four transplants every month."

Selection

So how are donees selected? On a first come first serve basis? Do they need to have certain requirements to qualify for a kidney transplant?

"The answer is 'Yes'.

"The recipients are all patients who have been registered at this hospital. They are also all on haemodialysis. We have made separate lists for them according to blood groups. They are then entered into a scoring system according to their age and duration of dialysis, and then grouped before they get selected."

So who selects them eventually?

"Selection is under our automated system. It is the system that selects the recipients. So no one can accuse us of being prejudiced or having any bias. You need to be on the Living Donor waiting list for about three months to be eligible."

And the Deceased Donor list?

"We have just started this project. So we will have to wait and see the response. The main thing is the public response.

We need to raise a lot of awareness and educate the public about this as it is still a very new concept. If we get a good response, and the project is a success, we will be able to save a huge amount of expenses for the state in terms of treating kidney ailments including dialysis, as well as minimizing the hardships faced by those patients waiting for a kidney transplant.

If will also help to reduce the economic woes of people who have to spend a lot of money transporting their relatives for dialysis from remote areas, to a dialysis centre," says Dr Abeysinghe.

For those who wish to donate their kidneys for this worthy cause under this Project, further information can be obtained by contacting the following numbers:

0773649405/0776662966/ 0716158986