Nigerian hospitals explore deceased-donor kidney transplant

…As cases rise amid low living donation

With kidney failure on the rise in Nigeria, hospitals are exploring the deceased-donor transplant option as organ donation, which is often transactional, from living donors remains low.

They are pushing for a highly regulated cadaveric system to take root as the primary source of kidney transplantation, a process where people can offer their organs for the use of others after they have been certified dead.

Health facilities with the capacity for renal care are recording increases in late presentation of cases which may lead to permanent placement on dialysis treatment or transplantation.

BusinessDay’s findings show that a new dialysis unit, which opened only a few months ago at the Lagos State University Teaching Hospital (LASUTH), is currently oversubscribed due to a plethora of kidney problems.

At the Federal Medical Centre, Ebute-Meta, cases seeking dialysis daily are on the rise, especially among young people and those challenged by long-standing cases of hypertension, diabetes, or inflammation of the kidney.

Almost two in every 10 Nigerian adults suffer either chronic or acute kidney failure, according to the Nigerian Association of Nephrology (NAN).

Dialysis has remained the most common and accessible form of treatment in the country, even though many do not make it through either as a result of financial constraints or deterioration of their condition. Only a few well-heeled patients are able to get kidney donation in a process that some experts worry could have been induced by financial rewards.

Experts say there is a wave of cadaveric organ donation being explored across the world, and Nigeria can benefit from it.

Adetokunbo Fabamwo, LASUTH’s chief medical director, said in an interview that while the laws that guide the process are currently being pushed at the Lagos State House of Assembly for ratification, the hospital is also building structures to begin trials.

“We have already designed how we are going to do it. We are going to keep a register of people that need kidneys and another register of those that want to donate. We will set up a unit that is going to manage it. We can do it,” the director said.

“The challenge about transplant is the donor. A lot of relations do not like to donate to their relatives. So they are looking for commercial donors. We don’t encourage that. If you are going to have a transplant in LASUTH, you must bring a relative who will consent to donate. Nigeria should have very strict regulations about donation.”

He explained that through the system, people before they die, if suffering from some other fatal illnesses that do not affect their kidney, could sign up for donation. Immediately after they die, the kidney can be removed for someone who has been waiting for a kidney, he said.

Olugbenga Awobusuyi, president-elect of NAN and the Transplant Society of Nigeria, similarly explained that the primary donor source in advanced countries has shifted to organs from deceased individuals.

According to him, the organs used are those from people who die in the hospital, mostly those in the intensive care unit and are being maintained on life support.

“Their brains can die but because they are on life support, we are able to assist the breathing and beating of the heart of the dead person. We can sustain the function of other organs, even though the brain is dead,” the nephrology expert said.

“We believe that if we can have such a programme in the country, it is going to benefit society a lot, in that people don’t have to buy organs. Organs from dead people are highly regulated strictly by established criteria.”

For instance, in the United States, hospitals are required to have written agreements with organisations that coordinate organ and tissue donation and recovery. There are 58 organ procurement organisations, according to the US Centre for Diseases Control and Prevention.

For screening and testing, organ and tissue recovery organisations are required to obtain a medical and social history of deceased donors by asking their next-of-kin, and sometimes other persons who knew the potential donor, questions about behaviours that may have exposed the potential donor to certain diseases. This questionnaire serves as one of several resources to assess the donor’s risk for having a disease.

Hospitals are required to evaluate living potential kidney donors for the presence of behaviours or medical history that may increase the risk of infection in the donor.

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Hospitals that perform organ recovery from kidney donors are also required to perform certain tests to see if the potential donor may have infections such as human immunodeficiency virus (HIV), hepatitis B or hepatitis C virus, syphilis, and cytomegalovirus. These test results are provided to the healthcare facility where transplantation of the organ or tissue will occur.

Awobusuyi said NAN had been pushing the adoption across the country, with Lagos State leading the charge.
Drivers of kidney failure

Fabamwo lamented that many are drinking different sorts of toxic concoctions that are being sold by traditional vendors, without minding the toll it takes on their health.

He listed the abuse of some medications, hypertension, and diabetes as some of the commonest causes of kidney failure, saying people are not checking their blood pressure and sugar levels until the kidneys are affected.

Olamide Olowoyo, consultant nephrologist and head of Nephrology Unit, Department of Internal Medicine, Federal Medical Centre Ebute-Metta, said the prevalence of chronic kidney disease now ranges between 11 and about 15 percent.

According to him, unlike what happens in other countries where it is mainly elderly people who suffer chronic kidney failure, “in Nigeria, we tend to have a younger population who are the economically productive population. Ours is a bit worse”.

She said the inflammation of the kidney, HIV, hereditary kidney diseases, toxic concoction and obstruction of the urinary tract are also drivers.

Olowoyo said one of her patients, a security officer, who should get routine dialysis every week only appears twice due to lack of funds.