The doctor’s perspective on kidney transplantation

In the run-up to World Kidney Day 2012, some ISN’s members and partners give their views on the theme for this campaign. Kidney donation and transplantation is the focus this time around. What are their thoughts on this issue?

Vivek Jha, ISN Councilor, Executive Committee Member and member of the ISN India Committee: “kidney transplantation is the most viable renal replacement option in India due to the young age of early stage renal disease patients and lack of dialysis facilities outside major cities. Between 5,500 and 6,000 transplants are performed every year but challenges continue to include financial issues and a lack of an organized deceased donor transplant program.

Things have started to change. The government is in the process of drafting a National Organ Transplant Policy, hoping to set up a countrywide network for organ retrieval and sharing. This has already seen an increase in organ retrieval rates in several states.

The Organ Transplant Act was amended in 2011 to increase the efficiency of organ retrieval from deceased donors and promote ethical living donor transplantation. It has now helped put in place transplant coordinators and established a transplant registry for recipients and donors to increase transparency and improve outcomes. Several states have instituted insurance schemes for the poor sections of society, which will remove the financial barrier.” 

Paul Harden, Chair of the ISN Global Outreach Sister Renal Center Program: “the ISN GO SRC Program helped set up a transplant program in Ghana, which has now successfully carried out 11 kidney transplants. We helped train local staff, set up procedures, care for patients after the operation and manage any complications. Aside from the issues of expertise and medical resources, there is an increased risk of infections such as hepatitis, tuberculosis and HIV.

With no tissue typing available in many countries, it is important initially to build the infrastructure for a living donation program with the support of an existing transplant center. Once this is in place, a deceased donor program can be considered and established within an appropriate legal and ethical framework.

It is valuable to build dialogue between emerging and developed transplant centers to provide support throughout the evolution of a new transplant service. In April, we are sending a team from Oxford to Senegal to visit facilities, train local staff and start a new kidney transplant center.” 

Jeremy Chapman, Immediate Past President of the Transplant Society (TTS): “today transplantation is available in 80 countries worldwide, but does not meet the needs of the community in any of them. Organ donation is insufficient in all, but in most emerging economies there are too few trained surgeons, physicians and nurses. In many countries, dialysis is simply too costly so prevention and transplantation are the key to saving lives.

It is vital to encourage deceased organ donation and have the trained staff in transplant programs across the communities. The Transplantation Society and ISN have recently extended their collaborative agreement so they can work together on programs such as ISN Global Outreach to identify and train doctors in the developing world, raise awareness about deceased donation and assist in establishing new programs.”