As Jamaica observes World Kidney Day today (March 12), a local nephrologist is calling on the government and health care stakeholders to look beyond dialysis as treatment for kidney disease and to revisit kidney transplantation.

Professor Everard Burton, former chief of the Nephrology Department at the University Hospital of the West Indies and former chair of the Department of Medicine at The University of the West Indies, Mona, advocates that kidney transplantation is a more sustainable option for people with kidney disease to live longer.

Delivering a keynote at a Jamaica Medical Foundation meeting recently, Burton said that kidney transplantation is not new to Jamaica or the wider Caribbean, with procedures taking place as early as the 1970s at Kingston Public Hospital.

“Drugs available then were simple ones, but patients with transplants lived as [long] as 30 years later…In those days, kidney transplantation was mostly from deceased donors, which is referred to as cadaveric donors,” he explained.

Professor Burton noted that while there is much discussion about having the right legislative framework for organ donation, kidney transplantation only requires that people are willing to donate their kidneys for transplantation, whether they are alive or deceased. He reflected on the first patient donor transplants taking place in Jamaica in the 1990s when other Caribbean countries sent patients here to get the procedure done.

However, he pointed out that one of the challenges patients face post-surgery was accessing affordable medication. If a patient undergoes transplantation outside the public health system, then accessing drugs can be expensive. Burton therefore recommended that Jamaica’s national Health Fund can add medication for post-surgery transplantation to its list of subsidised drugs.

“In terms of the drugs, we have an armamentarium of drugs …in the government sector. We have to find ways of getting it to patients …outside the [public health] sector for transplantation needs to be more active,” Burton added.

Public education

To increase kidney transplantation in Jamaica, Burton recommends a more active public education and engagement campaign highlighting the risks of chronic kidney disease.

“I think we need more educational programmes because that was when more people came forward to donate kidneys for their affected relatives. And so in the 1990s, we (nephrologists) aimed to do one kidney transplant per month. Most of these were live donors: relatives giving kidneys to the affected person. There were also some deceased donor transplants,” the founder and chairman of Caribbean Institute of Nephrology shared.

“Dialysis is not the end-all and be-all of kidney disease. It is part of the long-term renal replacement therapy, but so is kidney transplantation. And so, we have to put emphasis on kidney transplantation [because] there are many young people languishing on kidney dialysis,” he added.

Creating a kidney bank

Professor Burton related a situation of a 33-year-old man who has been on dialysis for almost 30 years but came close to having a kidney transplantation.

In calling for an “active kidney transplant programme”, the kidney specialist suggested creating a kidney bank where “people can volunteer to donate their organs while they are alive, should they become brain-dead”.

While conceding that a kidney bank is an expensive venture, he pointed out that one of the best setups he has seen is in Bristol and London.

“It takes a lot to run it, and perhaps we may need one in the north Caribbean and one in the southern Caribbean. I do believe that it is something that can be done in conjunction with one of our regional organisations like The University of the West Indies, Ministry of Health, but there ought to be a public-private partnership also involved,” Burton stated.

On this note, the nephrologist also reflected on the efforts of the Lions Club in Jamaica for creating a donor card system for people who wished for their organs to be used in transplantations. But this, he said, also faced challenges, since a next of kin of the deceased donor could disagree with the extraction of the organ.

The Lions Club in Jamaica has contributed to renal therapy with the Mandeville branch donating $1 million to the Renal Unit of the Mandeville Regional Hospital in July 2010.

Organ donation across CARICOM

“The other question is, how do we transport these organs across jurisdictions?” Nurton asked, adding that there needs to be coordination across CARICOM for policies to deal with organ donations

“There are a lot of complexities, but we cannot continue to be cowed down by these (challenges). We have to find ways to solve these and to move forward, and I think we have talked enough. We need strong action, and I’m quite sure that if there’s a problem with law, a problem with moving the organs across jurisdictions, I’m quite sure that CARICOM can be of assistance here.”

World Kidney Day is observed each year on the second Thursday in March. In Jamaica, the day is recognised with a week of activities beginning on the Sunday prior and culminating on the Saturday following.