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The gift of life

BRUCE GOLDING

Sunday, March 24, 2019

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Thousands of Jamaicans suffer from incurable diseases that sooner than later cause them to die. Yet, they do not have to die so soon. Many could live much longer and enjoy a good quality life if they were able to replace their damaged organs.

Renowned urologist Dr Lawson Douglas successfully carried out the first kidney transplant in Jamaica at Kingston Public Hospital almost 50 years ago. What should by now have become a frequent, if not routine, procedure has been stymied.

A kidney transplant programme was started at Cornwall Regional Hospital in 2013 with support from the UK-based Transplant Links and a small number of kidney transplants have been carried out there.

Last year, doctors from Nemours/Alfred I duPont Hospital for Children in Delaware visited Jamaica to perform liver transplants on two infants at Bustamante Hospital for Children.

We have surgeons with the competence to do transplants. The problem is with the availability of transplantable organs and tissues, the logistics and, even more so, the cultural resistance to harvesting body parts.

Transplant technology

Ten years ago, in addressing a conference of the Diabetes Association of Jamaica, I promoted the idea of us making a living commitment to donate our useable organs when we die. I went even further to suggest the establishment of an organ bank where organs and tissues could be stored. Dr Douglas was quick to point out that I was not only ahead of myself, but also ahead of the available technology. Organs harvested from persons declared dead have a very limited shelf life — in most cases only a matter of hours.

Yet, the concept of an organ bank is not to be totally discarded. Transplants are often facilitated by living donors as in the case of kidneys and even livers where a portion can be taken from a living donor to save the life of the recipient. That allows timely scheduling of the procedures to extract and transplant. But if organs taken from a dead person could quickly be brought to a depository, compatibility quickly determined and potential recipients available for surgery at a moment's notice, as is done in some countries, many persons who might otherwise have died could be given a new lease on life.

The logistics for extracting, preserving and dispatching body parts is challenging but it is not beyond us. A friend of mine spent two years in Miami awaiting a liver transplant. He eventually got one and is now in robust health.

There are some tissues that can be stored for longer periods. For example, corneas that can restore someone's sight can be stored for several days and heart valves for several years.

Significant advances have been made in cryopreservation by which organs and tissues are frozen and stored for extended periods, and work is being done to find a way to return them to body temperature without damaging the myriad of cells they contain. So, organ banking may not really be light years away. Stem cell research is also aiming to develop the means to regenerate damaged organs and tissues.

Cultural issues

The inclination to donate organs after we die has been hampered by a cultural disdain toward interfering with the body of a loved one. Yet, cremation, which is becoming increasingly popular, burns to ashes vital body parts that could have saved other lives. Interment in the cemeteries across Jamaica sees us surrendering to worms and decay many organs that could have been used to save lives.

Cuba is well advanced in organ transplants. It has carried out over 6,000 procedures involving the transplanting of kidneys, lungs, hearts and pancreases. Over 90 per cent of the organs transplanted were taken from dead bodies. Many more thousands of cornea transplants have been done and an eye bank is maintained. The Government actively encourages citizens to make a living commitment to organ donation.

In applying for a national identification card in Cuba, which is compulsory at age 18, each person is asked to indicate whether he is willing to have his organs donated in the event of death. That provides the authority, when that person dies, to retrieve the useable organs and tissues for transplanting. An active database of committed donors and potential recipients is maintained.

Organ transplanting is expensive, especially the cost of the drugs needed to fight the risk of rejection, but it is an option that ought to become more available. Renal patients who have to be dialysed twice per week probably spend far more in order to stay alive than it would cost to have a kidney transplant if one were available.

National policy for transplanting

Five years ago, then Minister of Health Dr Fenton Ferguson announced that a national policy for kidney transplants was to be developed. Not much has been heard of it since then. The concept should be broadened to include the transplanting of other vital organs.

One of the issues to be addressed in such a policy is the danger of commoditising body parts. Iran is the only country in the world where the purchase and sale of body parts is legally permitted, but it is practised in many other countries where the willingness of the donor is secretly secured at a price. It is estimated that the illegal trade in human organs is worth more than US$1 billion annually.

We need to begin with the policy development that was promised five years ago. Next must come a public education programme to encourage organ donation commitments in the same way that we encourage the donation of blood. A real-time database would have to be maintained to meet the logistical challenges of harvesting and transplanting organs within the limited time frame, as is done in Cuba. Advantage can be taken of those situations where death occurs not suddenly but while in hospital care.

The churches need to be engaged since much of the resistance to organ donation is rooted in religious dogma that contradicts its own tenet that it is the soul that goes to heaven — not the kidneys, hearts, livers and lungs. I recall that when I raised the issue 10 years ago, support came from the Reverend Roderick Hewitt of the United Church but with the caveat that it would have to be carefully regulated.

The World Health Organization in 2010 established a set of principles to guide the procurement and utilisation of human cells, organs and tissues. For example, it rejects the use of financial inducement to secure body parts. It prescribes that the doctor who certifies that a person is dead should not be involved in the removal or transplanting of useable body parts. It stipulates that no body parts should be removed from a living minor and the selection of recipients should be done on a transparent and equitable basis.

Let us begin the conversation. Let us save some lives.

— Bruce Golding is a former prime minister of Jamaica


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