Chronic kidney disease, transplantation in Ja
CHRONIC KIDNEY disease (CKD) is a major public health challenge and a financial burden to the healthcare system. It is projected to increase dramatically because of the ageing population and the rising prevalence of its major risk factors including diabetes mellitus, hypertension, and obesity.
Currently, the Pan American Health Organization/World Health Organization (PAHO/WHO) ranks CKD as the eighth leading cause of death. However, according to the Global Health Metrics, it is projected to be the fifth leading cause of death by 2040. The possible result of chronic kidney disease is end-stage kidney disease (ESKD), requiring expensive kidney replacement therapy in the form of dialysis or transplantation.
There are two types of dialysis modality – Peritoneal and Haemodialysis. While some Peritoneal dialysis takes place in Jamaica, Haemodialysis is the most commonly used kidney replacement therapy for ESKD and the cost for treatment and the number of patients needing this modality are increasing. Both modalities can be effectively done in the patient’s home.
Haemodialysis began at the Kingston Public Hospital (KPH) and the University Hospital of the West Indies (UHWI) in 1970 and 1971, respectively. The first kidney transplant was done in 1970 at the Kingston Public Hospital, by Professor Lawson Douglas. This was the first transplant to be done in the English-speaking Caribbean. The second and third transplants, both from deceased donors, were done in 1971. Transplantation continued as a joint effort between KPH and the UHWI. Patients for transplantation were selected from both units with one donor kidney going to a recipient from each hospital’s renal unit.
By September 1980, 20 deceased kidney transplants had been performed on patients from both hospitals. In 1987, the first living donor transplant was performed at UHWI, under the leadership of Professor Lawson Douglas and the late Professor George Nicholson. The programmes continued until 2001.There were sporadic live donor transplants done between 20012005 at KPH.
In 2013, Cornwall Regional Hospital (CRH) performed their first living donor transplant with the support of Transplant Links Community (TLC), a charity organisation from the United Kingdom. UHWI re-embarked on an organ transplantation programme in 2018, with the support of TLC, offering patients with end-stage kidney failure a second chance to have a better quality of life. Current records reveal that 63 living and 121 deceased donor kidney transplants have been performed in Jamaica.
March being National Kidney Month, provides an opportunity to reflect on: Kidney health for all – starting from the primary healthcare level, where patients will be educated regarding the risk of CKD, and steps to mitigate the risk factors, early diagnosis of CKD, and treatment for slowing the progression to ESKD. Equitable long-term Renal (kidney) Replacement Therapy (RRT) must include kidney transplantation. A kidney transplant involves the transplantation of one kidney from either a living or deceased donor into the body of another person (recipient).
The success of kidney transplantation as a treatment option for ESKD when compared to maintenance dialysis, offers a better quality and quantity of life, and it is more cost effective. Transplanted patients have a better long-term survival rate. These patients often experience increase energy levels, find it easier to travel, have fewer dietary restrictions, improved sex life and fertility, as well as the ability to maintain gainful employment.
DONATION CRITICAL
The need for well-coordinated living and deceased donor programmes are critical to the treatment of ESKD. Both donation programmes have the potential to remove many persons from the long dialysis waiting lists.
Patients who wish to be considered for a transplant will be evaluated by the patient centred team at UHWI, Organ Transplant Unit, along with their donors. The result of this evaluation determines if a kidney transplant is the best choice to deliver the desired outcome. The evaluation process is thorough, includes questionnaire on medical, surgical and psychosocial history, as well as physical and laboratory (blood test) evaluation. The process can take several weeks to months to complete. Patients will meet with the multidisciplinary team.
Kidney donors have the chance to be someone’s hero, providing hope and a second chance of life. They will become a part of a community committed to making a difference and a positive impact on the world.
Improving the knowledge and attitudes of healthcare professionals and the general public regarding kidney donation and transplantation as the preferred treatment option for ESKD has the potential to enhance the healthcare system in Jamaica. It is critical to have public/ private collaboration to maintain a successful transplant programme. This will require appropriate legislation, regulations, and oversight to monitor donation and transplantation activities, practices, and outcomes. Adequate resources will be required for training of specialist physicians, surgeons, nurses and transplant coordinators.