GREY AREAS: ORGAN TRANSPLANTATION IN NIGERIA

Many years ago, during a posting in the Radiology department, I met a man in his fifties who came for an abdominal ultrasound scan. The indication on the request form was that he needed to be screened as he was going to donate one of his kidneys to his young nephew. As we scanned him, he kept fidgeting and asking us ‘Is everything all right? Can I give him? Do I have to give him my kidney?’

The last question prompted me to ask: “What do you mean by ‘have to’?”

Apparently, the man was to donate his kidney under duress from his brother. The patient narrated that he was a farmer who lived in a village with his family when his younger and significantly richer step brother came to ask for a favour. He wanted him (the patient) to be tested for kidney donation as his son was ill and urgently needed a kidney transplant. Mr Simon* was apprehensive at first, especially as he and his brother were not so close, but he was convinced by his wife to give it a try, after all, it was just a test.

When he proved to be a match, Simon became miserable. His brother promised to renovate his house in the village as well as buy him additional farm land. Simon’s misery stemmed from fear of the surgery and anger at the fact that his brother never bothered to help him until now. Family members called him repeatedly to encourage and thank him for saving his nephew’s life but deep within him, he knew it was not something he wanted to do. His brother’s sudden generosity only served to show him how content he was, prior to the issue of kidney donation.

Simon silently told us that he wished we would find something that would prevent him from donating his kidney. As both his kidneys were healthy, there was nothing we could do. I wrote down the findings and encouraged him to tell his brother how he felt.

The incidence prompted me to look up Nigeria’s policy or laws regarding organ donation. It also made me realize that not all donors are willing to donate their organs.

Worldwide, researchers and government bodies have agreed on informed consent for organ/tissue donation; consent of recipient should be obtained without coercion before embarking on such medical treatment. In Simon’s case, he had been compelled both emotionally and financially to give consent. The surgery went as planned and it was successful.

Despite the fact that Nigeria’s first transplant was fourteen years ago, the government is till yet to establish a policy concerning organ transplant. At present, kidney transplant in Nigeria is still based on the principle of medical ethics: Beneficence (doing good), Non-maleficence (to do no harm), Autonomy (giving the patient the freedom to choose freely, where they are able) and Justice (ensuring fairness).

And while these principles have served us well, it means we are still yet to move forward from live organ donation. Let me explain.

Presently, the only way to obtain a kidney transplant is the old-fashioned way: begging. The person in need of a kidney will have to go, cap in hand, asking family members to get tested so as to find a match. When that person is found, the person is further tested to make sure that he or she has no background illness after which an informed consent form is administered. Signing the form means a person has legally agreed to be an organ donor.

But what if we could by-pass this step?

Sixty-eight years after the first kidney transplant in the world and we are still yet to start organ donation on people that are brain dead. Whenever these issues are brought up, religious clerics start to fidget and the topic is hastily swept under the carpet.

No religion formally forbids donation or receipt of organs or is against transplantation from living or deceased donors. However, transplantation from deceased donors has been discouraged by Native Americans, Roma Gypsies, Confucians, Shintoists, and some Orthodox rabbis. Some South Asia Muslim scholars and muftis (jurists) oppose donation from human living and deceased donors because the human body is an “amanat” (trusteeship) from God and must not be desecrated following death, but they encourage xenotransplantation (transplantation between species) research.

It was believed by Catholic theologians that to mutilate one living person to benefit another violates the principle of “Totality.” Addressing the participants at the XVIII International Congress of the Transplantation Society in 2000, Pope John Paul II said “Accordingly, any procedure which tends to commercialize human organs or to consider them as items of exchange or trade must be considered morally unacceptable, because to use the body as an object is to violate the dignity of the human person”. However, he later added “The criteria for assigning donated organs should in no way be discriminatory (i.e. based on age, sex, race, religion, social standing, etc.) or utilitarian (i.e. based on work capacity, social usefulness, etc.).”

Among Muslim scholars and researchers, there are those who throw legal support as to its permissibility while the other group sees it as illegal. Organ/tissues transplantation is considered a medical intervention that touches on the fundamental rights of the donor or the recipient. Where there is an unlawful infringement of the right of such persons in any way may be regarded as against Section 34 of the 1999 Nigerian Constitution dealing with right to dignity of the human person.

In a nutshell- No religion exclusively forbids it.

Therefore, is it not time we considered organ donation for people who are determined brain dead? Instead of dumping away bodies after road traffic accidents in the mortuary immediately, would it not be remarkable if we could use their organs to save other lives? Is it not time for us to educate ourselves about the benefits of organ donation so that we could sign up as potential donors?

I hear some people murmuring. Or are we not ready to have these conversations?

Think about it. You may not necessarily be the donor, but would it not be cheering if your child, or sister, or brother or parent who needed a kidney was offered one through the hospital because someone, somewhere made the ultimate sacrifice? We need to have these difficult conversations and come up with a policy that monitors and regulates transplant in this country.

Thanks to technology, medical science is moving at skyrocketing speed and so the earlier we make laws to protect and save us, the better. A lot of Nigerians are now realizing that it is safer and cheaper to get a kidney transplant here in the country than it is to travel out of the country. Imagine if we could transplant more organs? Imagine if we start organ donation in patients who are brain dead or near death? More lives would be saved and we would firmly establish ourselves as a hub of medical tourism. Not every time India, abeg.

Think about it.

No religion formally forbids donation or receipt of organs or is against transplantation from living or deceased donors. However, transplantation from deceased donors has been discouraged by Native Americans, Roma Gypsies, Confucians, Shintoists, and some Orthodox rabbis.