Transplants need donors and doctors

Kidney transplants have been making news headlines for all the wrong reasons. But behind the controversy and the murky world of illegal “transplant tourism” is a commonly performed surgical procedure that will extend the lives of thousands of people worldwide.

It is the most successful of all organ transplant operations. First performed in 1954, countless ­recipients of donor kidneys have lived relatively normal lives for many years.
In fact, there are recorded cases of people living for well over 40 years after the operation.

A patient will be considered for transplant usually when end-stage renal disease occurs and the kidneys no longer perform their crucial functions. These include filtering and removing waste products and excess fluids, managing the body’s electrolytes and minerals and secreting the hormones that regulate the body’s absorption of calcium and produce red blood cells.

The most common causes of end-stage renal disease are diabetes mellitus and hypertension, two mostly lifestyle-related chronic conditions that are growing at alarming rates in South Africa. When it occurs—which is when kidney function drops to between 10% and 15% of its optimal level—there are two life-saving choices facing the patient: dialysis or a transplant.

As treatments, both are expensive and present various challenges. But transplantation is generally accepted as the most successful long-term option because the average patient will live 10 to 15 years longer with a kidney transplant than if kept on dialysis. The availability of donor kidneys is another major challenge. Kidneys donated for transplants are sourced from dead or brain-dead donors as well as live donors, which according to South African law must be related to the recipient.

The success rate of transplant operations for all organs has been bolstered over recent years by the great strides made in the development of immunosuppressive therapy drugs. They are crucial to help avoid the recipient’s immune system from attacking and rejecting the new kidney—something that would inevitably happen to all recipients of transplanted organs, except identical twins who have a perfect tissue match.

Another factor that has led to more success in renal transplants has been new surgical techniques such as laparoscopy or keyhole surgery. For the person donating a kidney, laparoscopy has enormous benefits. Being a far less invasive procedure, there is less pain and recovery time is dramatically accelerated from seven to two days in hospital.

Throughout the world, tens of thousands of people have their lives extended dramatically through what is considered a straightforward three-hour procedure.

But in South Africa the challenges for end-stage renal-disease patients in the public health system are stark: the high cost of dialysis adds to already overburdened public health budgets and there is a severe shortage of facilities countrywide.

The department of health has issued the following criteria for selection of patients fortunate enough to be considered eligible for dialysis or transplant operations:

  • Suitability for transplantation;

  • Be younger than 65;

  • Compliance with treatment; and

  • The absence of any significant pathology that would interfere with the treatment.
  • Of course, the one obvious benefit of kidney transplant operations for the public health system is that every patient who receives a new kidney means one less person needing dialysis, freeing up facilities for other patients. But transplant operations need skilled surgeons and a steady supply of donor organs, both of which are in short supply here.

    Kidney transplants will be the subject of Bonitas House Call on May 14 on SABC2 at 9am

    This article originally appeared in the Mail & Guardian newspaper as a sponsored feature

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