By Devina Samaroo
With hundreds of persons dying because of kidney failure worldwide, local doctors and graduating medical students are advocating for more patients to undergo renal transplant surgeries.
Kidney failure kills millions globally and is believed to be among the leading causes of deaths in Guyana.
The most popular treatment option here is hemodialysis, which is the process of purifying the blood of persons with weak kidneys.
But recent research by a group of graduating medical students from the University of Guyana found that this option is the costliest in the long run, and the chances of having a normal life are slim.
Dr Kishore Persaud, a kidney transplant surgeon attached to the country’s premiere health institution -the Georgetown Public Hospital Corporation (GPHC) – strongly advocates for patients to consider kidney transplants, noting that all 18 persons who have completed the surgery in Guyana within the past three years are living healthy lives.
Feddie Budhoo, 58, is the oldest person to have undergone the operation. Budhoo was diagnosed with kidney failure in November 2017 and subsequently began the dialysis treatment, which he described as “tough.”
He was in constant pain and the frequent trips to the hospital were burdensome.
After being placed on the waiting list for a kidney transplant, Budhoo underwent the surgery in July 2018 and now his quality of life has increased.
“I feel much better, more relaxed,” he noted.
Cost analysis
The research findings show that over a five-year period, the total cost for a patient with dialysis is roughly US$57,170 compared to US$184,699, which is the cost of maintenance treatment for transplant patients.
“To be on dialysis, I look at it as false hope. It makes you feel good but it makes your family and you a pauper in the long-term,” Dr Persaud asserts.
While the government generally stands the expense for both treatment options, patients still incur expenses for certain tests and medications.
Dialysis patients require more personnel such as a consultant, medical doctor, registered nurse, cleaning staff and biomedical technician whereas transplantation patients need only a consultant and medical doctor.
Dr Persaud, who is a product of the University of Calgary in Canada, also asserts that patients on dialysis are often a burden to their families, given that they are frequently admitted to the hospital and are unable to work.
He explained that transplant patients rarely get admitted to the ward and can return to work.
A minimum of $1.2 million is required for transplantation, the doctor notes, explaining that the money is paid to an overseas institution to conduct a compatibility test while the hospital stands the burden of the other associated expenses.
What further makes transplantation the ideal treatment option in Guyana, according to Dr Persaud, is that the waiting time for a donor is significantly less than anywhere else in the world, where it takes years before patients get a donation. In Guyana, he says the average waiting time has been one year.
Kidney transplant challenges
But kidney transplantation has it challenges, especially in Guyana where many persons are fearful of donating their organs and there is no facility for testing compatibility.
There are two types of transplantation: living-donor transplants and cadaveric-donor transplants. Guyana only offers living-donor transplant, where the organ is taken from a living person.
Dr Areefa Alladin, of the Guyana Kidney Foundation, explains that persons are hesitant to give up a kidney because they will feel vulnerable in the event they develop complications in the future.
“The general fear is that, if they give a kidney, when they need one they wouldn’t have or if they get sick, they wouldn’t have,” she said.
Dr Alladin explained however that persons are extensively screened before they are qualified to make an organ donation; if they are at risk of developing certain complications later in life, they are disqualified from donating their kidneys.
“We will not take it from people who may need their kidneys later,” she posits.
Further, prior to donating the organ, a compatibility test needs to be conducted to ensure the patient does not reject the kidney.
“The problem with donation is that we don’t want somebody to donate an organ and then the patient rejects it,” Dr Alladin explains, noting that a series of tests needs to be conducted to ensure the organ and receiver are a good match.
Once an individual is proven to be compatible and healthy enough to donate a kidney, they can live a normal life with only one such organ, Dr Alladin assures.
In fact, she believes there needs to be a more robust national discussion on this topic to educate the public about kidney failure and kidney donations.
Legislation needed
For years, doctors have been lobbying for necessary legislation to govern cadaveric-donor transplants, where the organs are taken from brain-dead patients.
Dr Persaud notes that this option would be ideal, especially in situations where persons are unwilling to donate.
Minister within the Ministry of Public Health, Dr Karen Cummings noted that the Government is working assiduously to draft the necessary legislation.
In an interview with News Room, she explained that systems would have to be put in place to avoid the commercial sale of organs, a practice that is illegal most countries and exposes donors and recipients to unnecessary dangers.
As with many diseases, Dr Cummings noted that prevention is better than cure. This is why the Ministry’s Chronic Disease Department, in collaboration with the Pan-American Health Organisation (PAHO), works vigorously on health promotion and disease prevention campaigns, she explained.
The primary causes of kidney failure are hypertension (high blood pressure) and diabetes, which is the among the top ten leading causes of deaths worldwide, according to the World Health Organisation (WHO).
Diabetes killed 1.6 million people in 2016, up from less than 1 million in 2000, WHO reported.
A Global Burden of Disease (GBD) study estimated that in 2015, 1.2 million people died from kidney failure, an increase of 32% since 2005.
Symptoms of chronic kidney disease may not appear until the organs are extremely damaged, the Amerindian Kidney Fund states.
If someone’s kidneys are beginning to fail, they may experience itching, muscle cramps, vomiting, loss of appetite, swelling in feet and ankles, trouble sleeping, amongst others.
There is no cure for kidney failure but persons are urged to live healthy lifestyles and drink plenty water to avoid developing other health complications which can prompt the kidneys to stop functioning.
The American Kidney Fund says in order to stay alive with kidney failure, a patient would need either a transplant or dialysis, options that can disrupt someone’s entire way of living.
“Having to change your lifestyle to make time for your treatments can make coping with this new reality even harder. You may have to stop working or find new ways to exercise,” the non-profit organisation noted.
With so many persons prone to developing this complication, it generates a tremendous economic burden globally.
WHO points out that high-income countries typically spend more than 2–3% of their annual health-care budget on the treatment of end-stage kidney disease.
With the global demand for dialysis projected to double by 2030, local doctors and medical students are urging Guyanese patients to choose transplantation to lessen the burden on the economy and to live a better life.
Mr Budhoo understands what the better life is.
He still needs to take medication every day and visit the doctor every week, but the number of trips will decrease incrementally.
That means more times to enjoy life’s pleasures, such as spending time with family, and farming.
