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Professor Olugbenga Awobusuyi is the president-elect of the Nigerian Association of Nephrology and the Transplant Association of Nigeria. In this interview by SADE OGUNTOLA, he explains how Nigeria can circumvent the dearth of organs for transplantation and measures that need to be put in place to ensure Nigerians with kidney failure have a shot at recovery.
T HE kidney donor source in advanced countries has shifted to organs from deceased individuals. How is it done?
They are primarily harvesting organs from deceased donors. Since kidneys from deceased donors are not enough for those who need kidney transplantation, living relations of individuals who require kidney transplantation are also used to compensate for the shortage of organs from deceased donors. A deceased donor is a dead person, someone that must be certified dead. Nobody that has been certified dead has ever regained consciousness.
These are people that are brain dead; they don’t use those in the vegetative stage. They are for instance individuals in the intensive care unit on life support machines that keep their lung function going. Consent is obtained from the relatives and they give a go-ahead, they harvest their organ and it is transplanted into the patient who needs the organ.
Are there criteria for such kidneys that can be harvested from deceased donors?
There are contraindications; you cannot transplant organs from an HIV-positive individual to another individual that is HIV-negative. Organs of individuals with cancer are not allowed for transplantation. The age might not be a barrier per se. But the older a person is, the less likely the functionality of that kidney is when compared with that of a younger person.
The expanded criteria donor (ECD) is any donor over the age of 60, or a donor over the age of 50 with two of the following: a history of high blood pressure, a creatinine (a blood test that shows kidney function) greater than or equal to 1.5mg/dl, or death resulting from a stroke. Using a donated kidney that only meets extended criteria for donors requires its recipient to be made aware of what is involved and the additional risks of having such an organ that did not meet the standard criteria for donors. If the patient now agrees that he does not mind the organ, then they now proceed to transplant such.
Given the increasing incidence of kidney failure in Nigeria and the dearth of life kidney donors, how can Nigerian hospitals explore deceased donor kidneys for transplantation?
The deceased donor kidney transplant is the way to go in Nigeria because it is an area that we have not explored. It is commonplace in other countries; they use it regularly. In Nigeria, we are just starting to explore its possibility and there are concerns.
People may misinterpret our actions in terms of thinking that the organs are probably used for rituals or that the patient was killed by the hospital for the sake of organ transplantation. So certainly, the media has to educate Nigerians about deceased donor transplantation and its benefits.
A single deceased individual can help to save the lives of 8 patients. We can transplant the heart, lungs, two kidneys, pancreas, intestines, cornea and tendons from a deceased patient. Every individual has 2 kidneys. One kidney can go to Mr A while the other goes to Mr B. Establishing deceased donor programmes is something that can be established in Nigeria; it will benefit a lot of people apart from those that need kidney transplantation.
Take, for instance, the eye bank at LASUTH, they have challenges with getting corneas. They import most of the corneas that are been used to help people see when there is cornea damage. You can see why it is important for us to establish deceased donor participants.
What measures need to be put in place to avoid abuse of the deceased organ donation?
A critical requirement in deceased organ transplantation is strict regulation. And, that is why we are at the forefront of ensuring that there is strict legislation governing the harvesting of organs from deceased individuals. There is a Bill that has been sent to the Lagos State House of Assembly to ensure this. We are so committed to making sure that when the programme is started, it is highly regulated.
Certainly, there will be a government agency that will regulate it and ensure that any hospital that will transplant an organ from a deceased donor is dully registered as competent to do so. The hospital must have the component of manpower for transplantation, including surgeons, nephrologists and transplant coordinators.
It is a highly regulated programme. When done, somebody can die in Maiduguri and the person needing the organ is in Lagos or Port Harcourt. The hospital does not have control over where the organs are coming from. The responsible agencies would have what is called the waitlist.
Names of individuals with kidney problems and/or on dialysis will be placed on the waitlist by the nephrologists. When an organ is available, the person will be called up and the organ transplantation will be done when the person reports to the hospital. It is doable.
When is LASUTH starting this procedure; at what stage are you in ensuring this service becomes available in Nigeria?
Presently, we are waiting for that Bill. We don’t want to perform one and we say we have done it and after that nothing works again. We have a full complement of surgeons, nephrologists and nurses who can handle it. There is a functional intensive care unit that can sustain such individuals, so we are prepared. What is delaying us is that Bill, so that we can have a legal framework within which we can operate.
What do Nigerians need to know about their kidneys to ensure they remain functional for life?
First we need to realise that kidney disease is common. About one in every 10 adults in Nigeria has some kidney dysfunction, but these are mostly in the early stage of kidney disease. Those who have late-stage kidney disease are those on dialysis or who require kidney transplantation.
Second, if we detect it early, it is treatable and we can retard its progression to late-stage kidney disease. Individuals above 40 years need to have yearly medical checks on their kidneys. That is the only way to detect kidney disease early. Many people with early-stage kidney disease, who are followed up by kidney experts, were picked up when participating in medical check-ups. Quite a number of people with kidney disease that I have been following up for more than 10 years were picked up during medical check-ups; their kidney function is stable.
So, participating in a screening programme ensures that cases can be picked up early and then going to a specialist for follow-up and management is important.
Also, certain diseases and conditions are contributors to kidney disease. These include diseases like hypertension, diabetes and sickle cell disease. Also, people with stones in their kidneys and elderly men with an enlarged prostate may end up with kidney failure. Individuals with diseases like these should ensure they have regular kidney function checks.
Individual requirement for good kidney function varies, but talking generally, I will advise that individuals desist from taking herbs and use of un-prescribed medications, including “akapo”, a combination of many pain relievers that many people take after a hard day’s work. Taking about 2gms of that for about 2 or 3 years can damage the kidneys. People don’t realise that two tablets of paracetamol is 1 gm already, meanwhile, some drivers take as much as 4 or 5 combinations of those pain relievers at a go. Over time many of them develop kidney problems.
Nigerians need to desist from using drugs they buy on transit in commercial buses. It can be deleterious to their kidney. In terms of diet, we advise people against a high protein diet for a long time. Such a diet over a long time can cause damage to the kidney in people with background kidney function impairment. Likewise, cutting down on salt intake is also important.
The body needs water; you don’t want to get dehydrated more especially with global warming which had caused an increase in atmospheric temperature in all countries of the world. Moderate and severe dehydration reduces blood flow to the kidneys, causing their functions to be impaired. So we need to take adequate water.
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