EXPLORING NEW MEDICAL FRONTIERS WITH ORGAN TRANSPLANT: A MACROSCOPIC VIEW INTO CADAVERIC ORGAN DONATION.
EZE, WILLIAMS
DOKITA EDITORIAL BOARD MEMBER
Introduction
The survival instinct is an innate trait that is common to all humans. Consequently, this instinct can drive the development and advancement in the medical sphere as well. Organ transplant and related surgeries are advancement that create opportunities to prolong live for others. For instance, end-stage renal disease (ESRD), explores organ transplant as the best choice of treatment. Therefore, transplantation of solid organs has become the treatment of choice for end stage renal, hepatic, cardiac and pulmonary disease. [1] Furthermore, organ transplant is not restricted to a particular age cadre.
According to the organ donation and transplantation statistics of the National Kidney Foundation, people die each day while waiting for a kidney transplant. As at January 2016, there were 121,678 people waiting for lifesaving organ transplants in the USA and of these, 100,791 await kidney transplants. [2]
Within a decade and half (2000-2015), a total of 201 kidney transplants have been performed in Nigeria, principally from living donations. [3] So far, organ donation and transplantation represents one of the best clinical and the most cost-effective care when compared with alternative available treatments. A key drawback of organ transplant and related surgeries is shortage of organs. Consequently, this paper focuses on cadaveric organ transplantation as means to breach organ shortage while examining the legal and cultural perspectives.
Definition
Sollinger et al (1999) defines organ transplantation as an act of transferring an organ, tissue or cells from one person (donor) to another (recipient). With respect to the global space, kidneys are the most commonly transplanted organs then, the liver and the heart. Other organs that could also be transplanted include the lungs, pancreas, cornea, intestine and thymus etc. [4] It is broadly classified based on the similarity between the site of transplantation and also between the donor and the recipient.
Auto-transplants is the transfer of tissue or organs from one part of an individual to another part of the same individual. Allotransplants involve transfer from one individual to a different individual of the same species. Solid organ transplants in humans are an example of allotransplant. Xeno-transplants involve transfer across different species and is largely relegated to the laboratory, given the complex, potent immunologic barriers to success. [5]
The Nation Health Acts suggests that, avenues to obtain organs for transplant is limited to living and cadaveric donors. [6] In developed climes organ donation is usually from living donors, which is estimated to be over 85% of all organ donations. [7] living donors are usually genetically related individuals albeit genetically unrelated donors yield better surgical results. [5] However, this source for organs cannot meet the demand.
Organs cab be taken from ‘brain – dead’ individuals can be referred to as brain dead or cadaveric donors. Brain death occurs when severe brain injury causes irreversible loss of the capacity for consciousness combined with the irreversible loss of the capacity for breathing. [5] Many countries now rely on cadaveric organs to meet the demands of organ shortage.
FIGURE 1. Number of kidney transplant recipients by year in Nigeria. [3]
A Brief History of Organ Transplantation in the World and in Nigeria
History suggests that, there have been several transplantations in the past, both between animals and between humans but the first ever success of this in humans could be traced to the first human kidney transplant carried out between identical twins in 1954 by Dr. Joseph Murray in Boston. [4] Transplantation is not only limited to organs; tissues like bones, tendons, cornea, skin, heart valves, hairs and veins can also be transplanted because they also offer life prolonging and lifesaving options. [4] In Nigeria, the first successful organ transplant carried out was a kidney transplant performed at St. Nicholas Hospital, Lagos in 2001. [8] So far, total of 201 kidney transplants have been performed between 2000 and 2014.
Legal Perspectives
Nigeria will require to enact a comprehensive laws dealing with various aspects of organ transplantation such as legal requirements for donation, enacting an ethical board etc. In Nigeria, matters concerning human organ donation and transplantation are regulated by the National Health Act. [6] Our constitution identifies that, the nature, purpose and the risk of organ donation or receiving an organ must be explained to the subject by the surgeon and who must carry it out in a licensed hospital. [9]
Federal Government has funded and upgraded a total of seven public tertiary hospitals in the country to carry out renal transplant and offer dialysis sessions as well to Nigerians living with such conditions. These institutions include: Aminu Kano University Teaching Hospital (which does routine transplant), Obafemi Awolowo University Teaching Hospital, Ile-Ife, University College Hospital, Ibadan, Lagos University Teaching Hospital, Idiaraba, University of Ilorin Teaching Hospital, University of Nigeria Teaching Hospital, University of Maiduguri Teaching Hospital, Delta State University Teaching Hospital and the Cardiac and Renal Centre, Gbagada, Lagos. [10]
Consequently, the bill identifies that, informed consent for organ/tissues donation and for recipient should obtained without coercion before embarking on such medical treatment. [6] A lot of ground is yet to be covered such as; the government including organ transplantation funding in the National Health Insurance Scheme (NHIS). Therefore, enacting a more holistic law/legislation on transplantation and encouraging research in the field of transplantation in conformity with Helsinki declaration of 1964 must be duly considered to achieve landmark success in the above field. [9]
Culture
The Chief Medical Director (CMD) of the Lagos University Teaching Hospital (LUTH) Prof Christopher Bode, “organ donation is rare in Nigeria because of ignorance and a way of improving the situation is promoting donation by deceased people”. [11] Adverse beliefs and misconceptions concerning organ transplantation stand as a major barrier against the fruition of cadaveric transplant in the country. The sale of organs could lead to people refusing to donate organs and relatives who have lost their loved ones could resort to selling these organs. [12]
Way Forward
The suggestions below are geared to combat the challenges faced with organ transplant, more importantly cadaveric donor options. Technology and by extension data is a key facet of our world today. However, with the future in mind; there ought to be a National register for organ donation. Beyond keeping records, organ transplant recipients can be adequate monitored to gauge success of surgery. [13] Furthermore, such data can serve as evidence in drafting an appropriate bill and an awareness campaign.
Nigeria is arguably Africa’s largest economy and most populous nation with over 60% of the population being youths ranging from the ages of 15-35 years old. [14] With the above statistics in mind, they are the prime target for awareness and sensitization in consideration of the future. With modules like the civic education taught in secondary schools and General Studies (GES) taught in the universities can be deployed respectively to educate the core of our population as
regards organ transplants. Furthermore, creating seminars to educate Pastors, Muslim clerics and traditional priests can play a huge role in driving awareness to the citizens of the country.
For a better public awareness and as a goodwill gesture, the then President of Pakistan, on the 17th March 2010, became the first President to donate all his body organs, after signing a landmark bill to regulate the transplant of human organs in the country. [15] In same breath, having well-respected obliged to donate their organs when a futuristic opportunity is presented can influence the mindset of the larger populace.
A lot needs to be done as regards NHIS (National Health Insurance Scheme). The NHIS should be adjusted to include transplants as this will better portray one of the objectives of the NHIS which is to protect families from financial hardship of huge medical bills. The question to answer will be, whether this can be achieved in Nigeria with the present economic situation in the country. This will definitely require funds, and the determination of relevant stakeholders. [12]
By-Products Fostering Landmark Success in Organ Transplant
Medical tourism is a situation where citizens of a particular country travel to other countries for medical treatment due to delay in obtaining effective treatment or lack of facilities and man power in the healthcare system in their own country. [16] Medical tourism could lead to health risks because of the long travel where some patients are exposed to harsh weather conditions and exhaustion. It incurs huge financial expenses which includes the cost of travelling, together with hospital bills.
There is also the risk of accidents, whether by air, land or sea. Organ transplant infrastructure will cut-down the above stated risks and offer an opportunity to improve our health care possibly create a path to our desired utopia. Furthermore, such infrastructure creates an opportunity for more job creation because of the different experts require to create an iron-clad infrastructure as regards organ transplant.
The trend in the Nigerian medical space is that, Nigerian doctors seek better paying job offers with better conditions working and living in other countries. The outcome of the above trend is human capital is lost and the quality of healthcare plummet as a result of shortage of health personnel while some range of services will be unavailable as well. [17]
Conclusion
In conclusion, the subject of organ transplant must be considered critically across the themes of legislation and awareness. However, erecting the appropriate infrastructure as regards organ transplant can open doors to untapped advantages in the health-care space in Nigeria.
References
[1] Michael MH and Jeremy NT, editors. W.B. Saunders; an imprint of Harcourt Publishers Ltd, London. 1st ed. 2001. p. 193-204.
[2] National Kidney Foundation, Organ Donation and Statistics [online] https://www.kidney.org/ news/newsroom/factsheets/Organ-Donation-and-Transplantation-Stats [accessed 10 November 2021].
[3] Ifeoma IU, and Chinwuba KI. Organ Transplantation in Nigeria. Wolters Kluwer Health, Inc. 2016. Available from: DOI: 10.1097/TP.0000000000001149.
[4] Esther HE and Ijeoma FN. Legal and ethical developments in the regulation of organ donation and transplantation in Nigeria. April 2016 vol 100 4 p 695. [cited 3 September 2019]. Available online on https://journals.lww.com/tranplantjournal/fulltext/2016/04000/organ_transplantation_in_nigeria.1.aspx
[5] Abubakar AB, Umar SA, Mohammed AA, Sani UA, Emeka AN. Organ Transplantation: Legal, Ethical and Islamic Perspective in Nigeria. Nigerian Journal of Surgery Jul-Dec 2012 | Volume 18 | Issue 2.
[6] Section 53 and 54 National Health Act 2014. [accessed 10 November 2021].
[7] Remigius NN. Organ Donation and Transplantation.’ https://:www.lawexplores.com [Accessed 9 November, 2021].
[8] Vintage Medical Centre, ‘Kidney Transplant’ (Education) http://www.vantagemedicalcentre.com/education/kidney-transplant [accessed 10 November 2021].
[9] Ademola JY. Removal and transplantation of organs. Medical Law in Nigeria, published by Demyaxs press Ltd, Ibadan, Nigeria 2002:54-7.
[10] Shokunbi Y. (2015) Challenges of Kidney Transplant in Nigeria [online] Avaliable from: http://independentnig.com/challenges-kidney-transplant-nigeria/ [accessed 10 November 2021].
[11] See The Nation (2015) ‘Organ donation rare in Nigeria, says LUTH Chief’, 19 May [online] Available from: http://thenationonlineng.net/organ-donation-rare-in-nigeria-says-luth-chief/ [accessed 10 November 2021].
[12] Olusegun OO. (2017) ‘Challenges of organ transplantation in Nigeria’, Int. J. Private Law, Vol. 8, Nos. 3/4, pp.205–218.
[13] Aghanwa, HS. (2003) ‘Attitudes towards kidney donation’, Journal of National Medical Association, Vol. 95, No. 8, 725–731 at 725.
[14] National Bureau of Statistics. “Labor Force Survey”, March 2009.
[15] “President Announces Organ Donation”. Sunday Magazine Jang 2011; July 3.
[16] Bookman MZ. and Bookman KR. (2007) Medical Tourism in Developing Countries, Palgrave Macmillan. USA.
[17] Adams O. and Kinnon, C. (1998) ‘A public health perspective’, International Trade in Health Services: A Development Perspective, pp.35–50, UNCTAD-WHO Joint Publication, United Nations, Geneva.
[18] Sollinger HW, D’Alessandro AM, Deierhoi MH, Kalayoglu M, Kirk AD, Knechtle SJ, et al. Transplantation. Schwartz Principles of Surgery. 7th ed 1999.Publisher; McGraw – Hill companies and printed in USA. p. 361-439n. USA.