A death sentence can come in several forms. Often it is presented in the form of a medical diagnosis with little or no chance of the diagnosed beating the odds. But the Georgetown Public Hospital Corporation [GPHC] has been on a deliberate mission to change this dilemma for persons diagnosed with renal failure.
Kidney Transplant and Vascular Surgeon, Dr. Kishore Persaud
Renal failure is a condition where a person’s kidneys fail to a point that they are unable to filter waste products from the blood. There has been an increase in the number of renal failure cases in this part of the world, a condition that has been linked to diabetes and hypertension.
In fact, according to Kidney Transplant and Vascular Surgeon at the GPHC, Dr. Kishore Persaud, “while the true incidence of renal failure in Guyana is not known, the general incidence of renal failure in some countries is about 15 percent of the population.”
He noted that due to the evident high prevalence of diabetes and hypertension here, the cases of renal failure have been on the increase. “We have over 150 patients actually accessing dialysis right now,” said Dr. Persaud.
The form of dialysis offered at the GPHC sees patients being hooked up to a machine, which filters and purifies their blood, since their kidneys are unable to do this. This service is offered at no cost to patients. However, they are only eligible for a period of free dialysis at the GPHC, after which they must access this service at other facilities that are privately operated.
Dr. Persaud and team
The service at this point attracts a cost which can at times be more than some patients can afford. “Dialysis is expensive, it can cost some of them [patients] about $30,000 – $45,000 on a weekly basis,” said Dr. Persaud, as he underscored that accessing dialysis could weigh heavily on a patient’s pocket. What is also noticeable, Dr. Persaud said, is that only few patients live longer than five years after commencing dialysis.
LACK OF LEGISLATION
Moreover, he noted that while renal failure can be treated to a point through dialysis, it is certainly not the best option if someone is to maintain a good quality of life and remain a productive citizen.
Transplant, according to Dr. Persaud, will always be the better option for renal failure patients. Of those currently accessing dialysis, Dr. Persaud said about 75 of them are in dire need of a kidney transplant. The sad part about this state of affairs is that several of them do not have a donor to facilitate this process.
The recipients Michael Totaram and Malika Dey flanked by their donors Clayton Allen [left] and Mark Nelson“Some of them do not have any family member who could donate to them, either because they are not compatible or a family member may not be willing to donate,” said Dr. Persaud. But this could become a thing of the past if legislation is in place to enable cadaveric transplant.
According to Dr. Persaud, the Public Health Ministry is currently in talks with the Pan American Health Organisation on the way forward to put legislation in place to allow cadaveric transplants to become a reality. This means that instead of the kidney coming from a living donor for transplant, it could come from a deceased [cadaver] donor.
“The benefit of transplant is tremendous, because even with dialysis, these patients will suffer on a daily basis, not only financially, but they will continue to live a poor quality of life. Some of them are always sick and they just go for dialysis, and they are completely dependent on their families,” said Dr. Persaud.
The pressure to care for these patients is also great on the public hospital since, according to Dr. Persaud, those who are unable to access dialysis privately are subject to constant re-admission at the GPHC.
“Some of them have to get blood transfusion, and the medication to keep them alive is expensive…but with transplant these patients don’t need dialysis, they don’t need blood transfusion and they require less medication; and they can work, help to provide for their family, pay their taxes, and help contribute to the economy,” added Dr. Persaud.
As such, he emphasised that while dialysis may help a patient to hang on to life, it certainly cannot compare to a kidney transplant.
In was in recognition of this state of affairs, that the GPHC in late 2014 decided to introduce a Kidney Transplant Programme which has developed into a full-fledged Transplant and Vascular Surgery Department, headed by Dr. Persaud. In fact, Guyana is perhaps only one of two countries in the Caribbean that has a stable transplant department.
The department, which is endorsed by the Ministry of Public Health, offers both emergency and elective surgeries, free of cost to patients. The only cost filtered down to patients is that of cross-matching tests between donor and recipient, which is done in the United States. However, often patients are able to access financial support from the Public Health Ministry. “All other tests are done at the Georgetown Hospital free of cost and the surgery is done free of cost too, and that is done effectively right here…that actually is a plus for our country,” said Dr. Persaud, as he underscored the benefits of transplant surgery for renal failure patients.
A product of the University of Guyana [UG], Dr. Persaud gained his training in Surgery through the GPHC, after which he completed his Transplant and Vascular Fellowship at the University of Calgary in Canada.
To date, about 26 transplants have been conducted, and Dr. Persaud disclosed that of these, there have only been two deaths. “Our outcome has been comparable to the first world. We have had zero donor mortality since this programme started, and we keep track of all of our patients…they are able to become productive citizens. Ninety-five percent of our transplant patients are back at work and are providing for their families, they hardly ever get admitted back to the hospital,” he revealed.
With kidney transplant, a renal failure patient’s life expectancy rate could increase to about 15 to 25 years or even more, “depending on how well you take care of your kidney and the follow-up care,” Dr. Persaud shared.
His efforts to bring patients back from the brink of death are backed by a Registrar, four General Medical Officers, a Social Worker, a dietician and a pharmacist. This team, Dr. Persaud said, “allows us to provide holistic care to these patients.”
But in order to ensure that a greater cross-section of renal failure patients can access a life-saving kidney transplant surgery, the GPHC has introduced a paired exchange initiative.
The initiative, though not novel, was first introduced at the GPHC last year, and is one which sees kidney failure patients exchanging donors, once they are found to be a suitable match. This approach is one that has been adopted in a number of first world countries, since it has been found that although the relatives of some patients are willing to donate a kidney to their loved ones, they are sometimes found to be incompatible.
Explaining the compatibility of patients, Dr. Persaud said that, “a compatible donor is somebody whose blood group and tissues match the patient. If they are not compatible, their body will reject that kidney, and they will lose it right on the operating table or shortly after…”
The first set of renal patients to benefit from the paired exchange method last year were 30-year-old Ravi Narine of Enmore, East Coast Demerara, who was awaiting a transplant for two years, and 58-year-old Freddie Budhoo of Berbice, who was in waiting for about one year.
Although Budhoo’s wife, Kumarie, was found to be a suitable donor, a number of Narine’s family members, including his brother Ghansham, were found to be incompatible, and therefore could not donate to him [Narine]. However, once the paired exchange method was adopted allowing for the patients to find suitable donors. “It was fortunate that they were both compatible,” said Dr. Persaud.
The most recent round of paired exchange transplants occurred in September last, and benefiting on this occasion were 24-year-old Michael Totaram of McDoom, East Bank Demerara, and 24-year-old Malika Dey of Hadfield Street, Georgetown. Neither of them had family members who were suitable donors. However, Totaram’s friend Clayton Allen, who was willing to donate his kidney to him, was cross-matched with Dey, and Dey’s father, 49-year-old Mark Nelson, was cross matched with Totaram.
After a period of anxiety, they were all elated when the cross-matching results returned clearing the way for the transplant surgeries. Both Totaram and Dey and their donors have recovered well, and have already started to return to their normal lives.
“I never lost hope…I had faith right through…I cried sometimes yes, but my family used to give me words of encouragement, so I couldn’t give up…I prayed a lot,” said Dey, of her journey with renal failure.
Totaram who expressed satisfaction with his post-surgery state, has returned to his normal self, and said “I encourage anyone who can donate to a renal failure patient, please do so, because you will be saving a life.”