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Kidney donation: the gift of life

A WIFE wails as she begs for a spare organ to save her husband whose own kidneys are failing. But alas, either the wait list is too long or she’s waiting for nothing, because there are no organs ever arriving.

This is not an imagined scenario at the National Kidney and Transplant Institute (NKTI), but rather is the everyday calvary of the increasing number of people with end-stage renal disease (ESRD).

While the victims increase in number, the number of people who are fit to donate kidneys, both living and deceased, remains low.

The statistic says one Filipino dies every hour because of kidney failure.

Dr. Romina Danguilan, the deputy director of NKTI’s Hemodialysis Center and Clinical Trials and Research Unit, said diabetes and hypertension, which are non-communicable and lifestyle diseases, are the top two triggers for kidney problems.

In a different health conference, Dr. Augusto Litonjua, the president of the Philippine Center for Diabetes Education Foundation, said the country is losing the war against diabetes and its complications because of the rising number of fast food joints and call centers in the country. (Read: http://goo.gl/FMxa0u)

Dapat preventive tayo,” (We should be preventive) said Dr. Danguilan at a press conference on Aug. 25 at the NKTI.

KIDNEY STATISTICS
“Kidney diseases, especially ESRD, are the seventh leading cause of death among Filipinos,” said Dr. Danguilan.

The other leading causes of deaths in the country, in no particular order, are diabetes, heart diseases, pneumonia, vascular diseases, chronic lower respiratory disease, and accidents.

At the NKTI alone, 100 new patients with ESRD are confined every month.

While dialysis and transplantation are the two kidney treatments available, Dr. Danguilan said a transplant is the best treatment because it has a high survival rate. Between the years 2010 and 2015 however, the number of kidney transplants in the country plateaued at roughly 500 transplants per year, which is very low, she said.

In 2015 for instance, almost 14,000 patients started dialysis treatment but only 475 had kidney transplants.

“Only by substantially increasing the number of living and deceased kidney donors can we help save the lives of patients with ESRD needing kidney transplantation,” she said.

Here enters the REGALO advocacy or Renal Gift Allowing Life of Others, which aims to increase awareness on the safety of kidney transplants and to encourage more Filipinos to become organ donors. REGALO is the initiative of the Maria Corazon Torres y Javier Foundation, the Kidney Transplant Association of the Philippines, Novartis, and the Kidney Foundation of the Philippines (KFPI).

The goal is to double the number of Filipinos who receive kidney transplants in the next two years.

COMMON MISCONCEPTIONS
According to KFPI Executive Director Dr. Remedios Uriarte, the low kidney transplant turnout in the country is caused by constricting policies, lack of public information, lack of support, minimal funding, and myths.

“We have a misconception that says after you die, you must not have incisions in your body. Ayaw nila, dapat daw kasi ‘di na i-touch ang body after mamatay. (The family members refuse because they believe we should not be touching a person’s body after he dies),” said Ms. Uriarte.

Then there is the fear among possible donors that having one kidney renders them incapable of living a normal life.

Former President Fidel V. Ramos was among the guests at the press conference whose presence was meant to debunk this myth. He was 22 years old when doctors took his right kidney. It’s been more than 60 years since the operation, but he said everything physically has been normal.

The young Ramos, then a military student in the United States in the 1950s, contracted tuberculosis of the kidney. Back then there were few drug treatments for the disease and the best option was to remove the infected organ to prevent it from spreading the disease.

Left with one kidney, Mr. Ramos joked that he is willing to donate his remaining organ “at the right time.”

At the right time means when he’s brain dead.

WHO CAN DONATE?
Anyone can donate “as long as their heart is beating,” said Dr. Danguilan.

The requirements to be a live donor include being healthy (diabetes- and hypertension-free), 18 years old and above, and a relative of the patient who will receive the kidney. They have to pass a series of tests to get a cardiac clearance including a blood test, X-ray, and ultrasound.

In the Philippines, the “dead” donor must still have a beating heart, and can be on a respirator or life support. “Usually, those are patients with aneurysm, stroke, or inoperable brain tumors. The hospitals can call us, and we let HOPE do the evaluation if the kidney is okay. Then we get consent from the family,” said Dr. Danguilan.

HOPE, or the Human Organ Preservation Effort, is the non-profit organization under NKTI dedicated to harvesting organs for people suffering from ESRD.

“Once the heart stops beating, there’s no more blood supply to the kidneys, so they won’t work. But in the US and other Western countries, they do what’s called the ‘non-heart-beating donor.’ But your hospital needs to be setup so that as soon as the heart stops beating, you retrieve [the organ] right away. We don’t have that setup yet,” said Dr. Danguilan.

“Usually, the deceased donor comes from small hospitals without transplant program. They don’t have facilities like the NKTI, so retrieving the organ right away is difficult.”

The kidney should be “transplanted within the next 24 hours [from removal] or better, less than [24 hours], so when you transplant the kidney in another patient, it will work right away. The longer it is than 24 hours, there’s a chance that the kidney will not work right away. Minsan it takes two to four weeks before the kidney works [if it’s more than 24 hours],” she said.

It used to be that the harvested kidneys were put in an ice-filled container. “Usually, when we get the kidney from the donor, we put it on ice, in a Coleman,” she said.

The NKTI has since bought a mechanical preservation machine that is “pricey but is a worthy investment.”

“Now we have a machine with a fluid that continuously infuses the kidney so that it’s still working. So when we take the kidney from the machine to the patient, even if it is more than 24 hours, it will work right away.”

REVISING THE POLICY
Policies on who can donate — currently limited to the deceased and living relatives of the organ recipient — also need to be changed to improve the kidney transpant system.

“We are working on the revisions of the DoH (Department of Health) administrative order for organ donations. I sit on the technical group, and we’ve been trying to convince and revise the order to allow the purely altruistic [to donate]. There are people, like priests and nuns, who say ‘I’ll donate to anyone in the wait list.’ There are people who volunteer. We are trying to tell the DoH that there are people who are altruistic,” said Dr. Danguilan, who also sits as REGALO’s organizing committee head.

In other countries, there’s also the “pair exchange” option where two pairs of donors and recipients can exchange organs among themselves, even if they do not know one another, so long as they are blood type compatible.

“We are trying to fix the DoH order,” she assured.

LIFELONG TREATMENT
Having kidney failure, and surviving it, is a long battle, which includes lifetime medication.

A person with ESRD needs to take three kinds of tablets though the dosage is reduced over time. The recipient of a donor kidney is required to be on lifelong medication to prevent rejection.

“After one year, we remove one tablet requirement and the dosage goes lower in time,” said Dr. Danguilan. One tablet costs P90 while the other tablet is at P120 and a patient needs to take four of each in a day (two tablets twice a day). This adds up to a pretty penny.

As for the donors, they have to have a check-up two weeks after the procedure, then in the coming months with intervals at one month, two months, and six months after the procedure. After that they have to have a yearly exam. This is mandatory.

Fortunately, under the “Z package,” PhilHealth subsidizes P600,000 of the cost of having a kidney transplant, which includes hospital fees, laboratory exams, professional fees, and other mandatory services.

The Philippine Charity Sweepstakes Office (PCSO) meanwhile provides a one-year subsidy for medicine maintenance.

To boost the DoH funds, the incomes of the PCSO and the Philippine Amusement and Gaming Corp., which is about P40 billion, could be added to DoH’s allocation for medicines at P16.4 billion, making the 2017 budget for drug purchases P56.4 billion.

source: Business World
http://www.weekender.bworldonline.com/2016/09/02/kidney-donation-the-gift-of-life/