All you need to know about organ transplants

Globally, about 20 people die every day while waiting for a transplant. There are several organs and tissues that one can donate including kidneys, heart, blood, lungs, liver, pancreas, intestines, thymus, bone marrow, bones, tendon, ligaments, corneas, cells, skin, amniotic membrane, ova (egg donation), penile, and uterus, among others. 

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Although there have been many claims of illegal organ harvesting in Uganda, experts say this is impossible, mainly due to the many complexities involved. 

A kidney transplant is a surgery to place a healthy kidney from a living or deceased donor into a person whose kidneys no longer function properly. The pair of bean-shaped organs located on each side of the spine just below the rib cage, mainly filter and remove waste, minerals and fluid from the blood by producing urine.

When kidneys lose this filtering ability (usually due to disease), harmful levels of fluid and waste accumulate in the body. These can raise blood pressure, resulting in kidney failure when the kidneys have lost about 90 percent of their ability to function normally (end-stage renal disease). 

People with such failure need to have waste removed from their bloodstream via a machine (dialysis) or a kidney transplant. In Uganda, a session of dialysis on average costs Shs300,000 and one may need three sessions per week.

According to Dr Dennis Kiguli, a renal specialist at Case Hospital, for some people with kidney failure, a kidney transplant may be riskier than dialysis. Conditions that may prevent you from being eligible for a kidney transplant include alcohol or drug abuse, advanced age, active or recently treated cancer and severe heart disease, among others. 

Is organ theft possible?
Many doctors have refuted the possibility of organ theft in Uganda. Part of the document written by Dr J C Luyimbaazi, the executive director of Lubaga Hospital reads, “The million-dollar question here is; in a land-locked country with no active renal transplant programme, is it possible to harvest a kidney and transplant it into a recipient across the border as part of a larger organ trafficking network?”

According to Dr Luyimbaazi, there are a number of tests that must be performed on both the donor and recipient before the actual transplant. Several donor evaluation tests are done and if a compatible living donor is not available, your name may be placed on a kidney transplant waiting list to receive a kidney from a deceased donor.

“A thorough physical exam, blood tests and grouping, imaging studies, such as X-ray, MRI or CT scans, kidney, liver, heart function tests, response to foreign bodies, cross matching of the blood, psychological evaluation, matching age, kidney size and infection exposure,” Dr Kiguli says.

After evaluation, the transplant team will discuss the results with you and inform you whether you have been accepted as a kidney transplant candidate. Each transplant centre has its own eligibility criteria. In some countries, the donor must be a close relative. This is because in most cases, family members are more likely to be compatible donors.

The procedure is not available in Uganda currently so one has to travel to Kenya, USA, United Kingdom, India or the Gulf Countries and this can cost between Shs100m to Shs200m.

The transplant
When a donor accepts to give their kidney to a recipient, it is preferable that both are wheeled into the theatre at the same time, albeit in different operating rooms. Kidney transplants are performed under general anesthesia while the surgical team monitors your heart rate, blood pressure and blood oxygen level.

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In a living donor, laparoscopic technology is used. Here, the surgeon uses a special camera to view one’s internal organs. The donor kidney is removed through a small incision below the belly button and transplanted into the recipient.

“From the time the artery to the kidney is tied off, a timer is set. Everything from placing the kidney on ice, preparing it, and placing it into the recipient should happen in under one hour,” Dr Luyimbaazi says.
Why?

The goal of a successful kidney transplant process is that the transplanted organ (graft) should serve its recipient for the longest possible duration. One of the key determinants of how durable the organ will be is duration between harvesting it and transplanting it into the recipient.

“When a kidney is harvested by cutting it away from its blood supply, kidney cells start to die, and without preservation, the organ itself is un-usable after a few minutes. For this reason, it is preserved on ice between two to four degrees Celsius,” he adds.

However, even cold preservation can only slow down cell injury but cannot completely prevent it. Cold preservation triggers a cascade of harmful inflammatory and immune effects to the kidney cells, and these are amplified when blood supply to the organ is restored. 

The longer the cold preservation period, the greater the injury and, therefore, the lower the chances that the organ will function optimally and durably. Therefore, the risk of graft failure is small if preservation time is shorter than 36 hours.

During the surgery, the surgeon makes an incision in the lower part of the abdomen and places the new kidney at the right side of the recipient’s bladder. Unless your own kidneys are causing complications such as high blood pressure, kidney stones, pain or infection, they are left in place.

After a successful kidney transplant, your new kidney will filter your blood, and you will no longer need dialysis. You can live up to 15 or 20 years with a kidney transplant. If the new kidney fails, you can resume dialysis or consider a second transplant.

The Uganda Human Organ Donation and Transplant Bill, 2021
On September 29, the parliament of Uganda approved The Uganda Human Organ Donation and Transplant Bill, 2021 to establish a legal framework for the regulation of organ, cell and tissue donation and transplantation in Uganda. 

The proposed new law prohibits the sale of any organ by a living donor for financial or any other form of compensation. A person who contravenes the provision commits an offense and is liable, on conviction, to life imprisonment. The same punishment will also apply to a person who renders his or her services outside a hospital environment for the purpose of removing any human organ without authority.

Uganda does not have any law governing human organ donation and transplantation, which is increasingly becoming an area of health care used to cure non-communicable diseases that are rising rapidly. 

Due to the vacuum in the law, there has been a concern about the increase in the illicit trade in trafficking of human organs, cells and tissue according to Dr Jane Ruth Aceng, the Minister of Health.

Dr Aceng says, “Many Ugandan citizens are seeking medical care from countries such as India, United Kingdom and Kenya, among other cases where organ donation and transplant is the solution to their health problems. With the law in place, Ugandans will be able to access such services within the country with Mulago National Referral Hospital as the pioneer transplant centre.” 

Under the Bill, the government seeks to establish the Uganda Organ and Transplant Council to oversee and regulate organ, cell, and tissue donation and transplantation, prescribe criteria to be followed when designating a hospital as a transplant centre, regulate the conduct of donation and transplant activities and the appropriate consent to be given by donors, among others.

According to Dr Kiguli, the bill when enacted into a law will be very helpful, “we have been following guidelines and rules of procedure from other countries. This law will enable us to make our own guiding principles.”