Challenges Of Kidney Transplant In Nigeria | Independent Newspapers Limited
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Challenges Of Kidney Transplant In Nigeria

Posted: Jul 19, 2015 at 12:01 am   /   by   /   comments (0)

Yinka Shokunbi Lagos

Ndidiamaka Anuforo is today a survivor of renal disease after she has successfully undergone a transplant at the Lagos University Teaching Hospital, LUTH in 2012.



Until 2012 when help came to the young graduate of Lagos State University, LASU, the travail of coping with the disease dated back to 2002 when she first experienced symptoms that were later diagnosed to be associated with the disease. It was a long and tortuous journey.

Lanre Olaoba is 49 and a widower of five; he was only diagnosed last February of chronic kidney disease (CKD) but already, he is expected to undergo three sessions of dialysis a week because of the rate at which his condition is deteriorating. His family spends an average of N150, 000 weekly to stabilise him until the sum of N7m is raised for a transplant.

The story of Ndidiamaka and Lanre are just a few out of many patients who are living with renal diseases and regularly required to undergo dialysis while awaiting donors or money to do a transplant.

“Renal transplant for any individual diagnosed with renal failure is definitely cheaper for the survival of the individual on the long run” says Mr Adebayo Sokunbi, Managing Director and Chief Executive, Abeokuta Dialysis Centre and Kidney Consultants International, Ogun state.

Recently a female journalist with one of the leading Newspapers who went through the same travail had to be flown to India for a transplant when it became difficult to get a kidney donor. It was thought she had to get a commercial donor to enable her live and look after her family.

As at the end of last administration, the federal government had reportedly funded and upgraded a total of seven public tertiary hospitals in the country to carry out renal transplant and offer dialysis sessions to the nearly 3.2m Nigerians living with the condition. Unfortunately, many of the patients requiring the transplant services cannot access treatment due to high cost.

As of today the few known public hospitals where kidney transplant can be carried out in the country include: Aminu Kano University Teaching Hospital (which does routine transplant), Obafemi Awolowo University Teaching Hospital, OAUTH, Ile-Ife, University College Hospital, UCH, Ibadan, Lagos University Teaching Hospital, LUTH, Idiaraba, University of Ilorin Teaching Hospital  UITH, University of Nigeria Teaching Hospital UNNTH, University Of Maiduguri Teaching Hospital, UMTH, Delta State University Teaching Hospital, DELSUTH and the newly commissioned Cardiac and Renal Centre, Gbagada, Lagos.

Governments and some philanthropists have been known to subsidise some of the transplants while many others have had to source for public support and humanitarian gestures to get theirs carried out; sometimes they are unsuccessful.

Medical experts have therefore argued that the best option is for government to make the National Health Insurance Scheme as practicable as possible to accommodate some of the conditions that require such interventions-the chronic diseases.

Every human being is endowed with a pair of kidneys, each about the size of a fist, located on either side of the spine at the lowest level of the rib cage. Each kidney contains about one million functioning units, called nephrons.

The kidneys serve the body as a natural filter of the blood, and remove wastes, which are diverted to the urinary bladder. In producing urine, the kidneys excrete wastes such as urea and ammonium, and they are also responsible for the reabsorption of water, glucose, and amino acids.

Kidney disease usually affects both kidneys. If the kidneys’ ability to remove and regulate water and chemicals is seriously damaged by disease, waste products and excess fluid build-up occur, causing severe swelling and symptoms of uremia (kidney failure).

There are many different types and causes of kidney disease but can be characterised along hereditary, congenital or acquired.

Hereditary Disorders: can be transmitted to both males and females, and are known to produce clinical symptoms from teenage years to adulthood.

Congenital Disease: is known to usually involve some malformation of the genitourinary tract, usually leading to some type of obstruction which subsequently produces infection and/or destruction of kidney tissue. The destruction can eventually progress to chronic kidney failure.

Acquired Kidney Diseases: These ones are said to be numerous and generally referred to as nephritis (meaning inflammation of the kidney). The most common type of nephritis is glomerulonephritis, and again, this has many causes.

According to Dr Gbenga Awobusuyi, Consultant Nephrologist, Lagos State University Teaching Hospital, LASUTH, Ikeja, “Unfortunately, the cause of many kidney diseases is still unknown, but what we do know is that controlling high blood pressure and diabetes can reduce the risk of many kidney diseases”.

He noted, “Some identified causes include Hypertension, Diabetes, Glomerulonephrities, HIV/AIDS, Chronic Pyelonephrites, Analgesic Nephropathy, Bleaching creams and soaps because these contain heavy metals like mercury, certain diseases like Polycystic kidney diseases, Sickle cell diseases, Obstructive uropathy e.g stones, prostrate and cancers, Connective tissue disorder, Drug nephropathy; and of recent we have found a lot of young people in the productive age coming down with kidney disease, some as a result of consumption of various herbal concoctions sold on the streets of which their composition is mostly unknown”.

Living and coping with renal or kidney disease in Nigeria can however be quite stressful and agonising giving the numerous challenges facing either access to or cost of dialysis as well as getting a transplant.

Explaining the pattern of stress and agony, Sokunbi said, “Usually, most people who present with kidney failure do so often at the end stage when it is almost irreversible, it becomes quite difficult to cope with the cost of treatment at that stage.

“This is because an average patient with end-stage presentation would often require undergoing a 3 to 5 hour dialysis treatment three times per week at an average cost of about N25, 000 which means such a patient would require a minimum of N75, 000 weekly to survive; this is definitely unbearable to most of those who suffer the disease in Nigeria”.

He pointed out however that dialysis can only replace only about 10% to 15% of the function of healthy kidneys.

“Elsewhere like in the UK or US, a kidney patient can survive only on dialysis for upward of 18 years because the system already has the mechanism beyond the Health Insurance Scheme for paying for such patient and he would not have to bother or worry about how to raise money.

“Whereas the ultimate for any Nigeria patient would be to raise money and go through a transplant once and for all, as the task of going through weekly dialysis is not sustainable” he observed.

“A kidney transplant provides the patient with a healthy kidney from a donor but it often requires a lot more in terms of finances”, said Awobusuyi.

In the words of Awobusuyi, “the cost could be enormous as this would include cost of investigations of both the patient and donor whether the organ would match with that of the receiver or not, actual cost of transplant, anti-rejection drugs to sustain the kidneys as well as continuous check-ups”.

According to Sokunbi, “When eventually a donor (which so far in Nigeria have been living relatives, spouses or friends) is found, their suitability for surgery is determined and they are tested to determine if their blood type and other issue factors match the patients.

“Some of these investigations are done abroad and this helps to compound the cost of the surgeries. After the surgery, transplant patients must take immunosuppressant drugs, which keep their bodies from fighting and destroying the transplanted organ and these drugs must be taken for life with a combination of other drugs, which are usually not in stock by regular pharmacists due to their high cost. When required, they are often imported specially for patient’s use”.

On daily babsis the media is awash with lots of appeals to undergo the procedure for transplant especially overseas, India being the leading country of destination followed by South Africa and the US (where a total of 110 Nigerian renal specialists are currently practicing).

Speaking on the influx of Nigerians to India for renal transplant, Executive Secretary Nigerian American Medical Foundation International, NAMFI, Dr Adeyinka Shoroye

“18,000 Medical Visas were issued to Nigerians in 2012 as follows-10,621 were issued  in Abuja  while 7,611 were similarly issued in Lagos by the Indian High Commission, most  of whom were for renal transplant, underscoring the magnitude of the problem”, he said.

Although the cost of overseas treatment option is not cheap; as patients in Nigeria would require about N4 million for their renal transplant, if UK is the destination country it would cost about N13 million; the United States, N30 million; South Africa, N7 million and India, N1-N3 million, excluding transport fares. So why do people chose to travel abroad?

Awobusuyi and Sokunbi agreed that there is largely the issue of confidence and trust on the side of patients in the skills of the personnel and the facilities they would go abroad, even if the surgeon are Nigerians, the better for their confidence boost.

According Sokunbi, “most facilities and specialists overseas routinely do renal transplant and have recorded skilled successes of many years they can boost of and this profile encourages Nigerian patients to prefer their expertise even if it cost much more than obtained here at home”

Awobusuyi however cautioned on the overdependence of such trust saying, “because of the trust our people reposed in experts from India especially, a number of them are now being taken for granted and treated shabbily. We now have cases of Nigerians who go abroad, get commercial donors whose kidneys are often on the borderline and when they are hurriedly transplanted, are sent back home only to face challenges of complications which force the patient to go back to dialysis and eventually they die having spent hugely”.

Both experts advise that government would need to do much more to alleviate the sufferings and agony of end-stage renal failure or even prevent the onset by initiating social and welfare programmes that would include healtheducation and inclusion of treatment in the National Health insurance Scheme.

“The Health Insurance Scheme is a way to go but elsewhere, in US for example, there is the Medicare Fund where government and Volunteers pull resources mainly for patients with renal diseases where their health needs are taken care initially without having to wait for the insurance to pick up the bills” Sokunbi advocated.

Awobusuyi on the other hand is calling for the introduction of legal backing by the National Assembly to have an organ Bank where general harvests of organs of the dead can be carried out to support the living, “especially patients who died while under intensive care, as their various body organs like heart, kidneys, eyes and so on, can be harvested within hours of death and used to save many other lives”.

Some of the symptoms of renal disease are coloured urine, frothy urine, nausea/vomiting, loss of appetite and headache. Others include itching, swollen legs/eyelids, breathlessness and dry flaky skin. The high risk factors of the disease are diabetes, hypertension, family history, and obesity.

Those with one or more of the high risk factors are advised to always and regularly should check their kidney function.