Ebele Orakpo
7 September 2008
A ONE-day symposium entitled, Renal Transplantation in Nigeria: Current Status and Future Prospects, was organised by Saint Nicholas Hospital (SNH), Lagos, last Wednesday. It was time to share experiences and rub minds on the way forward for renal transplantation in Nigeria.
The symposium, which took place at the AGIP Recital Hall, MUSON Centre, Onikan, Lagos, had in attendance prominent members of the medical profession from across the country, representatives of Lagos State Government as well as those of the print and electronic media.
Professor O. O. Akinkugbe, Emeritus Professor of Medicine, University of Ibadan, was the chairman of the occasion, while Lagos State commissioner for health, Dr. Jide Idris, was ably represented by the permanent secretary, Lagos State Health Services Commission, Dr. Funmi Olatunji. The event featured speakers from Nigeria and the United Kingdom. They include Dr. Ebun Bamgboye, Dr. Sani Alhassan, Dr. E. O. Olapade-Olaopa, Dr. Ayo Shonibare, Dr. Jennie Jewitt-Harris, Dr. Andrew Ready (consultant transplant surgeon), Dr. Andrew Hunter and Dr Fatiu Arogundade. The symposium came at a time President Umaru Yar'Adua is reportedly ill and is said to be undergoing renal transplant surgery in a Saudi Arabia hospital.
In his welcome address, the Medical Director, SNH, Dr. Dapo Majekodunmi, expressed joy over the turnout and wished the gathering fruitful deliberations. The chairman of the occasion, who is fondly called the father of nephrology in Nigeria, in his opening remarks, congratulated SNH for organising such a symposium and for always blazing the trail, saying the symposium could be likened to an intellectual dialysis. Akinkugbe said Nigeria had come of age in the area of renal transplantation.
Olatunji noted that some renal transplantation centres in Nigeria were coming together to share their experiences. She said that a renal transplant unit was being proposed for Gbagada General Hospital by Lagos State Government. The hospital, according to her, will also house a Burns Unit, a cardiac unit and also act as annex of Lagos State University Teaching Hospital.
Alhassan, a transplant surgeon from the Aminu Kano University Teaching Hospital, spoke on Renal Transplantation: AKUTH Experience. He noted that renal transplantation started in the hospital in 2002 with the assistance of a Sudanese surgeon and a Kano-based philanthropist. They carried out 23 live-related donor transplants.
The scheme was not sustained because the surgeon had to leave and there were no experts on ground to carry on. He said that most dialysis patients die because they can only afford one session per month whereas they need three sessions a week. So far, the Kano centre, according to him, has been able to carry out 10 indigenous transplants. He said renal transplantation costs N2m in the centre.
He mentioned unpredictable supply of immunosuppresive drugs and their high cost which most patients cannot afford, and lack of legislation on transplantation in the country as some of the major problems facing the centre.
He noted that donors are abundant due to the extended family system in the area but said there is need to collaborate with other centres. Bamgboye, consultant nephrologist, SNH, who spoke on Magnitude of End-Stage Renal Disease (ESRD) in Nigeria and Contributions of SNH to Renal Care in Nigeria, noted that renal transplantation started ten years ago in the country but that many people are not aware of it, saying that's why people still go abroad for treatment.
Risk of fatality, according to him, is less in transplantation than in dialysis. On distribution of dialysis units in the country, he said 50 per cent of the units are situated in the south-west, 16 per cent in the south-east and 16 per cent in the north. He said that chronic kidney disease (CKD) cases increase by six per cent globally, more than the rate at which population increases.
The consultant said that the risk of mortality is less if the patient does the transplant early, without staying too long on dialysis. Noting that there are more Nigerian nephrologists in the UK and US than in Nigeria, he appealed to the government to create a conducive environment by putting in place the necessary infrastructure like power supply, pipe-borne water etc. so as to attract these specialists back home because they are needed more here as Africans are more prone to kidney disease.
According to him, in Nigeria, the ailment affects mostly the young population, where the average age of patients is 40 while it is 60 in the UK and US and males are mostly affected. He said estimated new cases of ESRD in Nigeria yearly is 14,000 and those on dialysis are just 1,000. When asked if a patient can undergo transplantation more than once, Bamgboye said a patient can undergo transplantation as many as five times.
A participant, Dr. Ebun Shoneye noted that instead of raising money for Obama presidential campaign, Corporate Nigeria should raise money for a more worthy cause like kidney transplantation. He suggested that banks could also set aside a little percentage of their profit, say 0.001 per cent, for such.
That, he said, would go a long way because some patients die even after transplantation because of their inability to sustain the treatment. Akinkugbe noted that there is no real health insurance scheme in Nigeria and so many people depend on donors who donate once for the transplant but nothing more to sustain the patient over the years.
Olapade-Olaopa, a paediatric neurologist at the University College Hospital Ibadan, while speaking on Renal Transplantation: UCH Experience, stated that the problem they face is how to establish a training programme in Nigeria so as to be able to feed the centres with professionals because, as a teaching hospital, their job is first of all teaching, training and then service unlike private hospitals whose main focus is service.
Arogundade of the Obafemi Awolowo University Teaching Hospital Ile-Ife, spoke on Outlook for Chronic Renal Failure (CRF). The surgeon noted that CKD is with us and we only need community screening to see that clearly. He said that about one million people die yearly from CRF. He said that in Nigeria, about 75 per cent of those needing dialysis are unable to afford it for one week, and only four per cent can afford it for more than three months.
This is to underline the gravity of the situation. He urged Nigerians to adopt healthy lifestyles as prevention is better than cure.
Shonibare, consultant urologist and transplant surgeon, Vantage Medical Centre, who spoke on Challenges of Renal Transplantation in Nigeria, said that the first dialysis unit was set up in LUTH in 1981 but due to bureaucracy, it couldn't pick up. He asserted that transplantation saves cost because dialysis is expensive.
A session of dialysis costs N36,000 and a patient needs about three sessions a week. He enumerated some of the challenges to include poor funding, poor leadership, patient support, transplant tourism, staff training, and grossly sub-optimal laboratory support.
The urologist remarked that poor leadership has a lot to do with the problems facing renal transplantation, noting that government can play more active role to help patients in area of post-care drugs especially immunosuppressive drugs as done in Sudan, or even Mauritius where dialysis and transplantation are free.
He said an advocacy group was urgently needed to carry out this fight. On patient support, Shonibare advocated the setting up of a kidney foundation. On transplant tourism, he stated that it is a big business as some middlemen are involved and they make huge profit. On the way forward, he suggested that the telecoms industry, the oil sector, the banks, etc., should take this as part of their corporate social responsibility.
He also suggested talking to drug firms to give concession on immunosuppressive drugs, and team effort as they will gain more through collaborative efforts. He noted that cadaveric source of organs has not been looked into and suggested that it should be looked into, and also laparoscopic donor programme which is currently the in-thing in the UK. This will encourage people to donate organs.
According to him, the total number of transplantations in Nigeria so far is 99, Sudan 400, and Kenya 120. He stated that SNH has indeed come a long way. IVF technology was pioneered by the hospital in the 1980's, followed by the transplant unit and then most recently, on September 1, 2008, the hospital started laparoscopic donor nephrectomy.
In his presentation, Hand-Assisted Laparoscopic Live Donor Nephrectomy: The way forward for Live-Donor Nephrectomies, Dr. Andrew Ready, a consultant transplant surgeon, from the University of Birmingham, UK noted that hand-assisted laparoscopic live donor nephrectomy was conceived as a means for decreasing donor nephrectomy morbidity and reducing disincentives for kidney donation. Since its introduction, it has witnessed explosive growth worldwide. This procedure, according to him, is emerging as a new standard of care for live-kidney donation.
He noted that this method encourages people to donate kidneys because the procedure is less painful, shorter hospital stay, fewer complications, and less morbidity than in the open procedure. Dr. Jennie Jewitt-Harris, founder and chairman of Transplant Links Community (TLC), a UK registered charity set up by a group of British doctors with the goal to save lives of children and adults in developing countries who suffer from kidney disease, said through TLC, leading UK surgeons and medical teams take their skills to countries where they are most needed. She said they had been to Trinidad and Ghana and are now in Nigeria to partner with as many transplant centers as are willing to work with them so as to benefit Nigerians.
Finally, Dr. Andrew Hunter of Covidien, a world leader in advanced energy-based surgical systems, spoke on Ligasure:Useful tool in laparoscopic surgery. The occasion was also used to inaugurate the Nigerian Transplant Society which will involve not just renal transplantation but all other organ transplants.
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