TT’s expanded transplant programme

WITHIN A FEW weeks, the most critical phase of Trinidad and Tobago’s National Organ Transplant Programme will begin. The Ministry of Health has set a target of July for the first transplant to be performed in this country since the launch of the organ donor registry earlier this year. It will take place at the National Unit, a facility established at the Eric Williams Medical Sciences Complex at Mount Hope for procurement, storage and distribution of tissues. While transplants have been done in this country before, the legislative framework was only recently established for cadaveric transplants which use tissues and organs from dead donors.

This has been made possible through the Human Tissue Transplant Act, which was enacted in 2000. Regulations to the Act were passed last year. This clears the way for an expanded programme for the transplant of kidneys and corneas, using regenerative and non-regenerative tissue from living persons and cadavers. In launching the new facility in January, Health Minister John Rahael, who became the first official donor in TT’s Transplant Programme said it fulfills a “longstanding need for the benefit of our citizens.” “The underlying principle of this venture, is that transplants will be done in a safe, ethical and dignified manner,” he said. According to local health officials, the programme is desperately needed — there are more than 1,000 patients in dire need of dialysis services which can cost as much as $9,600 a month. For many of these patients, kidney transplantation may be the best available treatment.

Kidneys may be transplanted from a living donor, since people are born with an extra kidney. However, for such procedures, a patient must find a willing donor in a friend or family member. If the donor is a match, they can proceed directly to the surgery stage. Kidney transplants have been done locally using living related donors. The first was done in 1985 at the San Fernando General Hospital when four patients received kidney transplants. The transplant team consisted of local and foreign doctors. Three of the patients are still alive but two of them now require maintenance hemodialysis. Because of several limitations with the local transplant programme, several persons have gone to India and, more recently, Pakistan for kidney transplants. In some cases, the procedures were done illegally in clandestine and unsanitary conditions and some of the patients died.

In the case of corneal transplants, local doctors had been relying heavily upon organ donations from abroad. Approximately 36 corneal transplants are done in TT locally but that is only a small percentage of actual demand for the procedure. It was in those circumstances, moves were made to establish the local programme. Immediately after the organ donor registry was established on January 28, there was an overwhelming response to the programme. However, interest has declined very rapidly since then. Persons interested in becoming organ/tissue donors are required to fill out a card indicating their wishes for such donations to be made upon their death. There is also a Family Notification Card which informs the donor’s relatives of the wishes and indicates that the appropriate medical professional must be contacted.

The cards must be filled out in the presence of two witnesses, preferably family members and donors are required to carry these cards with them at all times. Relatives of the donor must give consent before the organ/tissue donation can take place. Generally, acceptable donors are people who are brain dead but on artificial life support. Donation will only be considered after all efforts to save the donor’s life have been made, brain death has been declared and relatives have been consulted. The organs/tissues are harvested when the donor is technically dead, although the body is still functioning, which means the organs  remain healthy. Organs will deteriorate very quickly after the body itself expires, making them unusable for transplant. When a donor’s family authorises the removal of organs, several surgical teams immediately begin work harvesting.

In some countries, notably China, foreigners can buy the organs they need instead of waiting at home. These organs typically come from executed prisoners who have not volunteered to donate organs. This situation is extremely controversial. Paying for organs is considered unethical in most Western nations and is illegal in TT, as is harvesting organs if the donor has not agreed to donate them. As with most other surgeries, recovery from a transplant operation involves additional medication and hospital visits  to make sure the incisions heal correctly. While other surgery patients typically can move on from the experience, most transplant recipients must continue medical treatment for the rest of their lives. This is because of the immune system’s reaction to the new organ. A transplanted organ is made entirely of foreign cells, which means the body will attack it if left to its own  devices.

To minimise the immune response, transplant teams make sure donors and recipients have matching blood and tissue types. But even with a good match, the body will see the new cells as foreign matter and reject the organ (destroy it cell by cell). Only tissue from an identical twin will be fully accepted. Hyperacute rejection occurs as soon as the donated organ is in the body. This only happens if there are already antibodies in the recipient’s bloodstream that react to the new organ, which would occur if the blood types of the donor and recipient were incompatible for some reason. This almost never happens, since transplant teams always test for any  incompatibility ahead of time. If it were to happen, the recipient would most likely die on the operating table.

Acute rejection occurs at least a few days after the transplant, after the body has had time to recognise the foreign material. This is the normal immune response to foreign matter. Chronic rejection is a very gradual rejection, lasting months or years. It can be so subtle that the patient doesn’t notice any ill effects for some time. Under TT’s Human Tissue Transplant Regulations, donors will be evaluated to determine if their tissue may be accepted for transplantation. The evaluation includes serological tests, physical tests, evaluation of tissue and any other tests determined by the Chief Medical Officer. Local health officials say hundreds of lives will be saved once the transplant programme is fully implemented.