Eye on organ donation

The celebration took place in Constantia last week honouring the 700th kidney transplant

Kidney disease is rife and the medical fraternity is unable to keep up with the demand. This according to Sister Alexia Michaelides, one of the most experienced transplant coordinators in the country. She said there are two donor programmes, a living one, or a kidney from a deceased donor.

Statistics supplied by the Organ Donor Foundation show that 234 adults and 15 children received kidney transplants in 2016. Of these, 86 adults and six children received live transplants; and 26 adult kidney transplants were from dead people, with 37% of donors being related to the recipient.

On Sunday November 25 a group of about 50 doctors, medical staff and their families gathered in a Constantia garden to celebrate the successful completion of the 700th kidney transplant in a private hospital.

Doctors Derek Miller and Julian Jacobs and kidney surgeon Elmin Steyn got together in 1996 to set up a kidney transplant division at Christiaan Barnard Memorial Hospital and Sister Michaelides joined them two years later.

Dr Miller, who hosted the celebration with his wife, Michelle, said that in 1996 kidney transplant surgery was being done in two hospitals, Groote Schuur and Tygerberg.

“We centralised them at Christiaan Barnard, starting small, with an average of five to 10 in the first year. Now we’re doing 40 to 45 a year. Over the years they add up,” said Dr Miller.

Dr Jacobs said causes of a shortage of donors are that people are living longer andlonger lifespans and the high incidence of diabetes and high blood pressure leading to kidney failure were behind a shortage of kidney donors.

“Organ donation is something we all need to talk about, to think about. In the same way we donate blood,” he said.

Dr Anesh Naidoo, who joined the team, recently visited Bangalore, India, where he witnessed a kidney transplant done by robotics under control of a surgeon.

“It’s the future. We have the machine and use it for prostate cancer. It cost about R35m, with R1m a year service contract,” said Dr Naidoo.

Showing a video on his cellphone, Dr Naidoo said kidneys are usually removed using highly invasive open surgery. In 2011, Dr Steyn unveiled a revolutionary, non-invasive procedure of harvesting a kidney from a live patient through a tiny incision in the stomach.

Surgeons make three 1cm incisions in a patient’s stomach, insert an endoscopic camera, miniature medical instruments and a plastic bag and control the procedure while watching it on a monitor. The surgeon can loosen the kidney, clamp the surrounding blood vessels and manoeuvre the organ into the bag which is removed through a 5cm incision.

“In the past, surgeons would make a 25cm incision along the side of a patient’s stomach. This method is far less invasive and has a far shorter recovery time of no more than three days in hospital after the procedure, instead of seven days,” said Dr Naidoo.

Dr Miller said immuno-suppressant medication – anti-rejection drugs – had improved since the 1990s.

This class of drugs suppress, or reduce, the strength of the body’s immune system and prevent rejection of the kidney.
Dr Miller said most kidney recipients led a normal life after a transplant but the team’s greatest challenge was to find donors due to a lack of understanding and knowledge.

Dr Trevor Gerntholtz said another challenge was that from 10 people who wish to donate a kidney only four to six might be suitable.

Often potential donors have many hidden forms of disease that they did not know about.

There is also the issue of tissue compatibility, although modern technology has made it possible to transplant kidneys into incompatible recipients.

Dr Gerntholtz said a kidney usually lasts about 10 years with the first transplant and that this can get less with subsequent transplants.

Someone who has defied this is June Barrett who was diagnosed with a rare genetic disorder in 2007. Having gone through dialysis – the clinical purification of blood as a substitute for the normal function of the kidney – this Ottery woman needed a replacement kidney and her husband stepped forward and donated one of his.

Almost 15 years later she works as a secretary to Dr Miller and is handy to have on tap with advice for patients who need to know what she has gone through.

Henning Coetzee of Woodstock had his kidney transplant in April 2007. He had polycystic kidney disease – an inherited disorder in which clusters of cysts develop in the kidneys. Now, over 11 years later, his latest blood results are excellent and equivalent to those of someone with two healthy kidneys.

Mr Coetzee ascribes the success of his transplant to it being a good kidney, and to the professional care of Dr Miller.
By chance Mr Coetzee found out who his donor is and on the 10th anniversary of the transplant he wrote to the family via the nurse he is working with.

“I received a kidney from your son and it transformed my life. The specialist tells me the kidney will be with me till I die, of other causes. I can’t really begin to thank you for all of this, it is the biggest gift one can give, and receive,” he wrote.

Sister Michaelides said a living donor should be healthy and lead a healthy lifestyle. After the donation they will continue to lead a normal life with one kidney and will not require any medication or lifestyle adjustments.

Director of the Organ Donor Foundation, Samantha Nicholls, said anyone can register as an organ and tissue donor, for free, at www.odf.org.za or call toll free at 0800 22 66 11. You will receive an electronic pack with your donor card and stickers. You can also request that a postal pack be sent to you with a plastic donor card and stickers.

Discuss your decision with your family – they need to know your wish so that it can be conveyed to the medical professionals at the time of your death.

You do not need to undergo any medical tests when you register – all the relevant tests are performed at the time of your death. This is why anyone can register as an organ and tissue donor.