Kidney treatment dilemma
Although health professionals promote the virtues of a kidney transplant, it apparently costs kidney recipients much more to maintain the ‘new’ organs than remaining on dialysis treatment.
Immuno-suppressant drugs to keep recipients alive can cost anywhere between $80,000 and $150,000 per month, according to Vivienne Watson, pharmaceutical manager at HD Hopwood.
Compare that to the $20,000 monthly charged in public hospitals and $40,000 at private hospitals for dialysis treatment and one can easily appreciate the dilemma faced by kidney patients.
However, Marcia Campbell, who received a kidney from her brother last December, insists that no matter the higher cost of transplants, no one would ever choose dialysis over a kidney transplant.
“Even if being on dialysis costs less, there is no question, you live a better lifestyle with a kidney transplant,” she told the Sunday Observer.
Up to December, Campbell had to undergo weekly dialysis treatment for seven years, spending hundreds of thousands of dollars over that time. But even though Campbell, a teacher at Excelsior Primary School, is faced with a monthly bill of more than $80,000, she feels more comfortable without the inconveniences associated with dialysis treatment.
“You wouldn’t understand,” she said. “Imagine all your favourite foods taken away from you. I can’t eat a simple thing like a banana, and if you have no kidney you can’t urinate. It cannot be a normal life if you cannot urinate and eat foods that you
might want.”
Campbell is now free of the weekly drill of being hooked up to a machine for over four hours, twice per week, and the fear that missing sessions could mean her death.
However, her case highlights the major concern that the cost of treating renal failure poses for patients and health care professionals in the island.
There is a critical shortage of dialysis units to treat the 900 reported cases diagnosed each year. In an Observer story late last year, professor of medicine and nephrology at the University of the West Indies (UWI), Dr Everard Barton, said that prevalence of chronic renal failure was approximately 320 out of every million people.
Prof Barton indicated that in reality most of the 900 persons diagnosed with kidney failure annually would die, given the inadequacy of treatment facilities.
This grim revelation is compounded by a reluctance of people willing to donate kidneys, whether live or after death.
But amidst the gloom cast by this shortage of kidney treatment facilities, the renal unit at the Kingston Public Hospital (KPH) has at least one significant achievement under its belt. According to Dr Charmaine Watson Brown, consultant nephrologist at the hospital, the survival rate for patients there exceeds any other unit in the Caribbean, possibly the world.
Dr Watson Brown said that more than a quarter of the number of patients being treated for kidney failure at renal units around the world die from the ailment, compared to less than 10 per cent at KPH.
“With our limitations, our death rate in the renal unit at KPH is remarkably low. The reported death rate for patients on hemo-dialysis treatment is above 25 per cent,” Dr Watson Brown told the Sunday Observer. She added that at the KPH in 2006, only five patients of a total of 75 who received treatment there during that year died from kidney ailments.
Dr Watson Brown attributed the KPH’s success to a dedicated staff, coupled with a serious and intense education programme at the hospital. “Anybody who comes here has to be a part of our programme and learn about the disease,” said a passionate Watson Brown, who praised the staff at the KPH renal unit as being unique.
“The staff is second to none. There is a brilliant set of educated nurses, full of enthusiasm,” she said.
Being the only hospital in Jamaica that now performs kidney transplants, also sets the KPH renal unit apart from the rest.
The survival rate for people doing transplants is also admirable, according to Dr Watson Brown.
“Statistics show we have 95 per cent plus survival rate for live donor and a 90 to 95 per cent survival rate for cadaveric transplants,” said Watson Brown.
The unit boasts a record of 24 live-donor kidney transplants since 1994 and 13 cadaveric (from a dead body) since 1992.
“The high survival rate is possible because of the newer and better immuno-suppressive agents that are now being used,” said Dr Watson Brown. These agents will have to be used every day as long as the patient is alive, she added.
Veneica Morgan, head nurse at the renal unit, said that records for the unit only go back to 1992. However, Watson Brown was quick to remind that Professor Lawson Douglas performed the first kidney transplant in Jamaica at the KPH as far back as September 1970.
“The first one has died, our longest transplant has been 33 years for a young lady. The kidney eventually failed after 33 years and she subsequently had another transplant overseas. She is fine now,” Professor Douglas told the Sunday Observer.
“We keep in touch with all our patients, even the ones that were done in the 1980s, we still see them,” beamed Watson Brown.
Campbell, who had her kidney transplant done at the KPH, had high praises for the renal unit and was happy about the treatment she received during surgery.
“I am quite pleased,” she said. “Everybody rallied around, even a doctor who was no longer here, came back to see how it went.”