WITH a significant number of Jamaicans suffering from end-stage chronic kidney disease and other life-threatening conditions that require organ transplants, medical professionals are advocating a robust and comprehensive national transplant programme that raises awareness and encourages more citizens to become donors.

While transplant programmes currently operate at three major hospitals — Kingston Public, Cornwall Regional, and University Hospital of the West Indies (UHWI) — Dr Andrea Mignott, organ transplant coordinator at UHWI, and Dr Adedamola Soyibo, head of the Transplant Unit at the university, noted that these centres are not yet self-reliant and require increased investment in the training of local doctors and additional resources.

They also highlighted that a lack of public awareness about organ donation, along with necessary legislative reforms, continues to hinder the full development of a comprehensive national transplant programme, and there are steps needed to make it successful.

With an estimated one in seven Jamaicans diagnosed with chronic kidney disease Dr Mignott said the preferred choice of treatment is a transplant to remove and replace the defective organ.

SOYIBO… some countries have opt-in and opt-out deceased systems, which can be adopted in Jamaica

“I support and hope that we will get to the stage where we have a very good national programme because too many people are diagnosed with chronic kidney disease. When you have a transplant programme you can have more people getting a kidney transplant and now being able to go back to work and be productive. With a national programme we definitely need training of personnel in various fields so that we have the ongoing investigations being done,” said Dr Mignott.

She noted that the current Jamaican transplant programmes are not self-sufficient, and procedures such as human leukocyte antigen typing and cross-matching — which are crucial processes in organ and stem cell transplantation to ensure compatibility between donor and recipient, minimising the risk of rejection — are done overseas.

“If we had that, if we had a person doing that, then that would make life easier for us here. We want transplant surgeons, we want transplant physicians, transplant nurses, and transplant coordinators for the various organs. If you’re doing heart, we want a transplant coordinator who deals with the heart and stuff like that — and having all of those persons here is what would make a national programme a success.

“More people would benefit from transplants, which is the way to go — not to be on dialysis for any long time. Even having a transplant before getting to go on the dialysis machine — pre-emptive transplant — is one of the best options to have,” she told the Jamaica Observer.

Dr Mignott also emphasised the need to raise awareness about organ donation in Jamaica, and sought to assure individuals who are considering donation that they can do so and maintain their quality of life.

Jamaica has performed 63 living donor and 121 deceased donor kidney transplants across KPH, Cornwall Regional and UHWI.sturti

“As it relates to kidney donation, people out there need to know that you can live a normal life with just one kidney. I believe that you’ve got two to share or give one. If something happens to your relative or a friend, you can give. You can still father a child with one kidney, and you can still be a mother with one kidney. It is okay. You can live a normal life with just one kidney,” she assured.

“Just imagine the joy of the person receiving that transplant after you’ve donated your organ and you see that person, all of their skin colour is coming back and they’re looking as well as they were before. For those who were not making urine, they’re now making urine after getting a kidney. It is good to be an organ donor and to give someone a second chance at life,” said Dr Mignott.

She said strengthening a national transplant programme will also require changes to the legislation and policies that govern organ donation in hospitals across the island. Additionally, she emphasised the need for a comprehensive registry and identification system to effectively track both donors and recipients.

During her contribution to the State of the Constituency Debate in the House of Representatives in 2022, Member of Parliament for St Thomas Eastern Michelle Charles called for a national campaign to encourage organ donation. She said that consideration could be given to adding an organ donor designation on the National Identification (ID) card issued under the National Identification System (NIDS).

Dr Mignott and Soyibo said in many countries, symbols are placed on prospective donors’ source of identification, such as their driver’s licence, and this is a practice that can be adopted. However, they warned about the ethical considerations.

“Patients might question: ‘If I turn up at a hospital, will I get the care that I need?’ They might think, ‘If I’m an organ donor they’re not going to look after me, and they will just allow me to die because they need my organ.’ It may not even be viewed by the patient, it might be viewed by their next of kin or their family, and that will raise a whole lot of concern, but that’s something that has been done and that’s something that I would also advocate for,” Dr Soyibo told the Sunday Observer.

He further noted that some countries have opt-in and opt-out deceased systems, which can be adopted in Jamaica.

“You can make a national legislation that anybody who comes into the hospital who is pronounced or deemed brain dead should be considered as an opt-in as an organ donor, just straight off the bat. Some countries do that, and then some countries do opt-out, meaning you have to ask, and then you say yes.

“For opt-out it means, automatically, if nobody objects you are going to be an organ donor, so you have to tell them that you don’t want to be an organ donor in one instant. So, these are different models,” he explained.

Dr Soyibo further noted that the crime rate in Jamaica and motor vehicle crashes create an environment in which deceased donor programmes are possible.

“We have a lot of people who die from trauma, and believe it or not, those are the perfect people for organ harvesting and transplantation. But it’s a very peculiar, very funny topic to touch on — motor vehicle accident victims and all those things — because these are young individuals, mostly males, that are involved,” he explained.

“…The danger with that is, you don’t want people to be killed for their organs, so it’s a balancing act that we would definitely have to do,” he added.