THE University Hospital of the West Indies (UHWI) is working to revitalise its transplant programme after the COVID-19 pandemic, funding constraints, and a lack of resources hampered previous efforts.

After launching its transplant unit in 2018, UHWI performed two kidney transplants in 2019 using living donors. However, faced with the challenges of finding suitable living donors, the hospital partnered with the European Union (EU) and the Ministry of Health and Wellness in 2020 to develop a national deceased donor organ transplant programme.

The initiative aimed to address the growing burden of renal failure and end-stage kidney disease in the region. Unfortunately, the onset of the COVID-19 pandemic and ongoing resource constraints hindered the full development and implementation of both programmes.

Head of the Organ Transplant Unit at UHWI, Dr Adedamola Soyibo said that through the EU partnership three doctors were sent to the Donation Transplant Institute (DTI) Foundation in Spain to gain the knowledge and skills needed to get the programme running. However, the deceased donor programme hit a lull.

“There were three phases to the programme. The first phase was to sort of do like an analysis of the system that operates in Jamaica, and then the second phase would be to bring in the specialists to now do training within Jamaica. The third phase would be to implement all of those tools so we can start transplant disease donor programmes.

”The European Union was kind enough to be the sponsor for that programme. Unfortunately, the COVID-19 pandemic killed it. Then the team at the European Union changed, then the ambassador for Spain changed, so a lot of stuff just got left behind and so we are trying to get back onto that,” he told the Jamaica Observer.

Dr Soyibo said discussions are ongoing to follow through with the programme. He noted that a situational analysis was done and a report shared with the university and the DTI Foundation.

“The next stage will be to do a system analysis so we’re going to need to bring in the people to Jamaica so we can start looking at the infrastructure. As it is now, the way it will work is, we have identified where you call the transplant centres now for the deceased donor programme and then you will have centres that will deal with the organ harvesting,” he explained.

“Since we already have a programme in place at UHWI, Cornwall Regional Hospital, and Kingston Public Hospital, those three will definitely be involved in the harvesting and transplantation, whereas places like Spanish Town Hospital, Mandeville Regional Hospital, and St Ann’s Bay Hospital will be responsible for… organ harvesting, and then those organs will now be distributed to the centres that need them,” he added.

The University Hospital of the West Indies (UHWI) has completed eight donor transplants. Overall, Jamaica has performed 63 living donor and 121 deceased donor kidney transplants across Kingston Public Hospital, Cornwall Regional and UHWI.

He noted that while the deceased donor programme has not reached its full potential, the university has completed eight live donor transplants for patients with chronic kidney disease.

“We did two in 2019, four in 2020, and then the COVID-19 came; no transplants were happening, and then we started again in 2022. We did two more, and now we are on our next mission. If you’re reporting that to any transplant programme, that is not good enough… for continuity. You need to be doing more and more, so we are looking at improving the number of transplants that we’re doing,” said Dr Soyibo.

He reported that of the eight living donor transplants performed, two recipients died after contracting COVID-19. Notably, one of them passed away while the transplanted kidney was still functioning. He added that one donor also died from COVID-19, and another transplant recipient died due to post-operative complications.

“We usually measure the success of a transplant programme by death and those who have returned to dialysis; that’s generally how we measure it. The first paediatric transplant that was done, he has returned to dialysis but no longer lives in Jamaica, and then we recently had another one that she just returned to dialysis also. We’re not sure what happened but she had a rejection. She was doing perfectly fine and had a rejection so rapidly,” he told the Sunday Observer.

The remaining three transplant recipients are recovering well. To date, Jamaica has performed 63 living donor and 121 deceased donor kidney transplants across KPH, Cornwall Regional and UHWI.

Dr Soyibo noted that the university currently has approximately 45 dialysis patients who are eligible for transplantation. In addition, some patients have end-stage kidney disease but are not yet on dialysis; these individuals are classified as pre-emptive transplant candidates. However, he was unable to confirm how many of them will eventually require a transplant.

With these targets in mind, Dr Soyibo said the university is aiming to carry out the next round of transplants by September.

“Eventually, we’re going to do two per month but the hope is to at least continue without a lull at all. The idea is that we will still continue to work with the Transplant Links Community but we’re looking at other diasporas — especially those who are in the [United] States — who can support the programme,” he said.

He acknowledged that the high cost of transplant procedures remains a major barrier to the programme’s success, with limited funding posing a persistent challenge. One contributing factor, he explained, is that the required transplant medical tests are conducted overseas, further driving up expenses.

“Funding will allow you to remove some of that barrier, because if you can remove the cost for transplant you’ll have more people coming forward and you’ll have more eligible people. Then, you can have a programme that is running before you can get to the next stage of advertising that you have a programme where people are now going to now come to do transplant, pay for the transplant, and then that will now help your programme to be sustainable,” he explained.

He said another factor needed to keep the programme sustainable is access to affordable medication.

“The National Health Fund (NHF) is covering the cost of transplant by covering the cost of the drugs. Drugs that are used in transplant to prevent rejection can be expensive, and that is a major thing that you have to consider when a person is being transplanted. There are drugs that you also need to prevent acute rejection — the person is quite fine and then something happens, suddenly they have an illness, and the kidney goes down. You have to give drugs to try and prevent that spiral event so those drugs can also be expensive, too, so that’s where NHF comes in.

“The Culture, Health, Arts, Sports and Education (CHASE) Fund has been instrumental in funding, because when we get these overseas persons to come in to do transplant with our local team they provide their airfare, accommodation while they’re here,” he explained.

Dr Soyibo noted that the second phase of the deceased donor transplant programme must be completed to provide the hospital’s transplant coordinator with the necessary support to fully develop and expand the initiative.

“We need to send a clinical immunologist for training. We need to send more younger people, whether they’re nephrologists, whether they’re liver specialists, whether they’re nurses, separate dialysis nurses, or transplant nurses. We need to send those people for training so that when you start your liver programme or your kidney pancreas programme, the personnel and the expertise are going to be in-house,” he reasoned.

Dr Soyibo said the goal over the next three years is to achieve two living donor transplants per month and one deceased donor transplant every six to eight months, to ensure continuity for the transplant programme.