Liver transplants: ‘People need to accept the idea of donating organs of deceased loved ones’

Cadaveric transplants need to go up quickly, say doctors.

LAHORE:

At the end of a long corridor on the second floor of the Kidney Centre at Shaikh Zayed Hospital, sit the doctors who performed Pakistan’s first independent liver transplant last month. Now, they are discussing what can be done next.

The four surgeons work at the Hepatopancreaticobiliary and Liver Transplant Unit, Muhammad Arslan Ward at the SZH. The ward has been named after Arslan, a teenager who became Pakistan’s first organ donor. His liver was donated to a 42-year-old after a fatal accident.

The team – Dr Tariq Ali Bangash, Dr Amir Latif, Dr Umar Ali and Dr Khawar Shahzad – is worried about the long list of patients who need a liver transplant immediately. “There are 105 patients on our list who need a transplant right away,” says one of them.

The doctors did not want to be quoted individually because their contracts forbid them from talk to reporters on their own.

Dr Bangash spent many years as a surgeon in Leeds (UK), Dr Latif in Ireland and Dr Ali in China.

The first liver transplant at the hospital was done in August 2011. The rest were live donor liver transplants (LDLT), performed on February 9 February 10 and February 24. The last one was important in that the team performed the procedure independently.

The doctors call it “unfortunate” that there’s only been one organ donation after death so far. They believe that in order for a sustainable liver transplant programme, an effective organ donation system needs to be in place.

The doctors believe that cadaveric organ donation can go a long way in making up the shortage of organs. “People need to start considering doctors extract organs from their loved ones’ bodies when they pass away,” said another doctor. He cited Iran as an example, which has a successful cadaveric programme, he said.

Many countries in Europe have a Presumed Consent system, according to a BBC report, meaning that organs can be removed from an adult who passes away unless they chose, in their life, to opt out.

The UK, the US, Canada, Switzerland, Germany and Australia are among the countries that have an “opt-in” or Informed Consent system: People who want to donate their organs after death get registered during their lifetime.

In Pakistan, organ donation is regulated by the Transplantation of Human Organs and Tissues Act 2010.  The law allows cadaveric organ donation and transplantation. People in need of a transplant need to seek a live organ donation from within their family. In case where blood groups don’t match or there are other complications an Evaluation Committee can allow a person other than a relative to donate his organ. The committee needs to establish that the donation is voluntary.

Donation after death is also allowed under the law. Cadaveric donation is important, according to the four-member team, because it’s less complicated, increases the chances of finding a donor and is cheaper. The cost of medicines in a cadaveric transplant is around Rs2.5 million while that in an LDLT is about Rs4 million. The cost does not include doctors’ fee and hospital costs.

The team believes that donation after death will be more successful in Pakistan than in the West. “The accidental death ratio is quite high here. Those who die in accidents often have very healthy organs,” one said. He said that they had talked with the administration of the Lahore General Hospital where most of the people with head injuries are taken but nothing is possible without the consent of the relatives. “If they don’t want their loved ones’ organs to be transplanted the hospital cannot do anything,” he said.

The doctors refuted the impression that transplants in India were cheaper. “It’s just that they have a bigger infrastructure.” said one of the surgeons.

The procedure 

A patient with a bad liver is admitted to a hospital. A medical board, looks into the case and decides whether the patient really needs a transplant. The assessment takes five to six days. The donor’s case is then sent to the medical board to assess the health of the donor as well the organ. If approved it’s then sent to an Ethical Committee, headed by the sitting chief justice of the relevant high court. The whole process takes around a month.

Published in The Express Tribune, March 4^th, 2012.