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| Crucial
meeting to settle controversy over paediatric transplants at Peradeniya
Hospital Last Wednesday, the Director-General of Health, Dr. Athula Kahandaliyanage himself was in Peradeniya to discuss this issue with the consultants there. Peradeniya Hospital had begun kidney transplants for children with the help of transplant surgeon Dr. Oswald Fernando based in England in August 2004 and so far has performed seven. Currently, the DG has instructed the Peradeniya Teaching Hospital to halt paediatric transplants, on the grounds that the Kandy Teaching Hospital with its well-established nephrology unit has been handling transplants for several years. However, the Peradeniya Hospital consultants argue that Kandy is mainly dealing with adult transplants and there is a long waiting list for paediatric transplants, which they are capable of performing and without which many children who need urgent transplants may die. "One of the main issues discussed during the two to three hours I spent at Peradeniya was about the paediatric kidney transplants done there," said Dr. Kahandaliyanage, explaining the procedures and systems needed to ensure a successful medical unit whatever the "finer speciality". The Peradeniya Hospital is a teaching hospital set up to teach undergraduate and postgraduate medical students. The consultants serving at Peradeniya are partly at the university, with their main mandate being to teach these students while providing a service to the patients, who are needed for clinical studies. The Health Ministry manages the Peradeniya Hospital while the consultants are higher education people, he says. The Peradeniya Teaching Hospital is geared to handle the five basic disciplines of medicine, surgery, gynaecology and obstetrics, paediatrics and psychiatry that should be taught to the students, says Dr. Kahandaliyanage stressing that it is not supposed to bifurcate into the finer specialities such as nephrology, orthopaedics, ophthalmology etc. On the other hand, close by is the Kandy Teaching Hospital with these basic disciplines and also the other finer specialities. "Millions of rupees have been spent to establish a separate fully-equipped nephrology unit in Kandy to manage kidney transplants. Therefore, they can look after the paediatric cases as well. This nephrology unit serves as the centre of excellence for nephrology outside Colombo," says the Director-General, adding it is fully equipped with dialysis machines, drugs and trained staff where patients after a kidney transplant will get proper after care. So far the Kandy nephrology unit has carried out 188 kidney transplants, including one paediatric transplant and 10-15 transplants for children between 12-18 years, says Dr. Kahandaliyanage. The Sunday Times learns that the first paediatric transplant was done in Kandy in 2002 and recently even four cadaver adult transplants. Can Kandy handle the workload with more and more people including children needing transplants? This is a humane issue and there is a need to sort it out, says the DG who is in the process of exploring the possibility of the Peradeniya doctors using the facilities of the Kandy nephrology unit to help clear up the waiting list for paediatric kidney transplants. "It is very easy to start without the proper facilities but when something goes wrong who will be held responsible”, asks Dr. Kahandaliyanage. As the implementer of health policy, he emphasises that nothing should be started on an ad hoc basis. "There must be continuity and sustainability. Resources are limited and cannot be wasted. These are life and death issues. The Health Ministry will be held responsible if something goes wrong and the public will question the ministry as to why we allowed Peradeniya Hospital to perform kidney transplants without proper facilities." |
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