Bridging the kidney gap

As the health sector, equipped with only a limited number of dialysis machines, is unable to treat all renal failure patients, a voluntary group launches a wide-ranging plan to help them.

By Kumudini H.

"A 27-year-old mother of two, with the blood group A Positive, needs a kidney transplant urgently. Her family appeals to any potential donor to contact them immediately."

Numerous such appeals are published in the newspaper. It does not matter whether you are male or female, young or old. It may creep on you silently and estimates indicate that around 8,000 people suffer from renal or kidney failure, with 50% being between 40 and 60 years.

For most, hope lies in frequent dialysis and finally a kidney transplant. Renal failure is when the kidneys fail to remove the "waste" and purify the blood in a person's body. Patients suffering from renal failure fall into one of two categories 'Acute Renal Failure' (ARF) or 'Chronic Renal Failure' (CRF).

A nurse attending to a kidney patient undergoing dialysis at the Kalubowila Hospital

Some of those with Chronic Renal Failure are at the end-stage, when renal replacement therapy, lifelong dialysis or a kidney transplant, is the answer, explains Professor Mandika Wijeyaratne, Chief Transplant Surgeon of the Colombo University's Faculty of Medicine, Kidney Transplant Programme.

Patients with Acute Renal Failure will only require the use of a dialysis machine, for a short period, until the kidney rejuvenates itself but those with Chronic Renal Failure may need haemodialysis up to thrice a week, for life, or until they undergo a kidney transplant, The Sunday Times understands.

Can Sri Lanka cope?

"There seem to be too many patients with too few dialysis machines," says Prof. Wijeyaratne, adding that the National Hospital in Colombo has been providing haemodialysis since the early 1980s and the surgical unit has been performing kidney transplants since the mid-1980s.

About 11 state hospitals around the country provide dialysis, with the largest numbers being handled in Colombo and Kandy, it is understood.

The general feedback from nephrologists being that the facilities available are inadequate and seeing the critical need of these people led to the formation of the Kidney Transplant Support Foundation, a non-profit volunteer organization, says Founder and Chairman Ajit F. Perera.

Giving some shocking data, he says an estimated 8 out of 10 patients die within two years due to lack of resources. "Whereas more than 1,000 dialysis machines are required to keep patients suffering from chronic renal failure alive, only about 100 machines are available both in the state and private sectors,” points out Mr. Perera.

"Those who have reached the end stage of CRF are the worst-affected because they do not gain priority to use the limited number of dialysis machines available in the country. Nor do they possess the financial capability to sustain the level of dialysis needed to enjoy a quality life. Many patients die unless they receive a transplant. This is not often possible, as donors are not available to donate a kidney," he says.

According to Mr. Perera, with more than 5,000 patients receiving treatment at the National Hospital, a substantial number are pronounced brain dead with head injuries, brain haemorrhage etc. "The kidneys of brain dead patients who average two to three a week at the National Hospital could be harvested for transplants, if the next of kin is willing, but there also needs to be an adequately ‘dialysed’ patient pool to receive these kidneys," says Mr. Perera who has gathered data from doctors at the hospital.
The objectives of the Kidney Transplant Support Foundation, formed on February 15, this year, are:

• Creation of a dedicated dialysis unit with about 15 machines close to the National Hospital to cater primarily to those eligible for a transplant. This will be followed by similar centres in major cities. This service is to be provided free or at cost, depending on the funding available.
• Establishment of a pool of properly dialysed patients from which suitable candidates could be identified for transplant, as soon as a matching kidney is available.
• Increasing access to affordable and reliable medical care facilities for Chronic Renal Failure patients of low income families.
• To complement this, launch a National Organ Donor Programme where "live" non-related donors will grant consent when in a sound frame of mind, to enable harvesting when they are dead.
• To formulate a comprehensive database of all those who need a transplant and those who wish to be potential donors, so that "matching" and "compatibility" could be established to facilitate transplants.
• Launch a campaign to educate and counsel the next of kin of those who are potential donors, of the need to consent, so that another may live.

The Kidney Transplant Support Foundation has already got membership of the International Federation of Kidney Foundations, a prestigious world body, says Mr. Perera adding that the Sri Lanka Institute of Directors, launched under the auspices of the Ceylon Chamber of Commerce, has also endorsed it.

Health Minister Nimal Siripala de Silva has agreed to provide a location for the dialysis unit close to the proposed National Institute of Nephrology, Dialysis & Transplantation in Maligawatte, Mr. Perera explains, adding that the Foundation would get the machines through donations or buy them through fund-raising campaigns. "Medical staff would be sought on secondment from the National Hospital, to treat the patients for which payment would be met by the Foundation, while the administration of the unit will be handled by the Foundation."

Stressing the need for sustainability, he says the project, within 15 years, would establish an endowment fund that would contribute to its financial stability, continuity and expansion.