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‘Peradeniya has the expertise’
H.A. Kasun, 14, is from Elahera. He walks around the ward at the Peradeniya Teaching Hospital wearing a mask. He has had a kidney transplant in January, with his mother as the donor.

"He is among seven children who have undergone kidney transplants at the Peradeniya Hospital," says Consultant Paediatrician Dr. Asiri Abeyagunawardena who has also trained in nephrology in England.

The Peradeniya Hospital has conducted seven paediatric transplants, five of which were pre-emptive transplants, since August last year, he says adding that though they do not have their own transplant surgeon, an eminent transplant surgeon from Britain, Dr. Oswald Fernando comes down to carry out the operations.

Adds Consultant Paediatrician Dr. Chandra Abeysekera, "We have a quality team in Peradeniya and at present Dr. M.D. Lamawansa, Consultant Surgeon is undergoing training in transplant surgery in England."

Peradeniya also has dual theatres and support facilities such as a nuclear medicine unit that can carry out tests to detect kidney function before and after the transplant, a radiology department and also a very good path lab, says Dr. Abeysekera.

“We don't need huge facilities. It's the after-care that matters most and we can provide that in our paediatric wards,” explains Dr. Abeyagunawardena adding that soon after the transplant, the children are kept in the intensive care unit and later moved to the ward. "No special units are necessary."

In an open letter to the DG of Health Services, Consultant Anaesthetist Dr. Chula Goonasekera states that the termination of the only available renal transplant programme for children at Peradeniya is worrying.

The mortality and the number of grafts lost are the key indicators of the credibility of a renal transplant programme. All seven children transplanted at Peradeniya are alive and well. This success rate at a newly established programme is a clear indication of the expertise that has gone into this difficult task and the ability of Peradeniya to successfully manage it, he states.

"Renal transplantation in children is a complex process where preoperative and postoperative care involves an enormous workload in addition to what is needed for the operation itself. This is because most children in renal failure are in very poor health due to its effects on growth. Thus, care of these children involve highly specialised services worldwide and hence separate units are established for this purpose with inputs from paediatric nephrologists, paediatric surgeons, transplant surgeons, paediatric intensivists, paediatric anaesthetists, paediatric skilled nursing staff, pathologists, radiologists and experts in nuclear medicine and many others. Paediatric kidney transplantation is neither a process that is dealt by adult nephrologists nor a programme that can be sustained by a surgeon,” he states.

Peradeniya has already proven that it is able to generate the expertise necessary to put this service in place, he says, adding that as there is no dialysis centre for children in the whole of the country, affected children in end stage renal failure would have to die in a very short period unless transplanted.

"Stoppage of this programme shall be virtually a death sentence for such children unless their parents can afford to pay for treatment abroad at short notice," he adds.

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