MUCH has been written and more have been heard on the dilemmas surrounding kidney transplantation in the Philippines today. Unfortunately, by spreading only the abuse suffered at the hands of unscrupulous men and women who prey on patients with kidney failure hanging on to dear life, and the willing living kidney donor, the progress forged by Filipino transplant physicians is being trampled on.

Science has continuously sought to improve patient’s lives. The dream of transferring someone else’s body part to another to save his life was something you only watched in the movies. Yet in the past two decades, scientists found a way to successfully perform this miracle.

By improving the techniques of this procedure, by optimizing the fluid to bathe the newly taken body part, by optimizing medications required to overcome the body’s florid response to a foreign body, transplantation swiftly became a reality and an option for the 10,000 Filipinos who develop kidney failure each year.

This path was not easy. It took transplant physicians and their partners in the medical field years to develop the expertise, the chutzpah to tread the challenges of this new frontier.  Today, the National Kidney and Transplant Institute (NKTI) performs around 200 to 300 kidney transplants every year, a number larger than what the best transplant centers in Asia and even in the United States do. In the past four years the NKTI, partially subsidized by the national government, was able to bring this option to between 80 to more than a hundred patients with kidney failure, whom otherwise would have never been able to afford this miracle.

About a third of the transplants performed at the NKTI involve a bus driver, a farmer from Pampanga, a public grade school teacher, and a policeman in one of Metro Manila’s biggest cities.

Diabetes and hypertension

Developing kidney disease in the Philippines today affects the socio-economic life of a family, rather than just the individual. Once a patient starts dialysis, another member of the family or a caregiver becomes essential to care for this life-long treatment.

Oftentimes treatment is inadequate and the patient, who used to belong to society’s strong labor force contributing to the nation’s coffers, slowly sees his life force drained. Coughing out more than P30,000 a month on dialysis and medications cannot be sustained more than a year by the nation’s middle class. The patient’s security and savings run out and he becomes too weak to return to work, and rather spends the energy he has looking for ways to pay for his next treatment. His family members also focus on how to pay for his treatment. Savings for the education of their children, for a house they wanted to buy, all have to be siphoned off to pay for their brother’s dialysis.

This is the story of so many Filipinos afflicted with diabetes and long-standing hypertension that are the leading causes of kidney failure today. It is the story of your brother, your uncle, your neighbor or your teacher. No longer is it something you read about in the paper; it is your brother’s life.

Best option

SURVIVAL is one of the deepest, strongest and most unstoppable of human instincts. People fight to live, they look for options, they want their old lives back.

Undeniably, if dialysis is adequate, the patient continues with his normal way of life, but unfortunately this is not the reality for most Filipinos. The option of kidney transplantation becomes their dream. It is the only way back to the life they have lost.

Thanks to improvements in science, a living donor becomes the best option. A living donor results in the immediate function of the transplanted kidney and a quicker way to recovery. The patient applies to the national deceased donor program (organs from patients who are brain dead and whose families give their consent for the organs to be taken), but less than 30 transplants from deceased donors are done each year.

A relative is asked but diabetes and hypertension are commonly inherited diseases that run in families. What hope does this patient have? A distant relative, more distant relatives, an acquaintance, an anonymous donor?  Or does society quash his hopes for a new beginning?

Science has proven that living donors provide the best results than even the best matched kidney from a deceased donor. The living donor is healthy and free from disease.

Indeed, a transplanted kidney from a living donor starts producing urine as soon as clamps pressing on vital blood vessels going to the kidney are released.          

Transplantation becomes successful whether your donor is your brother, your nephew, your third cousin, your husband, your jogging partner, your officemate, or even someone you don’t know. Yes, science has allowed transplantation from these donors to whom you are not related, to become successful.

These advances in science made transplantation an easier option for Filipinos.  An extended family, a huge network of friendships from church, from various organizations made the option of transplantation easier.

The patient has a larger community from which a donor is possible. When the operation is completed, the patient has his life back, is well on his way to recovery. His gratitude is profuse, and he gives a gift for his donor’s sacrifice. He could never repay his donor enough for allowing him a second chance at life.

Brokers not eliminated

Unfortunately, the success of transplantation from nonrelated donors is not lost on unscrupulous people who seek to profit from patients desperate to have a kidney transplant and have no relative or acquaintance who can donate their kidney. The organ broker preys on these patients, and preys on people to be their donors for profit.

To eliminate the broker and to safeguard the donors from these profiteers was exactly the objective of the Department of Health in its issuance in 2002 of the Administrative Order regulating kidney transplantation from the living nonrelated donor. The donors were provided with health care from Philhealth, life insurance and livelihood or educational incentives. Their donation saved another’s life.

Should the debt of gratitude be limited? Shouldn’t it in fact be as much as one could offer?

However, implementation was inadequate and its provisions were not enforced. The brokers were not completely eliminated.

To meet this challenge, the Administrative Order was strengthened and revised this year, after a program implementation review showed its weaknesses and the areas that needed to be improved. The Implementing Rules and Regulations are now being formulated so that the safeguards to the living donor will be steadfast, monitored and safeguarded.

Media reports

A LOT of media time has been spent exposing the abuses to the living donor. This is time well spent so that the abuses should stop, and the living donor be safeguarded.

Unfortunately, transplantation was presented as a means to enrich oneself without regard for the patient. It was denigrated as a practice meant to lure hapless donors, and, worse, the Philippines was presented not as a leader in the science of transplantation but demeaned as a source of cheap donors.

We in the transplant community cannot disagree more. We should all be able to distinguish the abuse in transplantation from the act itself. Just because there were abuses in the care of the anonymous living donor does not make transplantation from these donors wrong. It means that the abuses should be stopped and provisions to prevent them strengthened.

To use an analogy, a knife can kill, but it is also the best implement to hunt an animal, to peel crops to eat. That it can kill does not make it a negative implement; it means that one uses it with respect and caution. Unfortunately, those who present the abuses suffered by hapless donors use these as evidence that the act itself is wrong.

This brings all patients suffering from kidney failure hanging at the end of the argument. What lies in future for the middle-class Filipino who does not have a relative since most of those close to him may be afflicted with the same disease? Should they be committed to death once they can no longer afford the treatment needed because they have no relative or acquaintance?

We in the transplant community certainly do not believe so. Let us separate the abuse from what science has shown us to be fact in the 21st century. Anonymous living donors can give a kidney, and forge new beginnings.

***The author is chairman of the department of Adult Nephrology, National Kidney and Transplant Institute.

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MUCH has been written and more have been heard on the dilemmas surrounding kidney transplantation in the Philippines today.