Dear Colleagues! This is Asrar Qureshi’s Blog Post #815 for Pharma Veterans. Pharma Veterans welcome sharing of knowledge and wisdom by Veterans for the benefit of Community at large. Pharma Veterans Blog is published by Asrar Qureshi on WordPress, the top blog site. Please email to firstname.lastname@example.org for publishing your contributions here.
This morning, I read the news on BBC about a young Nigerian man who was lured for a lucrative job in the UK and was brought to UK. He was put up in a hospital for medical checkup as requirement of job, but he smelled rat and ran away and reported to police. The investigations are going on, but it has transpired that he was probably brought so that his kidney could be harvested (without his knowledge) and transplanted in a Nigerian lady who needs a transplant. The ironic part is that the alleged lady is the daughter of a senator in Nigeria who had been instrumental in getting legislation against illegal transplants in Nigeria. The lady has been in the UK for some time, waiting to get the transplant.
Several years ago, when kidney transplant business was raging in Pakistan and some centers were publicly known to be doing this procedure legally and illegally, I happened to take a patient to one such (in)famous private hospital in Lahore. Our reason was to meet a consultant for an entirely different medical condition. As it happens, the medical consultants never see you at the appointed time, so we had to wait. Meanwhile, it was prayer time, and I asked someone for prayer area who directed me to the floor above. There was a lobby in the center of the floor where several people were sitting on sofas. Among them was a tall, hefty American guy who was telling his story in full volume. “You go to internet and search Pakistan; then you search Lahore for kidney transplant, and you will find xxxxx hospital; you go to their site and get their address and come here. I have come from Texas, and I shall buy a kidney and get it transplanted; it is the cheapest here”. After several months, the government decided to crack down on illegal kidney transplant surgeries and that xxxx hospital was also caught. However, they had done thousands of cases already. A similar story ran about a known urologist near Rawalpindi city who was alleged to have helped sell kidneys of couple of entire villages. The illegal donors got couple of hundred thousand rupees in the beginning, which became less and less as supply improved and finally got down to 25-30 thousand rupees. The atrocity and high-handedness have no limit. SIUT – Sindh Institute of Urology and Transplant stands tall in Pakistan because they have always done legal surgeries in the highest professional manner and have helped thousands of transplanted patients live a new, near-normal life.
In 2021, 41,353 organ transplants were performed in the United States: 24,669 kidney transplants, 9236 liver transplants, and 3817 heart transplants. Kidneys are the most transplanted organs worldwide, followed by liver. Both can be donated by living relatives who will keep living normally thereafter.
Kidney Transplant – Need, Procedure, Lure
Kidney transplants are done to help people with chronic kidney disease or end-stage renal (kidney) failure. These patients can no longer function without regular dialysis. The age of the recipient and the donor are also considered; a life expectancy of at least five years is to be there to receive transplant.
The recipient gets the new kidney placed in his/her abdomen and connected to the blood circulation, not in the place of the older kidney, but below it. The older non-functioning kidneys are left as such unless these are likely to become source of spreading infection or some other issue.
Kidney transplant has a history of its own.
In 1954, Joseph Murray and his team performed the first kidney transplant; the donor in this case was identical twin of the recipient. The transplanted patient lived for 20 years. Five months later, Jean Hamburger and colleagues in Paris were successful in doing another identical twins transplant who survived even longer. However, other transplant patients died early and quickly; the main reason being rejection of the new kidney by the recipient body. The doctors knew about it and tried various techniques to suppress rejection, none of which appeared to be working. Less than 10% of the several hundred recipients had survived as long as 3 months in about 10 years.
In 1963, at the conference organized by the National Research Council in Washington, about 25 top transplant surgeons presented their experiences, and all had depressing news of short life after transplant despite various experiments. The gloom was dispelled by the presentation by Tom Starzl, a newcomer to the field. He showed that his immunosuppressive protocol had allowed over 70% 1-year renal graft survival. It was sensational, and though he was contested by the participants, his data was convincing. Immunosuppressive drugs are now standard protocol after kidney and all other transplants. Their use has made it possible for relatives and non-relatives to donate an organ.
Organ donation may come from living people, deceased people, brain-dead people, people dying in accidents, and from those who write a will that their organs may be used after they die.
Kidney and liver donors can still do so while they are alive, and both are expected to live thereafter, though on medication and extra care.
Kidneys are particularly interesting because nature has given us two kidneys and their capacity to function is much more than what is needed in our lifetime. That is why, it is easy for the donor to decide to donate one kidney to a dear one.
Secondly, during the last 70 years, kidney transplant techniques, and related procedures have refined to a great extent. It is now considered a routine surgery.
Thirdly, the availability of a range of immunosuppressive drugs has made it easier to control graft rejection and increased longevity for the recipients.
Fourthly, the donor survival has also improved due to availability of diagnostic and treatment options if a problem occurs.
The above reasons also add to the lure of illegal organ harvesting with or without the information/consent of the donors. While a patient is lying on the operation table, under anesthesia for some other procedure, removing a kidney would not even be noticed by him. There are unconfirmed reports that this might also be happening. Buying kidneys from poor people has been rampant and is still rampant in all countries where a large population lives below poverty line, and the future does not hold much promise. India had been a much greater kidney transplant scam center, and they started earlier than Pakistan. Though government regulations have been put in place, occasional reports of illegal transplant centers keep surfacing. The analogy may be drawn with the drugs trade where despite laws and regulations, the lure of big money keeps pulling people to it.
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