By Dr Arnaz Maccum

MBBS (UWI), MRCP (UK)
Clinical Fellowship in Nephrology and Internal Medicine RCPE (UK)

The majority of people are unaware that kidney transplantation occurs in Trinidad and Tobago. Kidney donation can happen in two ways; (1) Living donor, whereby a kidney is donated by a relative or loved one; and (2) Donation after death (deceased donor), whereby kidneys are retrieved after someone has died (in a controlled setting like an ICU). The National Organ Transplant Unit (NOTU) of Trinidad and Tobago was established in January 2006 focusing on kidney and corneal transplantation. Dr Lesley Roberts was at the helm of this institution for 12 years since its inception and has done tremendous work in laying a solid foundation for us to build on. One of the main hurdles faced was amending the existing laws to accommodate kidney donation after death. In fact, Trinidad and Tobago is the only country amongst the English speaking Caribbean islands to have such a programme and this was brought into focus as the number of living donors was simply not enough to deal with the number of patients with end stage kidney disease. We have seen an exponential increase in the number of newly diagnosed end stage kidney disease requiring dialysis in the past few years, and it continues to increase annually. These people are alive due to the Ministry of Health’s External Patient Programme (EPP) which provides dialysis at a private institution and no cost to the patient. However, dialysis should not be the final step as complications increase yearly.

Can you live with one kidney? How do I know if I can give my kidney? How much will that surgery cost? These are just a few of the questions family members ask. Firstly, the operation and medications come to no cost to a patient as this is done via the Ministry of Health. To reassure persons thinking of donating a kidney, several studies following up of patients donating a kidney have shown that you can live a normal life with just one kidney. If someone wants to donate to a family member or loved one, the first thing to do is to find out your blood group (which can be done in any laboratory) and once you have a compatible blood group to the person you want to donate to, then more extensive testing would be carried out by the transplant unit to ensure you are fit for surgery, do not have any pre-existing kidney or heart disease and to ensure that the kidney would not be immediately rejected after transplantation. Also, a donor must not be overweight, which is one the more alarming health issues we have in this country as it is the precursor for diabetes, hypertension and kidney disease. Being overweight or obese would also delay someone from donating a kidney as it carries increased surgical and post operative risks. The government of Trinidad and Tobago reported in 2016 that more than 50% of the population over the age of 15 years is overweight or obese and over 40% of the population do not get enough physical exercise weekly. These figures are also reflected throughout other Caribbean countries. As a nation we need to adopt better eating practices and increase our daily physical activity. NOTU is currently housed at the Eric Williams Medical Sciences Complex under the purview of the Ministry of Health. Since the establishment of NOTU there has been 180 kidney transplants (33 being from deceased donors). This may not seem a lot for the past 13 years but given the circumstances and all the hurdles that had to be overcome, I think a lot has been done. In fact, our programme is one of the few amongst the other Caribbean islands that is self-sustained, and does not require surgical support from outside the region. The success rate of kidney transplant done in Trinidad and Tobago, is also comparable to international standards, with the one-year kidney survival rate being close to 93%.

There are currently hundreds of people in need of a kidney transplant (at present there are close to 1000 people on haemodialysis, around 90 people on peritoneal dialysis and many others with severe kidney disease who are close to needing dialysis) and that number continues to grow annually. Most of these people are on the kidney transplant waiting list, they do not have someone to donate a kidney to them and are hoping to get one from a deceased donor. There are people who also die every year waiting on a transplant reflecting that the demand for organs greatly surpasses the supply. The ones who are fortunate enough to get a kidney transplant have gotten a second lease on life and do much better physically and emotionally as they no longer rely on dialysis to stay alive. We all can do our part to help our fellow citizens achieve this and sign up to be an organ donor. Anyone on dialysis, who is deemed fit for a kidney transplant by their doctor can be referred to the NOTU at the Eric Williams medical Sciences Complex along with their potential donor who must be over the age of 18 years. Anyone wishing to become an organ donor can fill out an application form on the Ministry of health website (http://www.health.gov.tt) and drop it off, fax or email to the transplant unit (email: notutt@hotmail.com; fax: (868)662-7556; Tel: (868)-663-5534/7663).