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Issue 46 - March 2014 Official newsletter of the South African Transplant Society Vol 13 No 1 Issue 46 - March 2014 Editorial Professor Jerome Loveland Editor owards the end of this edition of Consequently, those patients that are fortunate enough to Transplant News, one will come across have access to private health insurance are then entirely at an advert for “The Heart of Cape Town the mercy of the healthcare funders and the confusing terms Museum”, which pays tribute to the and conditions of their contracts. world’s first heart transplant, performed on Louis Washkansky by Chris Barnard To answer many of these questions, and clarify some on the 46 years ago. What a privilege that the history of uncertainty, Elsabe Klinck has written a superbly informative transplantation has such a strong South African foundation. piece on the ethical and financial issues facing transplant patients, particularly those funded in the private sector, which In the early days of transplantation, all of this work occurred I would encourage all patients, administrators and healthcare in our world-class provincial/government facilities, which providers to read. I personally found it most beneficial. It at the time were pillars of excellence in healthcare, not only demystifies the cost of healthcare in this environment and with respect to transplantation, but all aspects of medicine. enlightens one on the rights of the patient. Today, an ever decreasing percentage of end-stage organ The tragedy lies in the fact that this article is necessary in the failure and transplantation occurs in these hospitals, with first instance! many patients not being afforded access to this care or being forced to the private healthcare sector to seek it. It is an absolute travesty that the Department of Health has allowed this situation to develop and enormous emphasis needs to be placed on restoring these services to the previous high levels of clinical excellence. As a result of this global collapse in many disciplines of state healthcare in South Africa, an enormous necessity for private healthcare and consequently private health insurance has emerged. Whilst playing a pivotal role in funding transplantation in the private sector, this has two significant disadvantages. First of all, it is an absolute disincentive for the state sector to improve their service, and secondly, fiscal control of the entire process becomes driven by the insurer, not the insured. Production Editors: Ann Lake Publications: Professor Jerome Loveland Professor Russell Britz Ann Lake/Helen Gonçalves Head, Dept of Paediatric Surgery General Vascular Design: Jane Gouveia Chris Hani Baragwanath Academic Surgeon Sponsor: Astellas Pharma Hospital, University of the Witwatersrand Wits Donald Gordon Enquiries: Ann Lake Publications Editorial and Transplant Surgeon, Wits Donald Medical Centre Tel:(011) 802 8847 Board Gordon Medical Centre, Johannesburg Johannesburg Fax: 086 671 9397 Email: [email protected]; www.annlakepublications.co.za The views expressed by the editor or authors in this newsletter do not necessarily reflect those of the sponsors and publishers. The South African Transplant Society Website: www.sats.org.za This newsletter was made possible by an unconditional grant from Corneal transplants: The gift of sight Dr Eduard Sevenster Ophthalmologist Pretoria Eye Institute Pretoria lindness secondary to cor- are transplanted, thereby significantly neal pathology is a major enhancing safety, improving the quality cause of visual disability of vision and shortening the recovery worldwide, affecting at time. least ten million people. Most of these patients can Unfortunately these techniques are be successfully treated and can regain use- extremely costly and dependent on ful or even normal vision after corneal many factors, including the skill and transplantation. training of eye bank technicians, as well as corneal surgeons. Approximately 150 000 corneal transplants (keratoplasty) are performed annually 80% of transplants are still functional worldwide, and there are several million after twenty years – making it by far the people alive today who can see and lead most successful transplant procedure. better quality and more productive lives. Approximately 10% of keratoplasties undergo rejection. The first successful corneal transplant was performed in Germany in 1904 by Dr Eduard It is the cheapest and There is a great need for more donor cor- Zirm. New technologies in microsurgery most cost effective neas, especially in developing countries. and new drugs to counter rejection transplant in medicine These shortages are due to financial con- transformed keratoplasty and made the straints, insufficient eye bank resources procedure safer and more effective. in terms of quality- and inadequate numbers of trained eye adjusted life years bank personnel. However, as with all It is the cheapest and most cost effective other organs, the ultimate factor limit- transplant in medicine in terms of quality- gained. ing corneal transplantation is insufficient adjusted life years gained. New techniques, procedures, numbers of organ donors. Ignorance, cultural differences, re- materials and medicines are constantly improving. ligious taboos, and political ineptitude are the reasons why people with treatable corneal blindness are not being helped A major step has been the development of lamellar in sufficient numbers. keratoplasty, where only either the anterior or posterior layers In South Africa there are tens of thousands of potential donors Dr Eduard Zirm, annually, yet our society places numerous obstacles in the way of utilising this precious resource. Currently, about 800 corneal an Austrian transplant procedures are performed in South Africa per year, surgeon, but by far the majority of donors are imported from developed performed countries with enlightened legislation and regulations, which promote rather than hinder transplantation of donor human the first semi- cells, tissues and organs. successful corneal The enemies we have to conquer in our battle to enhance transplant - and the “quality” and “quantity” of life of our fellow human the first successful beings are ignorance, apathy, prejudice and fear. The human organ weapons we have at our disposal are empathy, skill, dedication and perseverance. Fortunately these attributes transplant in are available in abundance in the whole community of 1905. transplant medicine. Transplant News 2 Vol 13 No 1 Issue 46 - March 2014 Giving of yourself Joanne Lillie Health Journalist Source: www.discovery.co.za There is a critical shortage of all donor organs for desperately ill patients, particularly kidneys, in South Africa. It’s the one organ you can donate while you’re still alive. igh school friends Duane Galloway Kidneys are by far the most in-demand organ in South and Clayton Powell (both 38) hope Africa. The diseases that contribute to the great need for to share more than a few old kidneys in SA are essential (genetic) hypertension, especially memories and class photographs. in the black population, diabetes (especially in white and They are making preparations for Asian population), glomerulonephritis and pyelonephritis Duane to become a live kidney (inflammation of the kidneys) and inherited diseases such as donor for Clayton later this year. polycystic kidneys. “We remained a close group of friends after school and several When disease causes kidney failure, dialysis treatment can of us offered Clayton a kidney. He never wanted to take one, take over the function of the kidneys, but transplantation is but at some point he had no choice,” says Duane. “I was a blood the ultimate aim for all end-stage kidney failure patients. group and tissue match.” Many more people are probably eligible for kidney Clayton and his brother were both diagnosed with end-stage transplant, but experts don’t have an accurate picture of the renal failure at the age of 21. He has already had two kidney numbers as people are turned away from dialysis centres transplants and since the last one failed in 2003 Clayton, a in the state system daily as there are just not enough keen poker player, has been on dialysis. “I go to the clinic machines. three times a week for four hours at a time. My biggest problem at the moment is my heart condition; ten years of One year after transplantation, about 90% of transplanted dialysis has taken a toll. Due to my history of transplants and kidneys are still functioning well. After five years, over 60% blood transfusions, I have built up antibodies, which means are still healthy and overcoming the need for dialysis. Some my body will reject any transplanted organ at this point,” he kidney transplant patients have survived for more than 30 says. For this reason, Clayton’s last hope is a live donor. years. “Clayton is currently undergoing desensitisation procedures, How to register to become an organ donor which he does once a month for five months, to trick his You can save 7 lives by becoming an organ donor (heart, blood into liking mine,” says Duane. Desensitisation aims liver, pancreas, lungs, kidneys) and 50 lives by donating to reduce the number of antibodies in Clayton’s blood and tissues, such as corneas, bone and skin. (No organ or match it with Duane’s. After the last session, Duane will tissue donations from deceased donors leave the body be tested again and all going well, the transplant will be disfigured.) scheduled shortly after that. Discovery Health has approved the desensitisation medication (which costs R60 000 per Register online at: http://www.odf.org.za/ or toll free by month) and given the go-ahead for the transplant to be fully phone: 0800 22 66 11 or email: [email protected]. You funded. In the meantime, the Department of Health needs to will receive an information brochure, a donor card for your approve the procedure, as it’s fairly rare as the transplant is wallet and organ donor stickers to put on your ID and driver’s between two people who are not related. licence. Live donations are almost always between close relatives, Don’t forget to discuss your decision with your family, so often from a parent to a child, or between siblings, because when the time comes, they can act on your wish.
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