Dr. Lesley Ann Roberts
On Monday January 2nd, 2006, Ms. Roberta Francis, secretary of the newly minted National Organ Transplant Unit (NOTU) and I stood outside the door of Building 11, Ground Floor, Eric Williams Medical Sciences Complex. As we turned the key and entered what were supposed to be the temporary offices of NOTU, little did either of us know that we were opening a portal for the peace of mind of so many kidney patients and their families.
It was a momentous occasion!
Finally, there was a Medical Unit within the public health sector that was dedicated to conducting organ transplants. Because the Human Tissue Transplant Act had been proclaimed, deceased donor transplantations would now be possible. The face of kidney transplantation was about to be changed in Trinidad and Tobago since the ability to obtain kidneys from deceased donors meant that many more persons would benefit from this wider donor pool.
Kidneys were the first organs to be transplanted. Our dialysis population was increasing exponentially. The high prevalence of Diabetes Mellitus and Hypertension in our population fuelled the number of people who required kidney transplants, but also limited those who could donate a kidney. Utilizing kidneys from deceased donors would significantly impact the care of patients who required kidney replacement therapy.
The first successful kidney transplant from a deceased donor was performed in 1964 when immunosuppression for transplantation had improved significantly. Our first deceased donor kidney transplant was performed on August 2nd, 2007.
As I reflect on my transplant experiences locally, I believe that my most memorable and inspirational moments were birthed during my involvement with the deceased donor programme. In addition to the relevant clinical and scientific processes that must be in place, there are so many more intangibles such as personal relationships, societal norms and perceptions which impinge on the success of this programme.
On that unforgettable day in August 2007, when the first deceased donor was identified and all the preparatory work done; two kidneys were obtained, two recipients were identified, and their cross matches were negative, anaesthetic clearance had been obtained and surgery was scheduled. I sat in the theatre to witness that historic occasion; but nothing happened. The vessels of the donor’s kidney were attached to the recipient’s, we detached them, we rotated the kidney, we flushed it, still nothing happened, the kidney just was not “pinking up”. I was horrified, this could not be happening. The kidney had to be discarded.
I immediately informed the surgical team that the second transplant should be aborted. The attending surgeon protested and said to me,” What! How can you? I have been waiting all night to do this surgery.” Because I feared another failure, I was adamant, but after a few moments, I recanted. On reflection, I realized that too many persons had invested in this experience: the surgeon, the team, the patient and her family. We could not just discard the kidney without trying and dash the hopes and expectations of all because of my fears and disappointment. So, with a prayer, trust, hope and belief we performed the second case.
Oh, what a great decision that turned out to be!
This year after thirteen years she passed on with a functioning kidney. During the time with her new kidney, she was able to live life to the fullest. She saw her young daughter complete university and care for her mother who had cared for her in her pre transplant period.
Patients on dialysis are survivors. Their quality of life is not good. Dialysis cannot replace all the functions of the kidney and ideally the best treatment for patients with kidney failure should be transplantation. An active deceased donor programme would significantly improve their chances of receiving a transplant.
Patients who have been transplanted see the world differently; they are no longer surviving, they are living. They glow externally, their life has added meaning and new purpose. They are eternal optimists despite counselling and detailing all the pitfalls that can be associated with transplantation and the fact that the drugs must be used indefinitely. It is sometimes challenging to provide the appropriate advice that can bridge expectations and reality, but this must be done.
We transplant organs but must never forget it is people with whom we deal. This is so evident when we realize the relationships that are fostered between “kidney brothers and sisters”. This is the term the recipients give themselves when they receive organs from the same donor. Previously strangers, they find themselves joined by an unbreakable bond, sharing the same “birthday”, being grateful to the same person and as a result becoming each other’s brother’s or sister’s keeper. They support each other in all endeavours, both personally and medically, sharing medications when they are in short supply.
But, the most important lesson for me in this cycle of life is the intangible that is known as a team – having to rely on others, to trust in them as we work together for the same, single purpose. There could be no programme without the input of the myriads of laboratory technicians and personnel involved in the transplant process, the staff of NOTU, the staff at the ICUs and operating theatres at all the other public hospitals and the indefatigable persons we call Transplant Procurement Managers.
Who are these angels? They perform a difficult and exceptional job in addition to their substantive roles in their respective Health Authorities. Transplants occur because of them as they are responsible for the management of potential donors. They get consent from families and care for the donor until retrieval is done. Without donors transplants can’t occur.
The Donor Transplant Institute, an organization from Barcelona, Spain has had a significant input and impact on our deceased donor programme. Because of their input, I have adopted two philosophies – (1) Hospitals are for the living as well as the dying and (2) An organizational chart for the procurement of organs is as important as one for the management of the transplant process.
Through the decades, the history of transplantation has been strewn with barriers; one by one they have been overcome and the deceased donor programme in Trinidad and Tobago is no different. This programme has taught me to be more trusting of my colleagues; embrace relationships both new and old as they become your pillars of strength in the face of adversity and to have a deep and unending faith in God. As the programme matures, may it continue to survive and live on.