Transplants move closer to reality

Four and a half years ago, a Caymanian brother and sister were wheeled into an operating theatre in Houston, Texas, to undergo a kidney donation and transplant.

Nicholas Powery, who was 18 at the time, had been diagnosed as having failing kidneys seven months earlier and had gone on an international donation waiting list for a kidney. However, tests showed that his sister Keisha Syms was a perfect match, so in May 2006, Nicholas got a new kidney and a new lease on life.

Despite both being from and living in Cayman, the siblings had to travel to Houston for the operation because it is illegal to donate or transplant kidneys or any other organs or human tissue in the Cayman Islands.

The groundwork for new legislation, which will enable human tissue and organs to be harvested and transplanted locally, is being drawn up by the Organ and Tissue Transplant Review Committee, consisting of lawyers, government representatives and medical professionals, among others.

Dr. Frits Hendriks, a nephrologist or kidney specialist, is one of the medical representatives on the committee, along with Dr. Steve Tomlinson of the Chrissie Tomlinson Memorial Hospital and Dr. Greg Hoeksema, medical director of the Cayman Islands Health Services Authority.

Speaking in a personal capacity rather than on behalf of the committee, Dr. Hendriks said having local transplants and donations would be a huge boon for the people of Cayman, but that as a new law, it was vital to ensure that people understood clearly what it entailed.

“It is very important to educate people about the change in the law which permits the doctors here to perform organ donations and transplants. There has never been organ donations here on site,” he said.

Caymanians have been recipients of hearts, lungs, kidneys, corneas and other organs over the years, either from the United States, which makes 5 per cent of its organs available to non-US residents, or from living relatives or friends.

“That means only one out of 20 [organs from the US] could go to a Caymanian,” he said. Even then, there is no guarantee that the donated organ will be a match to the recipient or that the patient will be able to get to the hospital in the US in time to get the organ if it has already been harvested.

One person can save up to eight lives through organ donations and tissue donations can enhance the lives of up to 75 others, according to GiftLife donor programme, based in the US.

The life spans of organs are limited once they have been removed. A heart, for example, should be transplanted within four hours of being harvested, while kidneys can still be implanted within 36 hours.

One of the main benefits to Cayman of a new law that will allow local transplants and donation is that the patient, the donor and their families will not need to travel off Island or incur the cost of airfares and hotels during the pre-op and post-op periods, which can last three months or more.

“It will be fantastic for Cayman. The family can stay here, the patient can stay here and the donor can stay here,” Hendriks said.

The Powery family agrees. Nicholas’ sisters, parents and close friends spent three months travelling back and forth to Houston and rented an apartment for three months.

His mother Dolcy Powery said that while insurance covered the costs of Nicholas’ operation, the family paid for its own travel and accommodation costs.

“We’re a very close family with aunts and uncles who would have been there for support if [the operation] had happened here. They were always calling to find out how everything was going,” Mrs. Powery said.

Before the operation, Nicholas’ sister Keisha stayed in Houston for a week to undergo tests to ensure she was a suitable match, returned to Texas a week before the operation to prepare for it and then afterwards spent five to six weeks recovering from the surgery.

“I have two small kids, I had to get them looked after and get my family organised because I was away for so long, but we had great support here,” she said, adding that the care and treatment she and her brother received at St. Luke’s Hospital in Houston was exemplary.

Syms says she is an advocate of organ donation. “When I was told a kidney transplant was the only option for my brother apart from dialysis, it was a no-brainer for me,” she said, adding that she intends to donate organs after her death.

The siblings now make return trips to St. Luke’s annually for check ups.

Nicholas, now 23, is getting married this weekend, surrounded by his family and friends who helped him through his illness, operation and recovery.

He had just turned 18 when he was told that his kidneys were operating at just 30 per cent performance and that he needed immediate care. “I didn’t feel sick at all, I had no symptoms,” he recalls when recounting how he found out he was sick.

A routine blood pressure check showed his blood pressure was high, so his doctor ordered a blood test. The results of that test led his doctor to admit the teenager immediately to intensive care.

“The doctor said if my potassium level went up one point higher, I was a dead man,” Powery says. Throat infections he had suffered as a teenager had drained from his throat into his body and damaged his kidneys, he says.

If his kidney functions fell to 10 per cent, he would have to go on dialysis, he was told. His kidney function dropped to that level the day before he underwent his kidney transplant, so he never underwent dialysis.

By then, he had begun to show symptoms, feeling tired constantly. “On the way to school, I’d sleep in the car. I’d sleep in school, I was sleeping all the time. I had no energy,” says Powery, who now works as an immigration officer.

After the operation, the kidney from his sister immediately started working, he says, negating the need again for him to undergo dialysis. Overall, he spent five days in hospital, but had to visit St. Luke’s every three days over about three months for check ups.

Introducing a new law governing the harvesting and transplanting of human organs brings with it some hurdles, including amending corresponding laws, such as the Trafficking in Persons Law that outlaws trafficking in human organs. That is one of the issues the Organ and Tissue Transplant Review Committee has addressed.

Hendriks says it is important that people understand more about transplants and educate themselves about the benefits of organ donations because even if people have stipulated that they want to donate their organs after death or if they are declared brain dead, the permission of the family must still be sought. He cited the case of the Netherlands where the rate of refusal from families to donate organs from relatives is high.

The definition of brain death will also be clearly covered in the proposed new law, he said.

The impetus for creating a new law now to legalise organ donations and transplants locally is the proposal to open a large medical tourism hospital by Indian cardiologist Dr. Devi Shetty in Cayman. Under the terms of an agreement between the Cayman Islands government and Dr. Shetty’s Narayana Cayman University Medical Centre, a number of laws in Cayman must be changed or introduced before the new hospital will go ahead.

George Town Member of Legislative Assembly Ellio Solomon, who chairs the committee and who brought a motion before parliament earlier this year on the need for local organ harvesting and transplants, said there had been plans afoot to introduce a law to enable local organ transplant before the Shetty hospital was an issue.

“It’s important to have this legislation, even if there was no Dr. Shetty hospital. The law would facilitate any local person or anybody coming to Cayman the opportunity to provide that service for people,” Solomon says, adding that anyone with the relevant facilities and expertise to carry out transplants could do so under the proposed new law.

Hendriks said that Caymanians and Cayman residents have been beneficiaries of heart, lung, kidney and other organ transplants for years, and this new legislation will mean that Cayman can reciprocate and donate organs to US citizens. “It is time we give something back,” he says.

About 40 people are on dialysis at the Cayman Islands Hospital and ten are on waiting lists for a kidney.

Solomon says the Organ and Tissue Transplant Review Committee expects to complete its work next week and that legislation will be drafted and taken to Cabinet for review before being subject to a public consultation and presentation to the Legislative Assembly. He hopes the law could be introduced by mid-2011.

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