Law allowing organ transplants keeps recipients waiting

Key parts of the law yet to be implemented

Heart transplant recipient Robert Hamaty poses in his office with a framed poem and photograph of the pilot whose heart he received 20 years ago. – PHOTO: KELSEY JUKAM

Three years after the government passed a law legalizing the donation and transplantation of human tissue and organs, there is still no organ donor registry or tissue bank in the Cayman Islands.

The 2013 legislation satisfied a stipulation in the government’s agreement with Dr. Devi Shetty to establish Health City, but was also aimed at helping patients in the Cayman Islands who need transplants.

Today, key parts of the legislation have yet to be implemented, including the establishment of a Human Tissue Transplant Council, an organ donor registry, and a tissue bank. Meanwhile, Caymanian patients in need of organ transplants are still at the bottom of waiting lists in the United States.

A transplant story

One man who knows the importance of having access to transplants is Robert Hamaty. Twenty years ago, after spending weeks in a Miami hospital in critical condition, he was given a second chance at life when he received a heart transplant.

Long before Mr. Hamaty founded the Tortuga Rum Company, he had a career as a commercial airline pilot. In the early 1990s, he was working as a pilot for Cayman Airways when he picked up a flu virus that had a devastating effect on his health, enlarging the left ventricle of his heart and causing him to develop cardiomyopathy, a chronic disease of the heart muscle.

Unable to pass the required medical exams, he lost his pilot’s license. He learned that although medication could keep him alive for a while, he would most likely need a heart transplant within five years.

“You kind of put that out of your mind because it sounds so drastic and you never thought that that day would come,” Mr. Hamaty said, sitting in a conference room at Tortuga Rum Company in front of a display of model airplanes and a banner-sized photograph of Cayman Airways planes.

“Almost to the date, five years later, I was in heart failure,” he said.

He compares the time spent in the hospital to “life on death row.”

“There’s no doubt about it, you don’t know whether you’re going to survive or not,” Mr. Hamaty said.

On Feb. 26, 1996, Mr. Hamaty received his pardon, the life-saving gift of a heart.
The nurses told him the heart was coming from Daytona Beach, Florida.

“I said, you know, that’s strange, that’s where I learned to fly in 1965, that’s where I did my flight training,” Mr. Hamaty said.

The heart had come from another pilot, a 27-year-old man who was involved in a skydiving accident during an air show.

Mr. Hamaty said he experienced a difficult period of survivor’s guilt after receiving the transplant, a guilt which did not ease until a priest, a fellow organ recipient, explained to him that “out of something bad came something good, as Jesus died on the cross to save us.”

He also got closure from meeting the young pilot’s fiancee, who even came to Mr. Hamaty’s 50th birthday party two years after the transplant. She gave him a frame which enclosed photographs of the young man and a poem:

“Once a stranger, now a friend/Brought together by chance/A sudden sorrow/Laying in a peaceful trance/His love he shared, with the precious and the few/And from his loss, comes our gift to you.”

Mr. Hamaty said, the young pilot, in his last hour, gave a lifetime. That’s true of all organ donors, he says.

Mr. Hamaty was lucky. Not only did he receive an organ, but it was a good match for him, and his body accepted it. Still, however, Mr. Hamaty had to wait six-and-a-half weeks for a heart, while his condition deteriorated.

Changing the law

While he was in the hospital, Mr. Hamaty learned that certain places, such as the Bahamas, were signatories to an organ procurement program, an agreement of nations to exchange organs. Individuals from jurisdictions that have such an agreement are given higher priority on wait lists and have a better chance of getting an organ.

Upon his return to Cayman, Mr. Hamaty wrote a letter to the governments of the Cayman Islands and Jamaica, encouraging them to pass legislation to allow organ donations and to set up an organ donation registry.

Almost a decade passed before there was any movement in Cayman to adopt legislation relating to organ transplants and donations.

In 2005, the government began investigating whether organ donations could be carried out in the jurisdiction, and in 2010, the government signed an agreement with Dr. Devi Shetty to establish Health City Cayman Islands, which required the Cayman Islands to allow the importation of human organs, tissues and body parts into the country.

Shortly thereafter, George Town MLA Ellio Solomon made a private members’ motion calling for legislation allowing human organ and tissue transplants to be performed in Cayman.

Mr. Solomon challenged comments which insinuated that the motion was only proposed to satisfy Health City’s requirements. He stated during a meeting of the Legislative Assembly that “even before the Dr. Shetty project” he had learned there was a serious problem regarding organ donation in the Cayman Islands and he wanted to do something about it.

The motion was passed, and a committee was established to develop the law.

In March 2013, the government passed the Human Tissue Transplant Law.

When he moved for a second reading on the bill before its passage, Mark Scotland, who was minister of health at the time, described its intent. The purpose of the law, he said, was to establish a Human Tissue Transplant Council which would monitor the “donation of tissue by living persons and the removal of tissue from deceased persons” and regulate the collection and use of such tissue.

The legislation, he said, would “potentially allow any resident of the Cayman Islands who may be in need of an organ or tissue transplant to live or survive, or to have a better quality of life to be given a second chance.”

Mr. Scotland said the legislation would also create an opportunity to establish an Organ Donor Registry in the Cayman Islands.

“Not having legislation to deal with transplants here in the Cayman Islands certainly precludes us from being on the International Organ Donor List, and so puts us in a position where persons from here who need transplants go very low down on the list when it comes to waiting for organs,” Mr. Scotland said at the time.

Legalizing human tissue transplants in the Cayman Islands also alleviates the huge financial burden on organ recipients, who must travel to other jurisdictions for the procedure.

In the case of kidney transplants, where a kidney can be given by a living donor, such expenses can be even higher.

According to Health Services Authority nephrologist Nelson Iheonunekwu, there are currently 55 patients on dialysis in Cayman. Ten of those are on the waiting list for a kidney transplant, and they have been on the list for more than three years.

The law that was passed in 2013, Dr. Iheonunekwu said, “hasn’t made a difference” to those in need of a transplant, yet.

According to Health City spokesperson Sebrina Rankine, no transplant procedures have been performed at the hospital.

“Despite the fact that the laws have been changed to accommodate, Cayman is still missing a few vital components,” Ms. Rankine said. “One being a donor registry and two being donors. In order for transplants to be performed, this portion of the law has to be implemented and a donor registry set up and donor registration forms sent to everyone with each passport subscription.”

In many jurisdictions, individuals who consent to donating their organs have a special designation on their identification cards, such as their driver’s license.

Mr. Solomon, who first pushed the legislation forward half a decade ago, said there was a “lot of work that went into it.”

“I don’t really know what it is that’s holding the government up,” Mr. Solomon said.

“It’s upsetting, and I think it’s unfortunate that they haven’t got it to a position right now where the country can say that it has the necessary legislation,” he added.

The Cayman Compass contacted the Ministry of Health for comment on the status of the Human Tissue Transplant Law, but had not received a response as of press time.

Meanwhile, Mr. Hamaty says he is happy the law was drafted and passed, and he hopes the government will expedite its implementation.

He said his transplant taught him this: “Don’t put off tomorrow what you can do today.”

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  1. I personally received a liver transplant from a deceased donor in Tampa in 2009.

    Here’s how it works and why we need to establish our own organ and tissue donor list.

    As a foreigner you ranked low than a US citizen as only a fraction of organs are allocated to foreigners.
    I was very lucky that the USA allows this. In the UK a British citizen, living overseas CANNOT receive an organ transplant.

    I was within weeks of death when I was put on the Florida transplant waiting list.

    With most surgeries one wants to do them as soon as possible. Got a grumbling appendix? Let’s take it out before things get worse.

    THE OPPOSITE IS TRUE with organ transplants. Since there is a long waiting list and more people needing organs than organs available they allocate organs based on degree of sickness and closeness to death.

    Someone who is slowly getting worse may be on the list for years. In my case I was going downhill fast so got to the top of the list in weeks.

    And I was not the only one to return to the living. That same young mans organs saved the lives of 2 kidney recipients, a heart recipient and someone dying from cystic fibrosis.

    To get to the top of the list you have to be near death.
    But here’s the catch, the sicker you get the less likely you are to survive the surgery. At a certain point the doctors will decide to let you die as it is unlikely you will survive the surgery so why waste an organ on you.

    You just have to hit the sweet spot, sick enough to reach the top of the list but well enough to survive the surgery.

    Did I mention that a liver transplant in Florida costs some $1/2 million?

    Lives and money can be saved if we move forward on this. How many young people have so sadly died in car wrecks in the last few years whose organs could, with permission, have saved several lives?

    Incidentally I am now in perfect health. Cycling, SCUBA diving, running, hiking and rock climbing.