Phased approach to transplants could start with live organ donors

At a glance

• Cayman still awaiting a raft of requirements to be met before organ transplants can be carried out locally
• Recent death of mother awaiting liver transplant highlights challenges
• Health minister says living transplants will most likely kick off a ‘phased approach’
• Health City’s kidney transplant programme making ‘strong progress’ and is awaiting approval

Despite legislators passing the Human Tissue Transplant Act 13 years ago, Cayman has yet to carry out an organ transplant on island as several other steps need to be in place before such surgeries can be done.

Those include measures such as establishing an organ donor registry, a detailed regulatory framework and consent procedures for living and deceased donations.

Health Minister Katherine Ebanks-Wilks, speaking with Compass Media on the sidelines of the annual Women’s Health Conference on 13 March, said her ministry is working to ensure that the necessary frameworks and oversight mechanism are in place to ensure organ transplants can be carried out in local facilities in a safe and ethical manner.

She said that since becoming health minister last year, she had been looking at “what needs to be established in order for us to roll out the opportunities for the health facilities here to be licenced as transplant centres”.

She noted that there were a “number of requirements that would need to be done in terms of how to have a mechanism in place that’s best practice, that’s safe, that’s transparent,” adding that this included establishing an ethics committee.

The Compass reported in early 2024 that Health City Cayman Islands expected shortly to be approved by the Human Tissue Transplant Council as a facility where kidney transplants could be carried out. Two years on, that permission is still pending.

In response to a request for an update on the situation, Dr. Binoy Chattuparambil, clinical director at Health City, said at the time of the 2024 article, the hospital had been “actively exploring the introduction of a kidney transplant programme as a phase one for the transplant programme, driven by a clear need within the Cayman Islands community and our commitment to expanding access to advanced care close to home”.

He added, “We have made strong progress toward establishing a kidney transplant programme at Health City, including developing the required infrastructure, clinical capabilities and staffing framework to support this service.”

The hospital’s formal protocols and processes have been submitted to the Human Tissue Transplant Council for review and approval, after which the matter would be sent to Cabinet to consider.

Next steps

Health City says the following components need to be in place before any transplant programme can begin:

• A fully operational regulatory and oversight framework
• Clear clinical governance protocols for donor and recipient management
• Ethical and consent processes for both living and deceased donations
• A national organ donation system or registry
• Defined pathways for organ retrieval, matching and transplantation

Chattuparambil noted that these steps are “essential to ensuring patient safety, transparency, and trust in the system. Given that deceased donation and a national registry require more advanced safeguards, the government could consider a phased approach, beginning with live donation.”

He said the transplant programme initially would focus on carefully selected living donor cases, “guided by established clinical and ethical standards”.

In parallel, he said, those efforts would “continue to strengthen the legal, regulatory and operational framework required to support a national donor registry. This will include developing a national donor registry, alongside public awareness initiatives, clear consent processes, and the infrastructure needed to support deceased donor transplantation safely over time”.

This echoed comments made by Ebanks-Wilks, who told the Compass she wanted to see a “phased approach” to carrying out transplants locally.

“I don’t see why we can’t start off with looking at live transplants,” she said. “So that is what I am exploring to see if we can at least get Cayman to a place where we can allow facilities [that] have all of the requisite equipment and clinical staff on board to start with live transplants,” she said.

The Human Tissue Transplant Act is currently under review, though Ebanks-Wilks confirmed that that review will not lead to any substantive changes to the legislation, clarifying that it mostly involved the Legislative Drafting Department adjusting “naming conventions”.

“They look to see if there’s any consequential changes, but nothing of any substance has changed in the legislation at all,” the minister said.

Overseas travel for treatment

Since no healthcare facility in Cayman is licensed to carry out organ transplants, patients that require the procedure must travel overseas to acquire a new kidney, liver or heart, for example.

Ebanks-Wilks acknowledged this, saying, “We shouldn’t have to have people here needing to be transferred overseas. And just last week, I was reminded of the importance of trying to advance this board, and that is going to be my mission from here.”

Earlier this month, Octavia Chikukura, a widowed mother-of-three living in Cayman, passed away while waiting to go overseas to receive a liver transplant. A GoFundMe appeal to raise money to pay for her to get treatment raised nearly $230,000, from more than 1,600 donations, as the local community rallied to help pay for her treatment.

Health City’s Chattuparambil said while he could not comment on this specific case, “recent events bring into focus the realities faced by patients who must travel overseas for complex, time-sensitive care, where factors such as insurance benefits, cost, coordination, and timing can become significant challenges”.

He noted that overseas transplants, particularly in the United States, can be extremely costly, added to which is the cost of travel, accommodation and ongoing follow-up care. He said, as a “general benchmark”, procedures at Health City typically cost 50-75% less than in the US.

“A local programme has the potential to ease some of those burdens, especially for families navigating already difficult circumstances,” he said.

Ebanks-Wilks says, even though relevant legislation and regulations exist, “there are quite a few requirements that need to be put in place in order to roll out a regulatory body to oversee the transplant centres”.

She added, “And it certainly needs to be done properly, because, the last thing you want to do is roll it out, and … we don’t have the framework in place, because then … we can actually put Cayman and our jurisdiction at risk [and] individuals at risk.

“But that’s not a reason to not move it forward. And I believe that we can move it forward … a lot faster by taking an approach where we start with just live transplants.”

The minister said this issue is considered a priority for government, and she would provide an update “before the end of the third quarter of this year”.