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…opposition expresses concern
In a historic move, the National Assembly passed the Human Organ and Tissue Transplant Bill – thereby creating a legislative framework for cell, tissue, organ and biofluid transplantation, blood transfusion, development of regenerative medicine, and expansion of medical education and scientific research.
In defending the Bill, Minister of Health, Dr. Frank Anthony said organ transplantation is not new, explaining that for more than a century, surgeons have replaced diseased organs with healthy ones and in the process, have been able to perfect surgical techniques, organ preservation, tissue typing and now even xenotransplantation.
Pointing closer to home, Minister Anthony reminded the House that the George Subraj – a renowned Guyanese philanthropist – was a strong advocate for organ transplant. “He funded several medical missions to Guyana, first to access the state of patients with ESRD [End-Stage Renal Disease], to develop a dialysis program, which led to the first kidney transplant by Dr Rahul Jindal and team on the 12th of July 2008,” he noted.
Between 2008 to 2014, 30 kidney transplants using living donors were done by the Balwant Singh Hospital. According to Minister Anthony, the pioneering surgeries gave hope to a lot of patients but it also inspired our local doctors such as Dr. Kishore Persaud, who was sent to Canada to train in organ transplantation. Upon his return in 2015, Dr. Persaud established a transplant unit at the Georgetown Public Hospital.
According to the Health Minister, the team at GPHC has successfully transplanted thirty-six patients who were diagnosed with ESRD. “The survivability of these patients has improved tremendously. This program has given hope to ESRD patients. Currently there are approximately 200 patients receiving dialysis, requiring three sessions per week. Many of these patients are unable to work because of this debilitating illness. Kidney transplantation is certainly changing that outcome,” he told the House.
He noted that the country’s success has attracted Caribbean-wide attention.
Guyana has also done a number of successful corneal transplants, he further reported, explaining that a corneal transplant replaces a diseased or scarred cornea with a new one.
The Corneal Transplant Programme here was Dr. Raul Jindal, Dr. Joseph Pasternak and Dr. Stephen Waller, who performed six corneal transplants in 2014 at the Balwant Singh Hospital. The transplanted cornea was acquired from an Eye Bank in the United States. The programme was subsequently transferred to the GPHC under the leadership of Dr. Shailendra Sugrim. To date, the local team spearheaded by Dr. Sugrim has completed 93 corneal transplant surgeries.
“Corneal transplantation has been a game changer for many patients, who a generation ago would have been blinded permanently. They now can have their sight restored with a corneal transplant. Currently the cost of such a transplant ranges from $13,000 to $27,000 US dollars. Unfortunately, the cost of the cornea is too prohibitive for most patients,” the Health Minister told the House.
He explained that the legislation will allow the development of a local Eye Bank, which would recover and store ocular tissue from donors for transplant to eligible recipients.
Similarly, he said blood transfusions have been an indispensable part of many medical and surgical therapies. Before the 1990s, several private and public blood banks collected and transfused whole blood, however, in 1990 a national blood transfusion service was developed, with the assistance of the World Health Organization, the European Union and later the US government through PEFAR. In the early 1990’s Guyana was able to separate blood into its red pack cells, platelets and plasma.
“In the 2000’s with funding through PEFAR, we developed a robust program to prevent transfusion-transmitted infections such as hepatitis B, hepatitis C, HIV, cytomegalovirus (CMV), syphilis, and human T-lymphotropic virus (HTLV 1 & 2), Chagas, malaria and microfilaria.
The Blood bank can now produce specialized blood products such as lueko-reduced pack cells and platelets, pooled platelets, pooled cryoprecipitate, apheresis platelets, and washed red cells. We have also changed the pattern of blood collection from the families of patients donating to almost 98 to 100% voluntary donation,” he reported.
However, he noted that while the country has transfused blood for several decades transplanted kidneys and corneas from 2008 and 2014, respectively, there is no legal framework to regulate the donation of blood, organs and tissues. The legislation, he said, would now establish that framework.
Additionally, he said the Bill will allow scientists and clinicians to explore and exploit the benefits of regenerative medicine.
One application of regenerative medicine is cell-based therapies. Cell-based therapies treat, repair, and replace diseased tissues and organs with new, healthy and functional ones. The discovery of stem cells and their capacities for self-renewal and differentiation has led to cell-based therapies, drug discoveries, and tissue engineering. Currently, cell-based therapies are used to treat: lymphoma, sickle cell anaemia, immune deficiencies and Beta-thalassemia; wound healing and skin injuries; neurological disorders such as Parkinson’s diseases and spinal cord injury among other diseases.
According to the Health Minister, the Bill is in keeping with the revised WHO Guiding Principles on Human Organ Transplantation, and all thirteen of the guidelines are reflected in the various sections of the Bill.
Notably, it will pave way for the establishment of a Human Organ and Tissue Transplant Agency, which will oversee all future transplants of cells, biofluids, tissues and organs in Guyana, as well as a National Donor and Transplant Registry.
The Bill also allows for the donation of organs after the patient dies. “This Bill makes it compulsory for anyone who would be donating must give consent. Consent is a fundamental component of this Bill, and the details are clearly outlined in Section V, VI and VII for live donors and IX for patients after they die once the individual’s consent or authorization is ascertained or where this is unknown, the next of kin have indicated that they wish to proceed with the donation. These sections of the Bill cover the activities for which consent is required, conditions on consent, which must be present and how consent can be withdrawn,” he detailed.
But while Opposition Member of Parliament, Dr. Karen Cummings, acknowledged that Organ transplantation marked an important milestone of the 20th century it is a highly sensitive issue for societies around the world where the emphasis is placed on the body of the deceased persons.
Dr. Cummings, who served as Minister within the Ministry of Health under the David Granger Administration, said while the Coalition MPs believe that organ transplantation is morally acceptable with the consent of the donor, they are concerned about commercial human organ harvesting and transplant tourism.
“Mr. Speaker, during the APNU+AFC Coalition Government in 2017, there was the drafting of this legislation to outlaw commercial human organ harvesting, transplant tourism, and organ trafficking which worldwide has been an incredibly attractive and lucrative business but an illegal global market. With Collaboration with the University of Calgary in Canada, meetings were held with local stakeholders to discuss and fine tune the content of the draft legislation,” she noted.
Dr. Cummings told the House that the Human Organ and Tissue Transplant Bill represents a good start, however, there is cause to send it to the park.
“If not seriously protected, this bill puts public health against private wealth. The bill has a measure of goodwill yet hold still. Why Mr. Speaker, Danger links with potential perks,” Dr. Cummings said.
She said it is not a secret that illegal organ harvesting has been linked to the equally notorious trafficking in persons (TIP) global business. “The World Health Organization (WHO) has said that patients in the United States of America (USA) can pay as much as US$70,000 to over US$160,000.00 for a transplant package. It has been stated that more than 120,000 patients in the US need various forms of organ transplants which include kidneys, bone marrow, liver, lung, intestine and cornea. And that five new persons per hour are added to the waiting list in the USA. Here in Guyana, Kidney transplant surgery is done free of cost at the GPHC but costs as much as US$40,000 (G$8M) at a private hospital,” she pointed out.
Dr. Cummings said it is for those reasons, the APNU+AFC Administration established a public kidney transplant program while advancing of the Nephrology and Dialysis Unit at the Georgetown Public Hospital Corporation (GPHC) – much to the benefit of patients diagnosed with end-stage kidney disease.
She said in Guyana, transplantation is constrained not by medical issues, but by legal ones, and their resolution is essential to saving lives and reducing human suffering.
However, Dr. Cummings noted that the most radical provision in the bill would be, the legalizing of the removal of an organ when the brain stops functioning, but the heart and lungs are kept going through artificial means.
“… careful attention must be paid by medical practitioners to not abandon the concept of brain death but retain the practices in organ transplantation, in other words there must be the maintenance of the commitment to the dead donor rule by not removing vital organs from individuals before they are declared dead. Hence the irreversible loss of circulation should be a major defining characteristic of death,” she warned.
In conclusion, Dr. Cummings submitted that the Government cannot be trusted with the distribution of these medical and scientific technologies to save lives on the basis that it has been accused of ethnic cleansing and the practice of political division.
“The question that is being asked by 218, 000 members of the populace is Mr. Speaker, could this regime be trusted? Mr. Speaker, we have seen the bad governance and the mismanagement of COVID-19 including the improper sourcing of a vaccine from a middle-man- as it relates to the health of the nation. The citizens would want to know if with the passing of this bill, if there would be any act of corruption and the flourishing of commercial human organ harvesting, transplant tourism, and organ trafficking,” she said.