Transplantation beyond us

Dear editor,

As kids the occasional after meal treats would be ours, for which recollection is mine, requesting treats having not completed what’s already on my plate. And as would be expected, such premature requests were swiftly and harshly dealt with, “Eat what’s on your damn plate before requesting more.”

But from all indications, such harsh words escaped Dr. Anthony, for evident it’s that his plate is mountainous with PPP Covid-19 catastrophes, yet he is demanding a transplant dessert.

Moreover, Covid-19 has exposed our Healthcare Sector as infantile creeping at best, and likely to be for an indefinite period. For creeping is evident in the many with comorbidities who’ve died from Covid-19. In infectious diseases and malnutrition still major causes of infant mortality.

In perinatal and neonatal mortalities still at crisis levels. In maternal mortality still shocking beyond belief, for the normal physiological process of parturition has become a huge gamble, with prepartum and postpartum haemorrhage still a burden. In the most basic of surgeries still of unbelievable complications.

In the 21st century, our Primary Care still only of blood pressure and blood sugar checks, with zero preventative interventions. For these are the basics of 21st century medicine that our Healthcare Service is in the creeping stage, yet they’re venturing into Olympics high-jumps of cardiac interventions and organ transplantation, beyond us for the following reasons,

1. We don’t have a transplant surgeon, for Dr. Kishore Persaud isn’t one such, having only undertaken a fellowship in Calgary. As a matter of fact, a simple check on the Alberta Medical Register websitesearch.cpsa.ca, unambiguously states under his name,“Not recognised as a specialist.” In fact, the same applies for Dr. Mahendra Carpen who self identifies as an interventional cardiologist, but the Ontario Medical Registerdoctors.cpso.on.ca states otherwise.
2. As a result, Dr. Anthony is of disinformation in stating that Dr.Persaud is a transplant surgeon. The fact is, not being trained as a specialist transplant surgeon, he is placing patients’ lives at risk, in which PPP is complicit.
3. Transplant surgery is more than a solitary masquerading transplant surgeons. It is a multi-disciplinary team effort, which we don’t have.
4. A transplant is as good as an available blood supply, measured in cold ischaemic time. So with our poor road service, absent air ambulance and helipads at GPHC, retrieved organ would be necrotic on arrival.
5. Transplants are foreign to our immune-system, thus face rejection, necessitating strong immunosuppressants. These drugs are potential harmful to the transplant and the recipient, necessitating blood monitoring, which in the early stages of the transplant, must be done daily. Unfortunately, our labs cannot undertake such testing, hence overseas, which will take weeks, is the only option, by which time the recipient or transplant is harmed.
6. Inevitably, transplant develop functional problems, mandating investigations, eg biopsy, sophisticated viral tests, vascular radiography and histopathology, which aren’t available.
7. Recommended immunosuppressants are costly, not available in Guyana.
8. The public is expected to be organ donors, but without public consultation, that seems unlikely, unless organs will be retrieved without consent.
9. Transplantation has the potential to become black market business, are we equip to deal with such?
10. Who will undertake cancer surveillance in these patients, for the expertise we lack?

So all things considered, organ transplantation is beyond us, but being primary care infantile creeping, that should be invested in. This should target optimal management of diabetes, hypertension, hypercholesteremia, obesity etc, to reduce incidences of renal, cardiac diseases etc. First master the basics before venturing into the complicated.

Regards 
Dr. Mark Devonish MBBS MSc Med. ed. FRCP(Edin) FRCP
Consultant Acute Medicine
Nottingham University Hospital