PPP kidney transplantation travesty

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For this the painful reality, PPP Healthcare is like a devilish casino, of which Russian Roulette is the gamble, and a body bag your transporting exit.

Thence the cruel truth, aware they are that 23 years delivered innumerable avoidable deaths, but unbothered are they, for their healthcare is delivered in foreign lands. Thus, as they experience the creme de la creme of healthcare, our 3-year-old experienced death from abdominal pain. Three children were of arrested breathing, with vincristine in their spines. A stab to the hip delivered death. The bearers of life rewarded with deaths. PPP Guyana reclaimed the maternal mortality lead, in Latin America and the Caribbean. PPP Guyana infant and neonatal mortalities remain morbid. PPP Guyana life expectancy is the lowest of the lows. For these indices evidence a healthcare sector that’s in crisis, deficient in basic healthcare, perennially delivering avoidable deaths. But these collective cretins, rather than remedy the tragic failures in basic healthcare, have eyes on the complexly expensive kidney transplantation, which is certain to compound the healthcare troubles, while exhausting the limited financial allocations. Thus, of this irrationality, we deconstruct to illuminate.

End Stage Renal Failure (ESRF)
For the prior week’s column expounded on Chronic Kidney Disease (CKD), preluding ESRF if mismanaged. Further, the very column outlined that more than 75% of the cases of CKD are accounted for by uncontrolled diabetes and hypertension. As a result, it proffered investments in Primary Care, to monitor such patients, aimed at preventing CKD or it’s progression to ESRF.

But ESRF speaks to kidneys that have terminally failed, hence toxins accumulate, rendering the afflicted unwell. As a result, Renal Replacement Therapy, dialysis and ultimately kidney transplantation, is necessary and lifesaving. Having said that, with good hypertension and diabetes control, the vast majority of CKD wouldn’t progress to ESRF. But of PPP failure to develop the health sector over 23yrs, such monitoring was nonexistent, with many now live and die with ESRF. Now provided a second opportunity to get it right, PPP are tunnel vision on the expensively complex kidney transplant, rather than addressing the source, poor monitoring of hypertension and diabetes, down to a nonexistent Primary Care.

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Transplant
But transplantation is no simple toenail clipping excercise, it’s very complex, of multiple stages. Firstly, the transplant team must establish the motives for the proposed kidney donation. Secondly, they must ascertain if the potential donor can survive with one kidney. And for this reason, anyone with an underlying disease that could impact their kidneys, are excluded from being a donor. Thirdly, deadly conditions are excluded in the potential donor, eg cancer. Fourthly, heart testing to ensure it’s fit for the rigours of transplant harvesting. Fifthly, blood testing undertaken to exclude dormant infectious diseases, which are potentially deadly in the immunocompromised recipient, along with genetic testing to inform compatibility between the recipient and donor. In contrast, in cadaveric donors, testing is undertaken on the ventilator. Thereafter, compatibility is undertaken with recipients on the transplant register.

Next is the transplantation process, which is one of team work, aimed at minimising the time the kidney is out of a body. To that end, the two transplant surgeons coordinate their surgeries, with one harvesting, while the other transplanting. But in some cases, the kidney may need to be transported, thus is preserved using special solutions, packed on ice then transported to the relevant Transplant Centre.

Transplant aftercare
After transplantation, the aim is preventing rejection, with complex immunosuppressive drugs. But these drugs are potentially harmful to both patient and transplanted kidney, hence the transplant nephrologist walks a thin line between preventing harm and preventing rejection. As a result, the

immunosuppressive therapy blood levels are monitored, daily in the early stages. But with the transplant established functional, and patient satisfactory recovery, discharge is considered for a transplant nephrologist follow up.

To that end, for at least six months post-transplantation, the transplant nephrologist reviews the patient. During these reviews, much is done including tapering the immunosuppressive drugs, to minimise adverse drugs reactions, balanced with rejection. Thereafter, from 6 to 12 months, the patient is follow up by a general nephrologist, in consultation with a transplant nephrologist.

And like most medical interventions, kidney transplant isn’t without complications. Thus, in such an eventuality, immunosuppressive drug blood levels, testing for infectious agents, transplant scans, biopsy etc, are undertaken to diagnose the, to inform treatment.

Additionally, transplant recipients are at increased risk of developing heart diseases, diabetes, blood disorders, skin and other organ cancers etc. As a result, close monitoring is required by a cardiologist, diabetologist, haematologist, dermatologist etc.

PPP Hell Care
Notwithstanding, the truth we expose, that described is the basics of kidney transplantation, nonetheless it should suffice to communicate the message that transplantation is a complex undertaking. And for this reason, a forensic examination of PPP kidney transplantation preparedness, is necessitated.

1. Transplant team: Each transplant Centre should’ve a transplant team, consisting of a sociologist, psychologist, transplant surgeons, transplant pharmacist, transplant nephrologist, transplant dietitian, transplant coordinator etc. ABSENT

2. Donor register: This is a register of persons who have consented to organ donation. ABSENT

3. Transplant surgeons team: Transplantation is a 24hr service, since transplant availability is unpredictable. Then this, Dr. Kishore Persaud who claims to be a transplant surgeon, is not a specialist, evident on the Calgary Medical Register, which unambiguously states he isn’t a specialist. ABSENT

4. Laboratory: Required to monitor blood levels of immunosuppressive drugs and other complicated test, in the event of transplant complications. Then this, prior to transplantation, genetic testing is required, which PPP is currently paying at least $1000,000 for, in America. ABSENT

5. Transplant Histopathologist and Radiologist: With transplant complications, with biopsy done, examination is by a transplant histopathologist. What’s more, a vascular radiologist examines the transplant blood vessels. ABSENT

6. Specialists to monitor complications of transplantation. ABSENT

The fact is, none of the above PPP has or will get anytime soon, yet endeavouring on kidney transplantation.

Mark’s take
So all things considered, transplantation is a major undertaking, that shouldn’t be tainted by politics. Thus, the thereunder recommendations to change course, before it’s too late.

1. Discontinue the unsafe practice of transplantation experimentation, with patients referred to the Trinidad National Organ Transplant Unit.

2. Invest in Primary Care, to surveil patients at risk of developing CKD, mitigating onset or progression to ESRF and transplantation.

3. Master the basics, before attempting the complex.



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