Why Kenyans cannot donate their organs

When Kenyatta National Hospital posted on its social media pages that its most frequently asked question is how much a kidney goes for, many people found it comical. But its cryptic message speaks volumes about the horrible state of organ donation in the country.

The lack of clarity on the way forward for the Health Act of 2017, which allows people to donate their organs for research and other persons, is limiting as it is the only reference point yet the Health ministry is yet to come up with a gazetted set of rules for organ transplantation, five years later.

The Health Act gave new hope for organ and tissue transplantation when it was enacted, but its implementation is taking ages, and lives continue to be lost. The set-back falls on the slow implementation from the Health ministry on rules and ethical consideration. The dire situation is compounded by the prohibitive cost of medical care, difficulty in getting suitable donors, and lack of capacity in public hospitals.
 
Dr Nduku Kilonzo, director of the Kenya National Blood Transfusion Services and Human Organs Transplantation, said during the World Transplant Day celebrations held at Kenyatta National Hospital on June 14 that a taskforce attached to the Health ministry is currently working on the regulations and ethical considerations that are likely to arise.
 
Organ and tissues transplants

Hair transplant

Are you bald-headed and you fancy some hair? Well, a hair transplant recommended by a medical doctor may be a good fit for you. According to the United Kingdom’s National Health Service, a hair transplant is a procedure that involves restoration of hair in ‘thin’ or ‘bald’ parts of the body. People eligible for such kind of procedures are either bald, have a medical condition for hair loss called alopecia or they want to increase their hair volume. In Kenya, hair transplant is not offered in many facilities but such services are available in some clinics and private hospitals. 

Dr Pranav Pancholi, a skin dermatologist working at Avane Clinic in Nairobi, explains that anyone who passes the medical examination that involves a series of tests can get a hair transplant. He tells Healthy Nation that it takes about 30 minutes to undergo a hair transplant. He adds that it is a day’s procedure and people can recover in just a week. According to Dr Pancholi, the results of the transplant can be observed in a month. 

Skin transplant 

Skin transplants are commonly referred to as skin grafts. This kind of transplantation is available in most facilities in the country, including public hospitals. It is mostly done in patients who have had burns, skin loss as a result of an infection, cancer, among others. It is one of a kind because the patient is also the donor of the skin as the replacement is done by removing a healthy skin from a different part of the body known as the donor site. 

There exist two types of skin transplants namely; partial or split thickness skin graft and the full thickness skin graft. The partial skin graft involves removal of a small layer of your skin to replace the ailing part. The full thickness on the other hand involves removal of most of the skin and the area is then stitched. The National Health Insurance Fund covers for the cost of such a procedure. 

 
Kidney transplant

 
This is one of the most welcome types of organ transplantation in the country. Earlier this year, kidney specialists in the country said there is a 90 per cent survival rate for patients who undergo transplants.  Kidneys serve as a filter for waste and excess water that comes from the blood as well as balancing other body fluids. When a kidney fails to function normally mostly due to high blood pressure or diabetes, the doctor may advise a patient to either get a donor or undergo dialysis. 

Those on dialysis due to suffering from high blood pressure, diabetes or cystic kidney disease may be candidates for a kidney transplant. The East African Kidney Institute stationed in Nairobi is an asset to kidney transplantation as it helps in the research and training of experts who specialise in diseases related to the kidney. The law in the country states that a person can only donate a kidney and not sell it to a willing buyer. This limitation results in most people dying without getting a suitable donor since all willing donors require a series of tests before undergoing surgery.  

Heart transplant  

In April this year, doctors at a hospital in Nairobi conducted a first-of-its kind heart transplant in the country. It was performed on an 83-year-old man who had been diagnosed with calcification (a process where calcium builds up in body tissue, causing the tissue to harden) as well as obstruction in one of his heart valves. 
 
The John Hopkins Medicine defines a heart transplant as one that necessitates a surgery that removes the ailing heart from a person and substitutes it with a healthy one from an organ donor. 
 
Some of the conditions that make a heart transplant necessary are cardiomyopathy (heart muscle disease), heart failure, myocarditis (inflammation of the middle layer of the heart) and heart disease. Recovery from a heart plant surgery takes about seven to 14 days or more. 
The national insurer has listed about 11 hospitals to offer services on heart related complications but is not clear on heart transplantation.  

Liver transplant

 
A liver transplant is a surgery that removes a liver that no longer functions properly (liver failure) and replaces it with a healthy liver from a deceased donor or a portion of a healthy liver from a living donor.

In 2015, Kenyatta National Hospital acquired an Ultrasonic Dissector, a key equipment used in liver transplantation. However, just this year, a doctor at the hospital said there is no operational liver transplant service in the country; asking the government to also consider other forms of life saving transplantations.
 
In adults, liver cirrhosis is the major reason for a liver transplant. Other conditions that may lead to liver transplantation include Biliary atresia, viral hepatitis and primary liver cancers.

During surgery, the sick part of the liver is removed and replaced with a donor liver. The procedure can take about four to 18 hours. The best thing about liver transplantation is that a donated liver can be given to two recipients.  In a split liver transplant, also called a partial graft, a liver from a deceased adult donor is divided between two recipients. The right lobe can be transplanted into most adults, and the left lobe can be transplanted into a child, since it is approximately the same size as a liver in a baby or a small child. The partial grafts grow to normal size in a few weeks after transplant.  

Cornea transplant

 
A cornea is the transparent layer of the eye that protects it against infection and allows light to go to the retina.
 A cornea transplant is one of the cheapest forms of tissue transplantation done in the country. It is, however, faced with some challenges since there are no willing donors of cornea in Kenya. 

 
Dr Fredrick Korir, an ophthalmologist and cornea surgeon, highlighted during the World Transplant Day that the country should invest in eye banks since most cornea donations come from different parts of the world. 
A clarion call from medics also is that there is need for a faster clearance process for corneas that are shipped into the country since they end up going bad without serving the intended purpose. 

Lung transplant

 
It is a rare type of transplantation but it helps in saving lives of people who have chronic lung ailments that are not responding to the available treatment. It involves replacing an ailing lung with a healthy one, mostly from someone who has died. 

 
This form of transplantation is available in the country albeit limited to very few private hospitals. It can help in curing pulmonary hypertension. 
At the height of the Covid-19 pandemic, a woman living in the United States was the first to receive a double-lung transplant. Studies show that severe Covid-19 affects the lungs. However, the world’s first double transplant was conducted in 1986. 

What the law says about organ transplantation

 
The enactment of the Health Act 2017 in the country was hailed as a game changer for organ donation. This law was a review of the Human Tissue Act that was enacted in November 1966. Shadrack Kipkorir, advocate of the High Court working with Muturi S.K &Company Advocates, explains that the Tissue Act was a colonial implant that was enacted at a time when advancement in technology and the practice of human medicine was limited. This was a few years after the first medical transplant of a body organ had been done in Boston, US. 
 
“There existed inherent doubts on the safety of human body transplant between living persons and so the Act limited tissue donation on who can donate, how and for what purpose. Donation pursuant to the Act is only limited to those who are ill and even then, they must expressly provide for the wish to donate either in writing or orally in the presence of two competent witnesses,” he explains.
 
Tissue and organ transplantation was limited to medical research and education. Another set-back of the Tissue Act was that relatives could object to the donation.
 
“With technological advancements in the field of medical science, one would expect that the Health Act 2017 provides for organ donation between living persons but woe unto you. The Act is loudly silent on it,” says Shadrack.
 
He explains that the Health Act provides that organ donation can only be given by an adult (does not need to be sick as is in the Tissue Act) through a will (specific instrument of donation provided yet there was no specific document in the Tissue Act that clearly identified the beneficiary of the body tissue in question.)
 
“If the beneficiary is not identified, the donation fails. It dies a natural death (this is not the case in the Tissue Act. Furthermore, the Act has added one purpose of donation, which is, for the subject tissue to be used by a living person,” he explains
 
He, however, says the will can be subjected to a legal challenge and at times families take time to have the will read. Even as there is delay in coming up with regulations, the lawyer says that the Act can still be enforced. “The Act states that the Health Cabinet Secretary may come up with regulations for the better operationalisation of the Act. It emphasises the word may. Legally then, the Act is enforceable with or without regulations,” he says. 

Ethical issues in organ transplantations 

The Health ministry is still drafting some of the ethical considerations that donors, medical practitioners and recipients need to take note of. In other parts of the world, however, studies show that the tissue and organ donation should take the best interest of the patient first. 
 
Medical journal of clinical medicine explains that medical practitioners are asked to do no harm, respect the person’s choice and also be fair and equal to everyone. There should also be confidentiality of medical records of both the donor and recipient. Also, the financial aspect has been highlighted, saying that organ donation should not be used as a money-making venture.

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