Organ transplantation can be lifesaving for patients with organ failure. Thousands of those patients may die because there are not enough donated organs to meet the demand. And this is only the tip of the iceberg of human suffering that this shortage of organs causes. The main factor limiting organ donation is that less than half of the families of potential donors consent to donation. Many organs can be donated, including heart, intestines, kidneys, liver, lungs, and pancreas. Tissues that can be donated include corneas, heart valves, and skin. Donations may be used in people who have organ failure, who are blind, or who have severe burns (Stevens, et al, 2008).
Interest in living organ donation is related to the potential for reducing the current organ shortage, shortening the wait time to receive an organ, permitting timing of surgery to optimize the recipient’s health, enabling identification of donors with the greatest histocompatibility, and improving function for the transplanted kidney postoperatively (Corley, Elswick, Sargeant, & Scott, 2000). For these reasons, living related and non- related kidney donations are advantageous to recipients. The limited number of cadaver organs available in this country makes the need for living organ donors very significant. Interest in living related and nonrelated organ donation has broadened from kidney donation to lung,liver, and bone marrow donation(Simmons, Schimmel, & Butterworth, 993).
The first organ to be transplanted from one human to another was the kidney. The earliest renal transplants were between identical twins. Because they share the same genetic make-up, there was no danger of the recipient’s body rejecting the transplanted organ as foreign. In all other combinations of donors and recipients of transplanted organs, however, it was and remains necessary to suppress the recipient’s immune system with medication, and to continue this medication indefinitely.
Renal transplantation is now widely acknowledged as the treatment of choice for those with end staged renal failure (ESRF). Since the time of the first transplantation in the 1950s, advances in antirejection therapies, surgical techniques and tissue matching have enabled kidney transplantation to evolve from experimental procedure to treatment that can offer the best quality of life and the most cost-effective care for kidney patients. Many patients view kidney transplant as the gateway to ‘personal liberation’ and as the opportunity to restore ‘control over one’s life’ (Thomas, 2002 p. 337). Kidney transplantation affords patients with kidney failure good health sufficient to resume their normal lives. With this second chance at life, a better lifestyle commonly emerges. Patients become smarter eaters, refrain from smoking, alcohol and take better care of themselves. Dialysis remains the best option, but for those who have been transplanted, life just got better.
Foreign and local studies have shown that kidney transplantation offers the best option for patients with kidney failure. The quality of life of a transplant patient is superior to one on dialysis. Patients who develop kidney failure see transplantation as the only solution to regain this lost lives. Funds are sourced to pay for the medical evaluation required for this major operation. For those who are fond medically suitable to undergo transplantation, a willing kidney donor is released.
In the country, 510 Filipinos received a kidney transplant last year, according to data from the Philippines Renal Disease Registry Annual Report in 2008. Among these, 170 (33%) transplants came from related donors, 313 (61) from non-related donors, and 27 (5%) from deceased donors. The number of transplants last year, compared to the number who developed kidney failure, was only 14%. Even if we assume that only half of those patients were found to be medically suitable for transplantation, only 14% of the patients were found to be medically suitable for transplantation, only 14% of the patients would have been provided the option of kidney transplantation.
Of the unsavory appellations attached to the Philippines, a wicked one is that of its being the “kidney capital of the world.” This is because of the rampant illegal trafficking of kidneys for transplants. And this is because there are many Filipinos who are so poor, jobless, and without any source of income except selling one of their two kidneys. I suppose they can also sell some of their other organs, like their hearts and eyes, and if they could, their souls, too. The sale of a kidney may help a family buy food and some amenities – but not for long. There is the possibility that with poor nutrition and unsanitary living conditions, the donor eventually falls ill, and having only one kidney left may easily contribute to his early demise.
In the Philippines, reciprocating a favor with some gift or token of appreciation is an accepted cultural practice, not in the context of payment or commerce, but in the spirit of gratitude. Admittedly, this is often abused. If one was dying or in grave threat and a stranger offers help (on this instance, his kidney), are there guidelines on how one may reciprocate on this kindly act? To say that our country attracts foreign recipients “only because they can easily buy cheap kidneys” is most unkind and undeserving of a reply. Organ transplantation is a rapidly developing scientific endeavor which unfortunately is beset with various issues of moral, ethical and legal ramifications. We must try to keep an open mind and face these challenging fields with no malice, other than try to remember why we physicians are here for. Yes, donors must be protected from any abuse, respected and even honored. Just as important is to help these suffering and dying patients take access to the advances of medical science today.
In Philippines slum desperately poor sell kidneys for cash. When things get bad the men sell their blood and when all seems lost many resort to selling an organ. Some had been paid with a certain amount plus a grocery package and some medication, but never received post-surgical care. Some now suffer from high blood pressure or renal disorders themselves. But in the slums of Manila, the broker is not interested. In an ideal setting, there would be proper medical examinations to determine a donor’s suitability. in ensuring the donor’s health, and the donor is not interested in telling the truth.
The issue of kidney transplantation and the use of living non-related donors especially to foreign recipients has been so muddled with misinformation, innuendos and aspersions to the country’s entire transplant program by some members of the local transplant community. One must look back to the past to understand the unfolding events in kidney transplantation in our country today.
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