The Future of Renal Transplantation Services in Nigeria

Prevention is a message at the forefront for Chronic Kidney Disease in Nigeria. As many efforts now are tailored towards raising awareness to share the message. Chronic Kidney Disease is preventable, and the causes are treatable. Patients that are akin to managing their diabetes and hypertension can prevent kidney failure. One widely used modality to monitor kidney health is using an ultrasound to visualize the kidneys. According to the Cleveland Clinic Health System, a kidney ultrasound is a noninvasive diagnostic exam producing images used to assess the size, shape and location of the kidneys. This test can also assess blood flow to the kidneys. This modality is useful for a general assessment, detecting cysts, tumors, obstructions, infections and to evaluate a kidney after a transplantation.

(Left) Dr. Babatunde Salako, Nephrologist and former Medical Director for the Nigerian Institute for Medical Research and (right) Dr. Charles Modlin, Urologist, Kidney Transplant Surgeon and former Director of the Cleveland Clinic Men's Minority Center.

According to Professor Babatunde Salako, former acting director of the Nigerian Institute of Medical Research, the increase in epidemic proportions of diabetes in Nigeria increases the number of patients who will soon require renal replacement therapy. As this is a challenge to the health infrastructure in a developing country such as Nigeria, the difficulty also lies in the lack of sustainability of care by patients and the government. As employment levels continue to rise, kidney transplantation- although needed- becomes an abstract concept for end-stage kidney disease patients already enlisted in the NAN's dialysis program.

(Center) Dr. Temitope Alonge, Orthopedic Surgeon and former Chief Medical Director, University College Hospital, Ibadan, (Left) Dr. Samuel Ajayi Nephrology, Dr. Gina Oladokun, Pediatrics, Integrate Integrity Team and (Right) Dr. Charles Modlin Urologist and Kidney Transplant Surgeon, MetroHealth

A nonrandomized cross sectional study led by the Renal Department at The University of Nigeria Enugu Teaching Hospital determined the frequency and pattern of transplant tourism among transplant patients in Eastern Nigeria. According to Okafor et. al, in Nigeria there is a growing population of patients with kidney transplant and transplant centers, however only 2 of the 8 centres that had done kidney transplant are transplanting regularly. A report from the most active transplant centre in Nigeria by Ebun Bamgboye at the biennial satellite symposium of the World congress of nephrology (10th conference on kidney disease in disadvantaged population) in Cape Town South Africa 2015 showed that more than 50% of their kidney transplant population had kidney their transplant abroad.

Lagos University Teaching Hospital Department of Nephrology and Community Medicine and Dr. Charles Modlin, MD MBA and Integrate Integrity Team

Additional background on the status of organ donation and kidney transplantation in Nigeria leads to the the National Health Act, which was recently signed into law in Nigeria, it is an offence for a donor or any of its agent to sell, trade or receive any financial or other reward for such donation, except for the reimbursement of reasonable costs incurred by him or her to provide such donation. Thus commercial donation and transplant trafficking is an offence in Nigeria punishable by imprisonment and/or option of fine. Hitherto there is no study on transplant tourism/commercial kidney donation in Nigeria.

Transplant tourism though can be legal, appropriate and permissible; it has been a leeway to various unethical activities including organ trafficking and bad medical practices. Thus World Health Organization (WHO) argues that though transplantation promotes health but the notion of “transplantation tourism” has the potential to violate human rights or exploit the poor. This could lead to unintended health consequences and unequal access to services; which ultimately may cause harm. Consequently a summit convened by The Transplantation Society (TTS) and the International Society of Nephrology (ISN) in 2008 at Istanbul in partnership with many countries through various acts, decrees and edict has discouraged commercial transplant tourism/organ trafficking (Istanbul declaration).

Dr. Olugbenga Awobusuyi, Nephrologist and Dr. Charles Modlin, Integrate Integrity Team and Lagos State University Teaching Hospital Department of Urology, Surgery, and Nephrology during Urology and Renal Transplantation at the Cleveland Clinic Presentation

Dr. Charles Modlin, founder and former director of the Minority Men's Health Center and present kidney transplant surgeon and urologist for the Cleveland Clinic transformed an interest in why African-Americans suffer a disproportionate share of diseases into programs that assist the minority community in Ohio. Upon his visit to Nigeria for the Global Integrate Program, he strongly promoted the importable of periodic health screenings to aid in obtaining treatment. His launch of the Center for Health Equity in Cleveland Ohio strives to address the economic cause of health disparities and solutions necessary for future success in kidney health and urological care.

#Transplantation #OrganDonation #RenalHealth #Nigeria