Negative beliefs stand in the way of Kenya’s drive to legalise body organs harvesting

Rhoda Wanjiru is friendly, has a charming smile and easy demeanour. She is thoughtful and speaks fondly of her seven-year-old daughter. “She’s my miracle baby,” says Ms Wanjiru, who unknowingly suffered from hypertension while pregnant and as a result nearly lost the child.

“One night, my entire body swelled and I began having convulsions. I think I collapsed because when I woke up I was already in hospital,” she reminisces.

The doctors performed an emergency C-section immediately. “It was either my life or that of my child. But luckily we both survived even though my baby was born prematurely.”

But the victory was bitter-sweet since a few days later Ms Wanjiru was diagnosed with kidney failure resulting from pre-eclampsia — a toxic condition of pregnancy characterised by high blood pressure, protein in the urine, abnormal weight gain, and oedema.

The condition affects some women usually during the second half of pregnancy or soon after delivery and damages the kidney.
Ms Wanjiru consequently had to undergo dialysis which made her weak and sickly.

“Some patients I had started dialysis sessions with died and I wondered if I was next.” The disease also interfered with her university studies.

Luckily, Ms Wanjiru was able to undergo a kidney transplant after just a year, following a donation from her mother. “We were a perfect match and that gave me a new lease of life.”

Six years later and Wanjiru says she feels healthy and energetic. “I was able to complete my studies. I am currently employed and happily raising my daughter.”

As a member of a kidney patients and friends association, Ms Wanjiru is aware that others may not be as fortunate.

Organ donation is legal in Kenya but only blood relatives are allowed to contribute. An exception is made for married couples, so long as they prove that they are legally married.

But in special circumstances, where tissues from potential donors do not match those of recipients, a kidney or any other organ can be sought from people not related to the patient.

“Thorough background checks are conducted to ensure that the organ is given voluntarily by the donor without any expectation of cash or other favours from the recipient,” says Mr Valentine Imonje, the National Kidney Foundation of Kenya chief executive.

Though well intended and aimed at preventing illegal organ trade, these background checks are often long and require potential donors to seek approval from various authorities like chiefs, police officers and the Ministry of Health (MoH) before giving organs to patients they are unrelated to.

As such, some potential donors give up along the way forcing recipients to wait longer, sometimes for over a decade, before they get a transplant and enjoy a new lease of life.

Aside from financial and capacity issues, the transplant queue at Kenyatta National Hospital (KNH), which stretches all the way to 2018, is exacerbated by a shortage of kidneys.

Countries in Europe, the US and parts of Asia have addressed this challenge by enacting laws which allow for harvesting of body organs from dying people for medical purposes. This is known as cadaveric donation.

Kenya is in the process of doing the same through a new health bill which is awaiting approval by a Senate committee before being signed into law by the president.

Dead person’s family

The bill allows the government to harvest organs like kidneys, livers, hearts, lungs, eye corneas and bone marrows to be used for transplants.

The organ harvesting will take place only after prior consent from the deceased through a will and permission from the dead person’s family.

In instances where relatives of the deceased cannot be traced and no will is left behind, the Health cabinet secretary will have power to authorise organ harvesting.

This is similar to what happens in South Africa and India. In parts of Europe, adult citizens become donors by default unless they state otherwise during their lifetime.

“Even though passing the bill is helpful, it isn’t enough. People need to be educated on the significance of organ donation,’’ says Mr Ephantus Maina, executive director of the Happy Kidney (HAKI) Foundation.

He says that awareness creation demystifies myths and misconceptions that hold people back from donating organs.

“We wouldn’t like to have a situation where we have the law in place but no organs to be used for health purposes,” Mr Maina says.

Even now, there are many Kenyans who fear donating organs to relatives. These individuals will be unwilling to have their organs harvested when they die.

“Yet this is the best thing that you can ever do. When you donate an organ to someone, you are giving them life. And this is very special,” says Mr Imonje who donated a kidney to a missionary friend in the United States in 2007.

“Many people discouraged me. They said I would develop health complications and would never have children.

‘‘But I still went ahead with the donation as this man had been instrumental in my life. He was the reason I completed my education and became what I am today.”

Mr Imonje adds: “That was nine years ago and I am still very healthy. I have never been to hospital for any sickness. And I also fathered another baby after donating the kidney.”

Potential donors are often subjected to a battery of tests and only those with a clean bill of health are allowed to donate.

“This gives you the confidence that you will be healthy even after donating.”

Dr Ahmed Sokwala, a nephrologist (kidney specialist) at Aga Khan University Hospital, Nairobi, explains that human beings can live healthy lives with just a single kidney. “After donating, the remaining kidney can still work well,” he says.

The liver is also a donation-friendly organ. Dr Kennedy Ondede, a liver specialist at KNH notes that the portion of the liver sliced off for donation grows back in just a month, making the liver regain its full functionality again.

He says that KNH alone receives about 40 to 50 liver patients daily, most of them with liver failure.

“Liver transplants can avert deaths and give these patients a new lease of life,” he says.

While still alive, people can also donate bone marrow, portions of their lungs and even pancreas or intestines to critically ill patients.

But organs like hearts or eye corneas can only be obtained from deceased donors as living human beings need the heart to breathe and eye cornea to see.

Dr Jyotee Trivedy, an opthamologist at Lions SightFirst Eye Hospital in Nairobi, says that religious and cultural beliefs are major stumbling blocks to organ donation in not only Kenya but most African countries.

Since opening its eye cornea storage bank in 2010, the hospital has been raising awareness and urging Kenyans to pledge their corneas to the institution “so that when they die we can harvest and use them to bring sight to thousands of blind children.”

Sadly, she says, aside from the Asian community most Kenyans are reluctant to donate their corneas. “Many say they can’t donate because they won’t be able to see Heaven without them,” says Dr Trivedy.

Some people also claim that donating organs is a sin. “God made you the way you are for a reason. If he thought you would just be fine with a single kidney, he wouldn’t have given you two. So you can’t give out one,” some say.

In most African communities it is taboo for the young to mingle with older people. Consequently, organs from these two groups aren’t supposed to ‘‘mingle’’.

A son cannot donate a kidney to the father and vice-versa, for instance. There have been cases of elders threatening to curse potential donors and accusing them of giving out what is not theirs since organs are considered to be God’s property.

Dr Joshua T.I, the deputy general manager of Global Hospitals in India, tells the Business Daily that these are some of the challenges that India initially faced when organ donation began.

Shortage of corneas

“So we worked closely with religious leaders who were able to convince people that organ donation is a noble act of charity which pleases God. Being a donor is a testimony of your kindness and love for fellow human beings.”

He adds that people were also reminded that when they die, it is their soul that goes to heaven and not the physical body.

“So you won’t lose anything by choosing to donate your organs to those that will be in need of them. At least your organs will give others life instead of decomposing in the soil.”

To address the shortage of corneas, Dr Trivedy says that Lions SightFirst Eye Hospital imports them from the United States.

“We charge Sh250,000 for a cornea transplant. But if we were to use locally donated corneas the cost would drop drastically to Sh60,000.”

Dr Sokwala states that the deceased donor programme, which will be legal after the bill is signed into law, is aimed at complementing the existing living donor programme.

The programme will increase the number of organs available for transplants.

By donating a kidney, a living donor only saves the life of a single recipient. But a dead donor will save more than eight lives due to the multiplicity of organs that he or she can give all at once.

These include two kidneys, a liver, heart, lungs, corneas, intestines and pancreas.

Embracing the deceased donor programme is also expected to reduce the cost of transplant surgeries.

The cost is currently high since doctors usually perform two surgeries. They first operate on the living donor to extract the desired organ then proceed to the recipient.

This also strains the already limited hospital infrastructure and resources.

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