A Bill making it easier for Kenyans to donate their body organs for transplant and research has been passed by Parliament.
Now waiting for Presidential assent, the law is expected to save or improve lives of thousands of Kenyans requiring organ transplants. The new law is part of the larger Health Bill 2016 passed by Parliament on May 25 and builds on the Human Tissue Act of 1966, which was reviewed in 2012.
The law allows Kenyans, either in a written will or oral statement before witnesses, to donate their bodies or body parts to persons or institutions of their choice upon death.
Ephantus Maina of the Happy Kidney (HAKI) Foundation explains that donations to institutions would ideally be preserved in an organ bank for use in competent transplant facilities. The challenge now, Maina says, is to have a significant mass of Kenyans volunteering to donate organs or their bodies after death. “The more the better but before then the country would need to build the capacity to effectively collect, screen and preserve the donations. Of course with a strong mechanism to keep charlatans away,” he says. For example, to make sure doctors do not coerce patients into untimely removal of organs, a doctor who authorises such a procedure will not play a leading role in its transplantation to the other party.
The law comes with a hefty fine of up to Sh10 million, or 10 years in jail or both for those turning lifesaving organs into an underhand cash cow.
If played above board, Maina says most to benefit will be kidney patients. The Kenya Renal Association estimates that about 6,000 Kenyans suffer kidney failure annually.
At the country’s only public kidney transplantation unit of Kenyatta National Hospital, there are about 200 patients on the waiting list. On average the renal unit does two transplants in a month.
Pressure on living donors
A recent in-house audit of the unit by doctors, Alex Muturi, Vihar Kotecha and Samuel Kanyi, says one of the challenges facing it is reliance on living donors. “In our centre majority of donors were first-degree relatives, 84.5 per cent, followed by second-degree relatives at 14.3 per cent. There was one case of a man donating a kidney to his wife,” says the audit report.
The new law now opens the way for a legal and regulated mechanism for donations from non-relatives.
Maina, who in 2006 walked for 120km to raise funds for his mother with a kidney problem, says an organ bank will ease off some pressure on living donors.
The KNH renal unit audit published on May 25 in the journal BMC Nephrology reveals some of the problems the unit faces due to reliance on living donors. Of the 118 potential kidney donors in 2010-2014, the audit shows, 17 scheduled donors failed to donate, with 11 declining at the last minute.
“Overall, we found the unit to be doing well and hope the findings will help make it even better,” says Muturi, a general surgeon, who was the lead investigator. Among the 84 kidney donors assessed in the audit, the team reported no fatality but recorded what it says are significant complications.
“This points to the need to institute measures both during kidney removal and in after-surgery care to minimise these complications,” says the team.
Complications included severe bleeding during surgery and post-operation pain, which the team recommend should be looked into.
The new law comes at a time medical researchers are questioning whether living kidney donors are at a higher risk of developing kidney complications compared to non-donors.
In a study involving some of the top kidney experts at KNH and the University of Nairobi published in 2014, the team reported evidence of hyperfiltration among living donors in Kenya.
Hyperfiltration is an abnormal increase in the filtration rate of the remaining kidney thought to have potential of causing serious health problems. One prominent study in the UK, for example, had demonstrated a decline in renal function of donors and an increase in the incidence of new onset of hypertension.
Locally, Dr Austine Bwire, Prof Seth Mcligeyo, Prof Athony Were and Prof Joshua Kayima, in the report published in 2014, had studied 52 kidney donors at the KNH renal unit at 15.9 months after donation. They reported all the donors had regained normal function but with a “tendency towards hyperfiltration”.
The study published in the Journal of Dental and Medical Services recommended that living donors at KNH be followed up as a routine after every six months to assess their health status. The study recommended that living donors need regular monitoring due to changes such as abnormal filtration, excess proteins in the urine and new onset of hypertension.
Also, unlike in developed countries where donors are much older, averaging 61 years, in Kenya they are much younger at about 34.
“The donors in our setup are young and in their most productive time of their life and it is therefore crucial for the operation to be safe,” says the Muturi audit.