DR. MALAYA SANTOS
Dr. Malaya Pimentel-Santos is a long-time community health advocate, having worked with several non-government health organizations. She is a fellow of the Philippine Dermatological Society and a professor of microbiology at the St. Luke’s College of Medicine.
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“Transplantation tends to be more cost-effective than dialysis, with successful transplantation incurring lower costs of treatment and producing better outcomes in terms of quality of life. Transplantation also results in a greater ability of patients to participate productively in the community.”
- Sarah L. White et al., Bulletin of the World Health Organization
Last September, social media went abuzz over a photo of singer Selena Gomez holding hands with best friend Francia Raisa while lying side by side on hospital beds. The touching photo was taken after Gomez underwent a kidney transplant necessitated by complications of lupus, an autoimmune disease. The transplanted kidney was donated by Raisa.
Kidney transplantation and RRT
Kidney transplantation and dialysis together constitute renal replacement therapy (RRT), treatments which are lifesaving in a setting of kidney failure, when the kidneys are no longer able to perform their essential function of waste removal and detoxification. Kidney transplants and dialysis (discussed in part 1 of this series) are both extremely costly, and in many low-income populations, access to RRT is still severely restricted.
As previously stated, the decision to have either dialysis or a kidney transplant must be tailored to the specific circumstances of each individual patient. In many instances, a kidney transplant is associated with better longterm outcomes, and is thus considered to be more cost-effective. However, not all patients with end-stage renal disease (ESRD) can be recommended as good candidates for the procedure. The patient’s medical condition must be carefully evaluated, together with other factors such as available resources, preand postoperative medical care, social support systems, religious beliefs and cultural preferences.
Kidney donor programs
Some transplant patients have to wait for many years for an available kidney. Kidneys for transplant can come from deceased or living donors. Living donors are either family members or friends (as in the case of Selena Gomez). The other source of kidneys for transplant is deceased (non-living or cadaver) kidney donations. However, there are a number of religious and cultural barriers, and continuous education and reorientation may be needed among health professionals and the general public in order to improve the acceptability and utilization of this option.
Like any other organ transplant, a kidney transplant is a complex and invasive procedure that requires a thorough evaluation of risks and benefits, careful pre-operative preparation, and appropriate post-operative care for the recipient as well as the living donor. For the transplant recipient, any transplanted organ is recognized by the immune system as ‘foreign’ tissue, which in turn triggers an immunologic cascade that, if allowed to continue, will ultimately lead to organ rejection. To prevent this catastrophic event, all organ transplant recipients must take immunosuppressive drugs. These medications are designed to prevent organ rejection, but are often expensive, and may sometimes have other side effects.
Kidneys for sale
Unrelated living kidney donations are currently restricted in the Philippines, in a move to help fight the disturbing practice of ‘donating’ organs for a fee. Sadly, in the midst of abject poverty and desperation, some communities have fallen prey to syndicates who broker the sale of organs to rich people (mostly foreigners) needing organ transplants. In 2008, the DOH issued a ban on live, unrelated kidney donations for kidney transplant recipients from overseas.
A 2008 article in The Guardian by Ian MacKinnon described ‘transplant tourism’ in the Philippines, naming our country as one of the main sources of donated kidneys worldwide, at the time. Specific slum areas in Metro Manila were identified as ‘hotspots’ for this exploitative, unethical and illegal practice. Ultimately, after their kidneys have been harvested, these paid ‘donors’ will go back to their humble communities without the medical care and support that should have been provided to living organ donors, leaving them exposed and vulnerable to various potential postoperative and long-term complications.
Local resources for kidney transplantation
Much has already been achieved in terms of broadening access to RRT. The Philippine Health Insurance Corporation (PhilHealth)now offers a Z package that covers the cost of kidney transplantation up to Php600,000. This package is available to patients who fulfill the selection criteria and who are being treated at selected partner hospitals. More information can be found at their website, philhealth.gov.ph. There are also private initiatives that help fund the ancillary costs associated with kidney transplants. The Philippine Organ Donation Program (PODP) of the Department of Health has put in place legal and ethical guidelines governing the practice of organ transplantation in the country, via a national donor/ recipient registry and a donor/recipient screening and matching system.
However, despite vastly improved Philhealth coverage for dialysis and kidney transplants as well as some private support systems, these treatments remain beyond the reach of most ordinary Filipinos. Programs directed towards health education, lifestyle modification and prevention of end-stage kidney disease are limited, and in many areas of the country, health and social infrastructures continue to be inadequate.
I deeply sympathize with Selena Gomez for her health struggles, and I have nothing but respect and admiration for the generosity of actress Francia Raisa who – literally and figuratively – shared a part of herself to help save Gomez. I am happy for the successful outcome of this kidney transplant. The fame and prominence of this pair of celebrities has undoubtedly stimulated public discussion and helped raise awareness about kidney failure and kidney transplantation.