‘Nephrologists working hard to improve availability of organs for transplant’

By Janet Ogundepo

The President of the Nigerian Association of Nephrology and Transplant Association of Nigeria, Prof Jacob Awobusuyi, says nephrologists and transplant experts are working hard to improve the availability of organs for transplant ethically.

His statement is coming amid the organ harvesting saga in Nigeria and the challenges recorded from the pig-to-human kidney and heart transplant carried out in the United States of America.

The ongoing development in the field of organ transplantation, particularly the use of genetically modified pig organs, has sparked significant interest and discussion within the medical community.

In March 2024, the Massachusetts General Hospital, for the first time, transplanted a genetically modified pig kidney into a living person.

Before the transplant, AP News reported that pig kidneys had been temporarily transplanted into brain-dead donors.

In April 2024, a woman in New York, USA, became the second person to receive a genetically modified pig kidney.

While recent reports noted that the recipient was doing well, the first person to have the transplant, Rick Slayman, died a few weeks after the transplant.

But the British Broadcasting Service, reports that the US hospital where the transplant was carried out said Slayman’s death was not as a result of the transplant.

Meanwhile, in September 2023, a genetically modified pig heart was transplanted into a 58-year-old man, Lawrence Faucette, making him the world’s second patient to receive such a transplant, according to the Voice of America.

Due to the long list and waiting time for patients in need of organ donation endured globally, new advances in science and organ transplants have come to the rescue.

According to the National Kidney Foundation, the use of non-human cells, tissues or organs to treat medical conditions in humans is referred to as Xenotransplantation.

The NKF further explained that the use of pig kidneys as against that of other animals is because pigs are widely available, have kidneys that are similar in size to humans and have a low risk of transferring disease.

It further noted that the pigs were raised in laboratories and had their genes edited to match human genes.

Although the first recipient of the pig-to-human kidney transplant died a few weeks after receiving the transplant, scientists and nephrologists noted that further research was needed to address the concerns.

People who have end-stage renal disease or chronic kidney disease, also known as kidney failure, need kidney transplants.

In the United Kingdom, about 5,000 people need kidney transplants annually.

The National Kidney Foundation noted that in 2021, 786,000 patients living with CKG in the US needed kidney transplants, however, less than 25,000 of them received transplants.

The NKF also stated that about 12 people in need of kidney transplants die each day while waiting for the transplant.

In Nigeria, there is a paucity of national data on the number of those in need of kidney transplants but data from a review of kidney transplants between 2000 and 2010 revealed that 143 transplants were done in the year reviewed and 70 per cent of them were carried out in private centres.

However, recently, due to the seeming rise in CKD, there have been several allegations of organ trafficking in the country.

Awobusyi in an earlier interview with PUNCH Healthwise, stated that illegal organ harvesting was giving the country a bad name.

He strongly condemned the trafficking of donors, noting that most people being trafficked were minors and financially disadvantaged people.

Further speaking with PUNCH Healthwise, the NAN-TAN president said although the transplant of genetically modified pig’s hearts and kidneys into humans was a welcome development, the death of the recipients, failure of the organs after a few weeks of transplantation, ethical issues surrounding the use of the animals, the genetic editing needed and the cost of the procedure, made its adoption not feasible.

He said, “Let me say, it’s a welcome development, but it’s not as easy. The pig’s organs are very similar to what we have as humans, so it’s utilisable, but there are many issues. What has made it possible is development. So, they are not just pigs that are out there, they are, in a way, humanised.

“And what do I mean by that? Their genes have been edited. In the last transplanted kidney, about 69 alterations were made to the pig’s genes to make it slightly compatible with humans. Pigs have some genes that code for carbohydrates, making their genes and tissues highly antigenic.

“That is, if you just take any pig and you transplant the tissue, our body will reject it almost immediately because of antigens that are on the surfaces of the pigs. So, they’ve modified by substituting some elements of human genes into them. And then, also, there is this aspect of some viruses that pigs carry, and they also altered that.

“And a couple of other alterations, you know, were done. So, it’s not just a pig as it were, but it’s a genetically modified pig. Not only that, the pigs for that purpose, whether it’s a heart transplant or whatever transplant, must be raised in a germ-free environment. We don’t want the infections that occur in pigs to be transferred to humans. We call them zoonotic infections. So, right from birth, those pigs will be reared in germ-free environments until their organs are about the same size as we have in human beings.”

Speaking on Nigeria’s progress in meeting the organ donation needs amid the high rate of organ harvesting, Awobusuyi said the only form of available organs in Nigeria is from living donors.

He added that kidney, bone marrow and cornea transplants were the three forms of transplants that have been done in Nigeria.

The don noted that while the kidney and bone marrow transplants were obtained from living donors, the cornea was obtained from deceased donors.

Awobusuyi said cornea transplants done so far in Nigeria were imported, noting that it put the country at a disadvantage.

“The kidney transplants and the bone marrow are from living donors and that’s usually how it is anywhere in the world. The cornea, of course, has to be from a deceased donor, from dead people and the cornea transplants that have been used and done so far, are imported, so that puts us at a disadvantage,” the Nephrologist added.

He also mentioned that TAN was considering the possibility of developing the deceased donor transplant programme in Nigeria.

Awobusuyi said, “What we are trying to do as the Transplants Association of Nigeria is to see whether we can develop a deceased donor or transplant programme in Nigeria. The deceased donor is a dead patient, and that is what constitutes the majority of transplants done abroad.

“So, what that would do is to increase the number of available organs for transplantation. It’s not as easy as living donor transplantation, because it involves a lot of organisation, collaboration, structure, legislation and law enforcement being put in place so that we don’t end up with sharp practices, which has a lot of implications.

“So, we are trying to see if we can look at a few government hospitals, and maybe one or two private hospitals, that can collaborate in terms of discussing the possibility, organising their intensive care units, having their transplant team in place, looking at where we’ll do the cross-matching and the laboratories that we can use.

“The idea, or the main thing, is to establish a firm in Nigeria, in a technically-conditioned environment. We know that it will require a lot of government input and we are also talking to the ministry in terms of developing guidelines. About three months ago, we were having meetings with the Ministry of Health, and that went on for close to two months. We have some kind of reports providing guidelines on how to improve transplantation in the country.

“We are working hard to improve the availability of organs ethically. We hope that this will encourage other transplants to take place in the country.”

The don further clarified that organ donation from seriously ill patients or those in the Intensive Care Unit was only after the patients had been clinically certified brain dead before any form of organ removal could be done.

“We test for function of the brain and when the ventilator is removed, you just see that there’s no effort to breathe by that patient. So the brain is dead and technically, that patient is dead,” he explained.

The NAN-TAN president further expressed hope that the potential expansion of organ transplantation in the country could bring life-saving treatments to countless individuals suffering from organ failure, especially for critical organs like the heart, lungs, and liver.

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