Thursday, 12 November 2015

2 can share a kidney


Gabriel with his younger brother, who donated a kidney to him.
 
JACK ZIMBA      
WHEN Gabriel Phiri was diagnosed with kidney failure in 2006, he felt like it was the end of the world for him.
“It was a fright. It was a question of am I going to live or maybe this is the end of it all,” says the 55-year-old.
Today, however, Mr Phiri lives a fairly healthy life, thanks to a donated kidney he received from his younger brother.
Mr Phiri discovered that both his kidneys had collapsed after a freaky incident. While waiting for a friend in a car park, a tiny particle entered his eye and he ended up at the hospital to have it removed.
However, after routine tests, it was discovered that Mr Phiri had high blood pressure, a shocking diagnosis, as he was not a known hypertensive. Prior to this episode, however, Mr Phiri had for a long time suffered loss of appetite, which he could not understand.
But it was the second diagnosis that scared him the most.
Further tests revealed that Mr Phiri had abnormal levels of urea and creatinine (a chemical waste which is a by-product of normal muscle contractions) in his blood. This led doctors to check his kidneys and confirm the worst - both organs had collapsed.
DIALYSIS VS TRANSPLANT
After the diagnosis, Mr Phiri was put on dialysis treatment, which he received three times a week at a private hospital.
But even for an established businessman like him, meeting the cost of dialysis at the private hospital soon became unbearable. At the time, treatment cost K800 per session, and a patient needs three sessions per week.
Today, the cost of dialysis ranges between K1,200 and K1,700 per session at private medical facilities.
Under a government scheme, however, the treatment can be accessed at highly subsidized fees. There are three categories of payments, with the highest being K400, while the least is K50 per session. There are others still, who get the service for free under the scheme, including children and pregnant women.
But although he was able to access cheaper dialysis at UTH, life on the machine was beginning to take a toll on Mr Phiri and his business, as he had to spend many hours out of the office.
“Four hours on the machine drains you,” says Mr Phiri, who runs a printing company.
After three years on dialysis, doctors recommended kidney transplant as a long term solution for Mr Phiri.
Although he was scared to undergo a transplant, he took the offer.
“When you are in a situation where it’s a question of life or death, you take anything that is offered to you as an option,” he says.
Two of Mr Phiri’s brothers offered themselves as possible donors of the bean-like organ, but it was Vincent, his youngest brother, who had a matching blood group.
“I did it out of love,” says Vincent, who was 33 years old at the time.
The Zambian law does not allow harvesting of organs from dead people; hence the only source of body parts is a living person, preferably a blood relative.
On March 29, 2009, Mr Phiri underwent the transplant operation at Apollo Hospital in India, making full recovery within two month.
As for Vincent, he leads a normal life just like before.
“People ask me if I feel like there is something missing in me…but I don’t feel anything,” he says.
“I think I have become more attached to him,” says Mr Phiri about his younger brother.
“Of course there is that feeling that if it wasn’t for him, I would probably not be here. There are people I spent time with at UTH who died because, in some cases, they never had the privilege that I had,” he says.
He says the transplant gave him “a second chance at life”.
It is a second chance that others long for.
Maganizo Mabengwa is a young man in his late 20s. He has a catheter permanently inserted in his abdomen and thrice a week he visits the renal department at UTH for dialysis.
He complains about life on dialysis and his face beams when asked if he would consider a transplant. 
“I wouldn’t refuse that…I wouldn’t,” he says.
Maganizo discovered he had kidney failure in October last year after visiting the hospital with symptoms that included swollen legs, vomiting and night sweats, and although he never suspected anything very serious, he was diagnosed with kidney failure.
Hypertension was given as the reason for Maganizo’s condition. But just like Mr Phiri, he, too, was not a known hypertensive.
According to Dr Charles Mutemba, a nephrologist or kidney specialist working at the University Teaching Hospital (UTH), many people will not know they have kidney failure until the condition becomes advanced, usually resulting in swollen legs.
Dr Mutemba says many people who are diagnosed with kidney failure are “crash-landers”, people who, like Mr Phiri, go to seek medical attention for something different.
He, however, says symptoms of kidney failure usually mimic the original disease, making screening difficult.
There are two types of kidney failure - chronic and acute kidney failure. Acute kidney failure, which is reversible, is usually caused by sudden occurrences such as accident, poisoning and diseases such as malaria.
Chronic kidney failure, which is a result of permanent damage to the kidneys, is caused by three major factors, according to Dr Michael Mbambiko, a UK-trained kidney transplant surgeon.
“If someone is hypertensive and the blood pressure is not properly controlled, one of the organs that gets damaged is the kidney and it is damaged irreversibly,” says Dr Mbambiko.
Diabetes is also listed among the major causes of kidney failure, while ethnicity is also a factor, with black people being more susceptible to the condition, according to Dr Mutemba.
He says Truvada, which is one of the first-line treatments for HIV/AIDS, has also been known to cause damage to kidneys, so has the prolonged use of certain painkillers.
PREVALENCE
Although UTH does not have records to show the prevalence of kidney failure, Dr Mbambiko thinks the number is “quite high”.
Dr Mutemba blames non-availability of statistics on kidney failure on lack of proper screening of patients.
Every year, the Zambian government sponsors 10 patients to undergo kidney transplants in India, spending about US$25,000 for each transplant. In South Africa, kidney transplants cost as high as US$65,000.
However, Dr Mutemba says some patients have failed to undergo the transplant because they failed to find a matching donor.
He says many relatives of kidney patients are afraid to donate a kidney even with assurance that they can live normally on one.
In fact Zambia’s celebrated football commentator Dennis Liwewe, who died last year at the age of 78, was born with one kidney.
“We still have a lot of work to sensitise our population that kidney donation is safe,” says Dr Mbambiko, who has performed many successful kidney transplants in Britain.
“We can’t perpetually be dialyzing patients,” he says.
Besides, access to dialysis machines is still very limited in Zambia. Currently, only two government hospitals have Hemodialysis machines – Kitwe Central Hospital and UTH.
Patients who are in places where they cannot access Hemodialysis are put on peritoneal dialysis, which can be administered at home. But peritoneal dialysis does not come cheap, either.
Dr Mutemba says the cost of dialysis cannot become cheaper with time, it can only getter worse, making transplant the best solution.
Transplant Links Community, a UK charity has offered to conduct the first-ever kidney transplants on a number of patients in Zambia, as well as to equip local doctors with skills in renal transplants.
Dr Mbambiko says although the initial cost of establishing a facility that would conduct kidney transplants in Zambia has not be determined, the country would save a lot of money in the long run.
“We have enough expertise to carry out kidney transplants,” Dr Mbambiko says.

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