http://allafrica.com/stories/201201091359.htmlRwanda: Law On Organ Donation Might Remove Taboo and Save Lives
Rodrigue Rwirahira
A new ministerial order makes it possible for people to volunteer to be an organ donor. For that to succeed, some resistance, especially from certain religious groups, will have to be overcome.
When Marie Ingabire Umugwaneza's sister recently donating a kidney to save the life of a friend, the act quite surprisingly provoked a lot of negative feelings in the community - people, it seems, consider is a taboo or even a sin, and organ donors are even discriminated or stigmatized in some places in Rwanda.
"People started to gossip that she cannot conceive and deliver a baby, and yet she has given birth to a daughter," Umugwaneza says. "There are also religious interferences when it comes to organ donation - some believers think that it is a sin to donate parts of your body, and some preachers indoctrinate their followers not to donate organs saying you should die as you were born. I find this complete ignorance in this century."
Recently the government of Rwanda issued ministerial orders determining the donation card and the will format for the person willing to leave his or her body or organs for research, medical, scientific and educational purposes; the government also adopted a list of diseases that must be tested in a person willing to donate or to receive organ or tissue.
According to Health Minister Agnes Binagwaho, the orders are meant to improve health care in the spirit of collective efforts in solving health issues. "This exercise should be well understood by the public because it aims at solving health issues collectively. People should understand that someone can donate one kidney to his relative or a friend and both live comfortably, it is scientifically safe and possible," the Minister said.
Joseph Ntarindwa, a nephrologist or kidney specialist at King Faisal Hospital (the only hospital nationwide which does organ transplantation), says the hospital has conducted three kidney transplantations last year, while another 35 cases are being treated.
According to him, the hospital is in a position to conduct the operations because they have the appropriate equipment, but there is a lack of qualified surgeons which is why the hospital still relies on foreign specialists who come to Rwanda to conduct the surgeries.
He also points out that there is a distinction between various types of transplants. "Scientifically, there are two type of transplantation: living related transplantation and cadaveric transplantation. Our government so far approves the living related transplantation only, so there is still a need to formulate and adopt the cadaveric transplantation law at the government level," Ntarindwa explains.
The doctor further explains that there are two types of living related transplantation, bloody and emotional associated. In bloody living related transplantation, the donors are relatives of the patient, while the "emotional" involves people who have no blood relationship such as a wife, a friend, a neighbor and others. But all have to be donor-qualified.
As for cadaveric transplantation, which involves people who are deceased or brain-dead, even if this type of transplantation has not been adopted it involves a lot of medic technological expertise. "It is very technical and involves a lot of departments - the organs of someone who is brain dead need to be collected earlier and be treated accordingly, the organs need to be metabolized at their designated temperature because they cannot be kept for a long period," Ntarindwa remarks.
Some organs need a cold ischemia process which consists of the chilling them during decreased blood perfusion or in the absence of blood supply. Cold ischemia time according to the nephrologist occurs when the organ is cooled with a cold perfusion solution after organ procurement surgery, and ends after the tissue reaches physiological temperature during implantation, which has to be done within 36 hours. While a warm ischemia time process starts then and ends with completion of surgical procedures and takes only five minutes.
"To be qualified as a donor has to be screened and fill a form before an operation. While screening we test things like HIV/AIDS, Epstein bar virus antibodies, renal function test, liver function test, blood sugar, chest X-ray, and others; when your results are fine, you fill a form confirming that what you are doing is from your own will and then you can be operated," explained Ntarindwa.
The hospital through the ministry of health is negotiating with an Egyptian university to have regular visits by surgeons to treat these cases, because currently most the time the King Faisal Hospital has to refer them to Indian hospitals or in South Africa. Yet in the first place, it will be a question to sensitize the public that organ donors are essential for the health sector, and should not be stigmatized but rather be complimented.
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