KARACHI: The light at the end of the tunnel for Karim Dad is growing dim-. He is a 36-year-old farm worker from Tando Jan Mohammad and has lived on dialysis for the last five years. A patient of end-stage kidney failure, Karim Dad could not have survived had he not been visiting the Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, twice a week to be hooked on to the dialysis machine which removes impurities from his blood. (This function is normally performed by the kidneys in a healthy person.)
SIUT has spent Rs 400,000 on Karim Dad so far and not charged him a penny. In the private sector, Karim Dad would have had to pay Rs 1,000,000 for dialysis to stay alive — something beyond his means.
The story begins five thousand miles away in the Dutch city of Maastricht. In mid-January a 14-year old girl slips into a coma and dies due to a ruptured cerebral aneurysm. Her grief-stricken parents decide to gift her organs to the dying. Thus they would have the satisfaction of knowing that a part of their child has not died.
That is how the central registry of the Eurotransplant Foundation in Lieden gets an AB+ blood group donor.
It is noon in Karachi. At the Sindh Institute of Urology and Transplantation (SIUT) in the Civil Hospital there is a call for the director, Dr Adibul Hasan Rizvi, from Dr Ganke Kootstra of the University of Maastricht. There is a cadaveric kidney available. Does Karachi have an endstage renal failure patient who needs the organ and has the matching tissue type?
Thus begins the miracle for Shehnaz, a young woman of 24 and a resident of New Karachi. She has been haunted by the spectre of death for the last four months since her kidneys stopped working. She has survived with the help of dialysis — a procedure in which the function of cleansing the impurities in the blood is performed by a machine to which the patient’s artery is hooked. But life has been robbed of all joy. Since October Shehnaz has had to come to the Institute thrice a week for a four-hour dialysis session. Then too, she feels fit for only a day, after which the nausea returns. She also gets breathless. Continue reading At SIUT the dead help the living→
Organ transplantation technology was introduced in the West in 1904 when the first corneal graft operation was performed in a New York hospital. The first kidney was transplanted in Boston in 1954. Today, surgeons in the Third World have adopted the technology with a growing measure of confidence and success. Nearly 40,000 transplantations are being performed every year all over the world and this technology has come to stay.
As happens in the case of any scientific breakthrough, many related issues, especially of an ethical nature, are now being debated. The 1 Institute of Urology and Transplantation, Civil Hospital Karachi, which has kept up a constant exchange of views and expertise with transplantation surgeons in Western centres, recently played host to two eminent gentlemen from the Royal Free Hospital, London. Dr Oswald Fernando, a surgeon from Sri Lanka, and Dr Zac Verghese, a basic scientist from India, have worked in Britain since 1963. They are therefore well placed to understand the challenges transplantation technology faces in the socio-economic conditions of the Third World. Continue reading Why not organs from cadavers?→
Two hundred children in Britain who faced certain death from liver failure are alive today and leading a normal, healthy life. They owe their recovery to the miracle of transplantation: the technology that allows surgeons to graft wholesome organs from one person to another.
Behind every milestone in medical science there is invariably a human story of sustained commitment and caring effort. In the case of these 200 British children the man who has made liver transplantation possible is Sir Roy Calne, a pioneer in the field of transplantology. A professor of surgery in the Cambridge University and president of the. International Transplantation Society, Dr Calne has contributed to the science of transplantation by his research on the immuno-suppressive drugs, without which no organ graft can be successful.
The defence mechanism of the human body normally ensures that it rejects foreign objects, which include organs taken from another person. Hence the use of drugs to suppress the immune reactions but in such measured doses that infections do not kill the patient. Continue reading Gift of Life→
In the early 1970s a magistrate from the interior of Sindh died of kidney failure in Civil Hospital, Karachi. This should normally not have merited a mention, especially twenty years later. Nearly 10,000 people in Pakistan come down with kidney failure every year.
But Mr Shaikh’s death, that was the magistrate’s name, proved to be an event of far-reaching consequences. In those days there were no facilities in Karachi for dialysis (let alone transplantation) — the only process by which the life of a patient of end-stage renal failure can be sustained. Mr Shaikh was sent to London where he was dialysed for a few weeks until his budget was exhausted. He was sent home with the false assurance that he was cured. He returned to Pakistan very pleased with himself looking forward to a new life. He brought as a token of his gratitude a small gift of handkerchiefs for the urologist who had attended to him in Karachi. Continue reading Organ transplantation has come to stay -Dr Adib Rizvi→
KARACHI, March 23: While condemning the unethical practices associated with kidney transplantation from unrelated living donors. Prof Kirpal Singh Chugh made a fervent appeal to the medical profession to spread the message to the public for the need for cadaveric transplantation of organs.
He was speaking on the “Ethics of Transplantation” at a symposium organised at a local hotel on Friday. Dr Chugh, who is the Professor of Nephrology at the Postgraduate Institute of Medical Education and Research, Chandigarh, India, was in Karachi to attend the Dow Medical College Annual Symposium on March 20-22. Continue reading Transplantation of kidney: Indian professor’s views→
Dr Rukhsana Parveen is a Senior House Officer in the Nawabshah Civil Hospital. Her job in the 73- bed medical ward is considerably demanding entailing as it does six hours of morning duty every day and four emergency duties a week — twice in the afternoon and twice at night.
For 27-year-old Rukhsana, her work as a physician is most satisfying. She speaks enthusiastically about her profession, narrating animatedly her experiences with her patients. She is proud of her achievements: in the last few weeks she has cured six patients suffering, from the deadly disease Hepatitis-B. Continue reading I was determined to live — and live normally→
When ‘ the first kidney transplant operation was performed at the Civil Hospital, Karachi, on November 20, 1985, few expected it to be more than a rare surgical feat accomplished once in a blue moon. After all, the obstacles to be surmounted were several, the most significant being financial constraints. Could a hospital in the public sector with a limited budget, sustain a programme which cost Rs 140,000 to provide postoperative care and drugs to one patient for one year?
There were other limiting factors as well. Even though the availability of surgical skill could be taken for granted, without an infrastructure of specialised nursing, extensive dialysis services and laboratory facilities, kidney transplant surgery could not be made routine. At that time arrangements did not even exist in the country for tissue matching, the first prerequisite for a transplant operation, and blood samples had to be sent abroad for this purpose.
Then there was the question of social acceptance of an idea that was quite radical for a society where life and death have a religious sanctity about them and are not. to be tampered with. Would donors be readily available and how would the people react to the concept of cadaveric donation, which has to be the ultimate endeavour of a transplant programme. Continue reading Helpful donors come to the rescue→