At the government-owned and -controlled NKTI alone, the spike in the statistics is almost mind-numbing. "In the past, we had 200 transplants in a year. Now we have 400," Lesaca discloses. "That's more than one a day." And that number doesn't only represent Filipinos. Many patients from other parts of the world are traveling thousands of miles to go under the knife here. There is currently a 10-percent cap on foreign transplant patients, but Lesaca thinks the ceiling may eventually be removed. "Many are complaining about the cap. There are suggestions that for every foreigner operated, he will be required to subsidize three Filipinos-two donors for work-up and one for transplantation," he expounds. The money would go to the nonprofit, privately funded Kidney Foundation of the Philippines (KFP). Currently, NKTI's foreign patients are already contributing to the fund, as the document on one patient's cost package reflects: An unspecified amount for "donor assistance/donation to the Kidney Foundation of the Philippines" is bundled together with other entries under "donor expenses."

    Foreign patients are flocking to the country, lured by the cheaper cost of getting a transplant, which is one-half to a fraction of the price elsewhere. The medical bill, excluding the varying professional fees and expenses arising from complications, can set the foreigner back by US$60,000. For Filipino patients, naturally, the cost would be lower. According to nurse Karen Ann Pilar, NKTI's transplant coordinator, the same package, inclusive of doctors' fees, ranges from PhP1 million to PhP1.5 million for locals.

    But what is perhaps most attractive to foreigners is the shorter waiting period. "The success rate [of the transplant] is comparable to that of the US. But there you have about 80,000 patients on the waiting list, and you have to wait two to five years or more for a kidney. Here, it sometimes takes six months only or less," she says.

    The huge discrepancy in the waiting periods is also due to a legal restriction in certain countries. "In the US and the UK, the law prohibits nonrelated donors. Only kidneys from related donors and the deceased are allowed," she explains. "We have a lot more flexibility, and now they're looking at our experience."

Changing the system

    Kidneys from nonrelated living donors may be a viable medical option, but they have raised a lot of eyebrows when reports of rampant kidney sales surfaced. Desperate to make ends meet, these "donors"-most of them lived in slums-resorted to selling their kidney for anywhere between PhP135,000 and PhP300,000, and tragically, many of them were exploited by their brokers, middlemen who scout for donors to match with recipients (see Kidneys for Sale).

    Lesaca has been liaising with the Department of Health (DOH) to create a system designed to hinder these commercial transactions from taking place in the future. Using America's United Network for Organ Sharing (UNOS) as a model, DOH plans to replicate NKTI's HOPE-the organizational arm dedicated to "the legal procurement, preservation, and placement of organs and tissues for clinical transplantation"-on a national and institutional level. The national HOPE will hold a comprehensive and computerized database of donors and recipients in the country, by having access to each transplant facility's HOPE unit. In essence, the individual broker is replaced by an organization with a vast network to tap into for "a more transparent and equitable allocation of organs to recipients."

    And instead of receiving an outright payment, the kidney donor is given a gratuity package by KFP. Part of the package includes livelihood assistance, which provides a more long-term solution to fighting poverty than monetary compensation alone. Lesaca notes that many of these donors, upon receiving cash for the kidney, could use up the entire sum in a short period, spending them mostly on household items and consumables. "Then it's back to square one for them," he comments.

    To warn against preying kidney brokers and to enlighten prospective donors and would-be transplant patients, HOPE conducts a twice-a-month pretransplant orientation. With the help of a multidisciplinary team of nephrologist, dietician-nutritionist, psychiatrist, physical therapist, transplant fellow, and chaplain, the "ins and outs of renal diseases" are explained and myths are dispelled, including the fear that losing one's kidney can affect one's manhood or one's ability to give birth. He cites former president Fidel Ramos as an example of someone who has lived a full life despite losing one of his kidneys to a disease. "He was the AFP (Armed Forces of the Philippines) chief. He did scuba diving, sky diving, and golfing, a very active life.... There are also people who don't know they have only one kidney because they were born with only one, and they have functioned normally," he relates. "Because of our advocacy efforts, people now know they can live healthy lives with just one kidney. As a result, we have more referrals now."

    Lesaca also stresses that only those who are physically fit and healthy can become donors, a precondition that should quiet critics who claim that impoverished donors have poor health to begin with, and that removing one of their kidneys would only disadvantage them further. "The moment they find something wrong with you, they disqualify you," he reiterates. In fact, based on his experience, about half of the walk-in donors would discover that they have health problems after doing the required exhaustive work-up. "Many of us think that just because we don't feel anything, we are healthy," he says.

    Retrieving organs from nonliving donors is another of HOPE's priorities. "In the past, [organ retrievers] were looked upon as vultures, lurking and waiting to get the organs of the dead," Lesaca observes. But by practicing tact when asking families for permission and through advocacy efforts, the yearly contribution from deceased donors have jumped from an annual average of five to 10 percent to more than 20 percent. And he is optimistic they can do better. Let's hope that he is right, for the sake of the 640 HOPE patients, as of the latest tally, and the countless others who are waiting for a kidney. M

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When money doesn't equal might

 

 

"Some people think that just because they have money, they can push their weight around," Dr. Reynaldo Lesaca of the Human Organ Preservation Effort (HOPE) opines, referring to rich folks who think they can jump ahead on the organ waiting list. To address this, Lesaca's team at HOPE is structuring a point-based organ-allocation system based on a new set of criteria that includes but isn't limited to age, length of time on dialysis, and presence of comorbidities. "For instance, we give priority to younger and more productive people," he says. "We want to work on beneficence, equity, and not palakasan or arbitrarily. We want to have a system that is orderly, transparent, and equitable."

Once approved, the point system will be adopted for the national HOPE.

An expensive upkeep

    You may have enough money to pay for the transplant, but you and your checkbook are not yet home free. Keeping yourself healthy after the surgery is going to cause a serious dent on your bank account. Karen Ann Pilar, transplant coordinator at the National Kidney and Transplant Institute (NKTI), says that the immunosuppression drugs needed in the first six months from the operation can run from PhP20,000 to PhP30,000 a month. Gradually, the dosage will taper off, bringing the cost of medication down to anywhere from PhP10,000 to PhP3,000 a month. Furthermore, the medicines have to be taken for a lifetime. That's why she advises potential transplant patients to consider the financial implications before undergoing the operation. "Sayang lang kung di naman nila maitutuloy yung gamot," she says. When that happens, the organ will be rejected by the recipient's immune system. Not only would he have wasted his money on the procedure, he would also have deprived others of the opportunity to maximize the use of the kidney.

Politically correct

    Lesaca says that it's no longer appropriate to use the terms "cadaver" or "harvest" organs. More suitable alternatives are "deceased" and "retrieve," respectively. M

 

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