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The importance of organ donation

Health minister: One brain dead cadaver could potentially save 10 lives
  • Health Minister Dr. Duane Sands says Bahamians are open to organ donation. He told The Nassau Guardian that families of patients who have suffered intracranial catastrophic events, or stroke or head injury, car accident, etc. have agreed to donate their organs. In the same token, he said there are families who have been approached who did not consent. FILE

Guardian Lifestyles Editor

Published: Aug 08, 2017

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Each brain dead cadaver could potentially help 10 people in their battle with health challenges through the potential donation of a kidney to two people, a liver, a heart, maybe both lungs, as well as both corneas, and sometimes bone and skin, according to Minister of Health Dr. Duane Sands.

With Anthony Michael Watkins’ recent successful heart transplant at a Florida hospital, Dr. Sands said Watkins is one of approximately 10 Bahamians with either kidney or heart or liver transplants walking around.

But just how open are Bahamians to organ donation? Dr. Sands says they are “quite open” to giving someone else a gift of life.

“We have had a number of patients who have suffered intracranial catastrophic events, or stroke or head injury, car accident, etc. and their loved ones have agreed to donate their organs,” the cardiologist told The Nassau Guardian. In the same token, he said there are families who have been approached who did not consent.

Dr. Sands said Bahamians like Watkins are unique in terms of being able to have access to cadaveric organs through the country’s relationship with the University of Miami and their UNOS (United Network for Organ Sharing) system.

“When you start looking at the options for saving lives, a number of Bahamians have contributed to UNOS over the years and that has made it possible for Bahamians to have access to care that many other people in the world don’t have. Because Bahamians contribute to the bank, they can withdraw from the bank.”

While most transplants are done outside The Bahamas, he said it’s in large part due to the patients having insurance and the companies demanding that transplants are done at centers of excellence — places that do a significant amount of transplants on an annual basis.

“If you have insurance and you meet the criteria for transplantation — whether it is a living, related donor or it is cadaveric, many of the local insurance companies will insist you need to have that done at a center that can maximize organ survival and patient survival. In general, all of these are now done in the United States — some done in Atlanta, some done in Florida, but there are a significant number … certainly more than five, closer to 10 Bahamians now with either kidneys or hearts or liver transplants walking around,” said the cardiologist.

While insurance companies opt for their patients to have their surgeries preformed abroad, that does not mean organ transplantation has not been performed in The Bahamas.

Dr. Sands said kidney and corneal transplant surgeries have been performed locally in the past, and is a program that needs to be resuscitated.

The health minister said reviving the organ transplantation program is one of the commitments of his administration, and certainly during his tenure as minister. But he said it would require recruitment of additional surgical and medical expertise for the management primarily of the organ specific immunosuppression. He noted that there is a significant amount of local expertise with Bahamian nephrologists and other professionals who now are able to manage the immunosuppression of patients who have had organ transplants.

As time goes on, Dr. Sands said the vision is instead of patients only having the option of dialysis — whether its peritoneal dialysis or hemodialysis locally — that the country would have developed the expertise to provide transplantation performed and managed in The Bahamas, and then increase access to corneal transplants.

Dr. Sands himself has at least seven heart transplants under his belt.

He said heart transplantation isn’t a difficult operation and technically not very challenging. He said the problem with cardiac transplant is the patient is very sick to start, and the management of the immunosuppression postoperatively is where most of the challenge lies.

“When you talk about the technical aspect of stowing in a new heart that’s not really hard. The hard part is managing the patient before they get in the operating room, taking out their old heart and then managing them in a postoperative period.”

Watkins had heart transplant surgery on December 4, 2016. He returned home in July as he had to undergo immunosuppression postoperatively.

The health minister said Bahamians like Watkins are unique in being able to have access to cadaveric organs due in large part to then Coroner Winston Saunders convening a session of the Coroner’s Court to establish the precedent of harvesting organs in The Bahamas.

As a result, The Bahamas established a relationship with the University of Miami and their UNOS (United Network for Organ Sharing) system, participating in a non-regulated way at the time.

“Almost 20 years ago, then coroner Winston Saunders convened a session of the Coroner’s Court to establish the precedent of the harvesting of organs in The Bahamas. We had established a relationship with the University of Miami and their UNOS system. We were participating in a non-regulated way. We [me, Robin Roberts, Adrian Sawyer and a few other people] got the subpoenas to go to court to explain how we were taking his organs. He supported organ harvesting and donation, and he wanted to make sure that the legal precedent was established,” said Dr. Sands.

That pivotal case then led to formalizing the relationship with UNOS and the University of Miami, such that they then on a more regular basis would fly into Nassau, harvest organs [typically at Doctors Hospital], then take the organs out of country, and that allowed Bahamians to both contribute and participate in organ sharing, and so it meant that Bahamians had virtually the same right or privilege of getting kidneys, livers, hearts, or corneas as any other person.

Dr. Sands said over the years a number of Bahamians have received kidney transplants because of the country’s participation in UNOS.

After his heart transplant Watkins told The Nassau Guardian that he had a new outlook on life, after estimating that it cost him approximately $1.8 million which, for the most part, was paid for through insurance to get to that point

According to Dr. Sands, transplantation is cheaper than having to undergo dialysis.

“The initial cost of the transplant is hefty. But if you think that the annual cost for dialysis is between $50,000 and $80,000 a year, the cost of the initial transplant — and these numbers vary from site to site — is about $200,000, but then the annual cost subsequently drops to about $30,000 a year, and so within a few years, the transplantation is more cost-effective than is dialysis — certainly for a patient with congestive heart failure. The cost for managing that person with a device — whether we’re talking about an artificial heart, or a left ventricular assist device, or resynchronization therapy … all of these devices are incredibly expensive as well as anti-failure medicines, hospitalization, monitoring and so on and so forth. Even though the heart transplant may cost $400,000 to $500,000, it ends up being less expensive in the long run than managing progressive cardiac failure.”

Dr. Sands said Watkins is a prime example of someone who needed catastrophic care — someone who was totally incapacitated by his heart failure — had an artificial heart and then required a heart transplant. And that he was able to do so because he had insurance.

“Imagine a 20-year-old or a 25-year-old Bahamian who is in the same situation and has no insurance, and they now have to find $500,000 for a life-saving therapy. But if they got that therapy they could lead a normal life, have children, be productive members of society. But you can’t fry enough fritter and you can’t fry enough fish to make $500,000.”

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Last Updated on Tuesday, 08 August 2017 14:09

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