How encouraging kidney transplants from brain-dead donors can save lives

Shamima Ahmed, 34, is now able to walk slowly inside the room of her family's rented flat in Mirpur, and no longer needs dialysis two days a week.

She underwent a kidney transplant on 18 January this year at Bangabandhu Sheikh Mujib Medical University (BSMMU).

Her doctors have reported that she was discharged from the hospital on 28 January as her creatinine levels were normal. However, she still requires medication and regular tests to ensure her continued health.

She is receiving free testing facilities at the BSMMU, and her family is only responsible for covering the costs of her medication.

It was the first-ever cadaveric kidney transplant – the process of transplanting kidneys from brain-dead medical patients.

The donor was Sarah Islam, a 20-year-old girl, who donated her kidneys before her death. She had been critically ill since childhood from tuberous sclerosis and was pronounced clinically dead on 18 January.

Another individual who received Sarah's kidney is Hasina Akhter, also in her thirties, who is currently in the process of slowly recovering after undergoing surgery on the same day at the Kidney Foundation Hospital and Research Institute.

However, Hasina Akhter is still in the post-transplant unit of the hospital due to complications such as infection and heart-related issues, and the hospital is covering all of her expenses. The doctors have stated that it will take some time for her condition to improve.

The surgeries have been celebrated by doctors as a significant milestone that paves the way for alleviating the sufferings of kidney patients in the country.

As a result, the BSMMU authorities are planning to form a national committee that will encourage kidney transplants from brain-dead patients.

Doctors say kidney transplants, which are a permanent solution for patients, are cheaper and more effective than dialysis. However, such transplants are still not popular in the country as it is hard to find donors.

Dr Habibur Rahman, head of the Renal Transplant Department of BSMMU, told The Business Standard, "In developed countries, about 90% of the kidneys are transplanted from brain-dead patients. However, since it has begun in Bangladesh, initiatives are now being taken to encourage this practice."

He said, "Kidney transplant patients require medicines worth Tk15,000-20,000 per month. Besides, they also require regular tests. The total cost, though, is less than it is for dialysis."

Dr Sheikh Moinul Khokon, non-communicable disease researcher at the Kidney Foundation, told The Business Standard, "This practice should be promoted in Bangladesh. The government should recognise and honour brain-dead patients who have donated their kidneys."

"Besides, kidney transplants have to be subsidised. The government now subsidises kidney dialysis, which is very costly. The patients also cannot live a normal life with it. Many patients will be able to live a normal life if subsidies are provided in kidney transplantations," he added.

According to the Kidney Foundation Hospital and Bangladesh Renal Association, about two crore people suffer from kidney diseases every year in Bangladesh. Of them, the kidneys of around 40,000 people are fully damaged.

Who are brain death patients?

According to doctors, the brains of brain-dead patients become completely unresponsive. In such a situation, the patient has no chance of survival.

Only brain death committees can announce that a patient on life support is clinically dead after conducting different tests. These committees are formed with at least three doctors of medicine, neurology and anaesthesiology.

Challenges of cadaveric kidney transplant in Bangladesh

Doctors say that relatives of brain-dead patients do not generally allow kidney transplants even in case of posthumous donations due to religious and social stigma, infrastructural problems, lack of transplant facilities in hospitals, etc.

Dr Habibur Rahman said that a national committee in this respect will be formed next month comprising people from various levels of society, including doctors, religious leaders, journalists, and social workers, to overcome the challenges.

"That committee will campaign to make people aware and to encourage kidney donations of brain-dead patients," he said.

"We have talked with the Bangladesh Army on transporting the kidneys of brain-dead patients from any corner of the country to us through their helicopters," he added.

Medical practitioners around the world observe 9 March as World Kidney Day. The theme for the day this year is "Kidney Health for All – Preparing for the Unexpected, Supporting the Vulnerable".