Saturday, February 27, 2021

Organ transplant and Botswana’s reality

The thought of human organs being manufactured sounds odd. However, in the coming ten to twenty years, it might be the norm, following ground breaking steps in creating implantable human organs. Companies are fast approaching the time when they can commercially manufacture human organs, with the assistance of 3-D bio printing.

In an interview with an online news source Keith Murphy, CEO of Organovo, an American based company that designs functional human organs, noted that “the ability to manufacture living human tissue for medical research and clinical practice has the potential to reshape the future of medicine.”

While growing cells have been feasible for many tears, the ability to produce tissue that in turn becomes a functional organ, has been giving many scientists a head ache. Now with technology advanced, scientists and companies can layer cells on a bio printer and produce tissue. One of the first discoveries on this was made by Doris Taylor, who was previously a director at the American University of Minnesota’s Centre for Cardiovascular repair. In 2008 Taylor and her team were able to strip organs of cellular make-up leaving a de-cellularised scaffold. Organs like the heart, lungs, liver and kidneys can be reseeded with cells that when supplied with blood and oxygen, regenerated the scaffold into a functional organ. Two years later, the CEO of a company named Mitromatix; Robert Cohen secured a licence to commercially explore this further. The technology will enable the replacement of entire organs harvested from donors; stripped of cells and either transplanted or re-cellularised from the recipient or compatible cell lines.

Every day, one patient who could have been saved by tissue replacement or organ transplant, dies, across the world. In Botswana, the situation of organ transplants remains bleak. More than a decade ago, the then Minister of Health Joy Phumaphi publicly said government had plans to establish an organ bank for Batswana. Nothing happened. A glint of hope was awakened recently after Dr Kolaatamo Malefho of the Ministry of Health recently told the Public Accounts Committee that the Ministry is working on an organ transplant policy. He noted that this is made possible by the Public Health Bill of 2012 which if effected, will allow designation of an authorized institution to oversee the acquisition and use of any tissue from the body of a living or deceased person.

In 2007, Parliamentary Speaker Margaret Nasha appealed to Batswana to consider donating organs. She noted that Batswana had initially frowned at the idea of donating blood but over time had warmed up to the practice. She also pointed out that the same education should be applied to encouraging Batswana to donating organs.

In Setswana culture, donating organs is still a shunned practice. Kagiso Seabilwe is a firm traditionalist who is skeptical of donating tissue. “These Western concepts of donating body organs are alien to our culture. What if you try to help someone and you die or the ancestors turn against you? When I die, I want to leave this world and be buried with all my organs. I even wonder if I would donate a kidney to a loved one. What if my remaining one doesn’t function in future?”

Neliswa Modinga on the other hand is adamant that she would be one of the first donors, should an organ bank be established in the country. “I don’t have a problem with donating tissue as I believe the medical personnel entrusted to carry out the procedures would do an exceptional job. An Australian friend of mine donated a kidney to a stranger several years ago. He also signed off permission that his body organs could be donated when he dies. If you are open-minded it’s easier to identify the positive aspect of it.”

Not only is there no organ transplant policy in the country but an organ bank seems a bit far off. An organ bank is a repository shared by hospitals for long term storage of certain tissues for transplanting. With an organ retrieval bank, a person can pledge that after their death, their organs can be used for transplantation to terminally ill patients. There are two types of organ donors ÔÇô living donors (can donate to immediate blood relations) and cadaver donors (they donate after their death). Donated tissue includes the heart, heart valves, connective tissue and bone marrow, livers and kidneys (liver and kidney transplantation), pancreas (diabetes), eyes (blindness) and skin (severe burns).

In the United Kingdom, approximately 4000 organ transplants were carried out between 2010 and 2012. Even India has an enacted transplantation of human organs act, which allows for organ donation. Botswana government currently doesn’t cover the steep medical costs of organ transplants. Even those who seek medical attention in neighbouring South Africa cannot get the necessary assistance as Botswana is yet to subscribe to the South African Organ Bank.

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