Organ transplant even for the poor

We treated him as best as we could for his medical problems but despite best efforts, including his personal efforts to make sure he was able to buy all the medicines he was prescribed and take them religiously, his kidney failure slowly got worse. Starting two years ago, he had to be on regular dialysis to cleanse the impurities in his blood which his kidneys could no longer excrete.

C.S. has what is labeled as end-stage kidney disease, and the only way for him to remain alive is to undergo regular dialysis or have a kidney transplantation.

His dialysis, which he is able to get at a discounted rate, already costs him half his monthly salary. He was advised by his nephrologist (kidney specialist) to have a kidney transplantation as soon as a kidney donor becomes available, but he has always hesitated because of the cost. Right now, his family is already neck-deep in debts and he doesn’t know where he could get the hefty sum of money needed for a kidney transplantation. Even in government hospitals, the cost of the surgery is at least a million pesos.

Financial assistance

I’m sure patients like C.S. will welcome the recent tie-up between the National Kidney and Transplant Institute (NKTI) and the Philippine Charity Sweepstakes Office (PCSO), which will provide financial assistance to financially challenged patients who need to undergo organ transplant. With the PhilHealth also pledging support for this surgery, having inadequate financial means is no longer a reason for the poor not to undergo kidney transplantation.

I’m not sure what the requirements are for beneficiaries so that they could avail of the expensive surgery through their individual Medical Assistance Program. I hope it’s not only for those truly indigent, but also for those who have some means but their financial status is not good enough to be able to afford the transplantation surgery and the cost of treatment after the operation to prevent rejection of the transplanted kidney.

At the helm of this program is Dr. Antonio “Sonny” Paraiso, who heads the Philippine Network for Organ Sharing (Philnos). I have known him to be passionate about his organ-transplantation advocacy, But before, he felt so frustrated that suitable candidates, especially breadwinners, could not undergo the needed surgery due to lack of funds.

Big challenge

The big challenge that remains now is where to get the donated kidney that will be transplanted to the patient. With the advances in treatments to suppress rejection, even nonrelated donors may already be considered. The indigent beneficiaries will just have to look for a kind soul, relative or nonrelative, who would be willing to share one of his/her kidneys as an altruistic act.

I don’t think the raging issue on nonliving donors being exploited by so-called “kidney brokers” will be applicable to this campaign to make the surgery accessible even to the poor. The kidney “black market” will not benefit from this campaign.

When we say that a treatment is cost-effective, the benefits must weigh more when compared to the cost of the treatment or surgery. Kidney transplantation—compared to dialysis—has been shown to be definitely cost-effective. In fact, it is considered the treatment of choice for those with end-stage kidney failure.

Maintaining a patient on dialysis in most hospitals may cost on the average around P400,000. If one spends P1.2 million for a kidney transplantation, there is already a 100-percent “return on investment” after three years, not to mention the increased productivity and better quality of life (QOL) one would have after a successful transplantation.

The average survival time of a donated kidney is around nine years. Some last much longer. The benefits and enhanced QOL all these years will definitely be worth the investment on the kidney transplantation.

But I hope Doc Sonny and our health officials are not looking at helping financially challenged patients for the kidney transplantation surgery alone. Everyone knows that intensive medical treatment should be sustained after the surgery to prevent complications, foremost of which are rejection and infections.

This can also be pretty expensive, and beneficiaries of this program should not be left hanging in the air, not being able to sustain the necessary postsurgery treatment.

A waste of funds

It would be such a waste of funds if poor patients undergo surgery successfully but die after a few months because of untreated complications. It’s also unfortunate if their medical problem that caused the kidney failure, like diabetes and hypertension, would still not be adequately treated because of poverty. In a few years, the patient will be back to where he was—with a failing kidney that would require regular dialysis again.

I hope the NKTI, the PCSO and the PhilHealth have looked at this campaign on a long-term basis, and are committed to help the beneficiaries all the way to treat their medical condition. Rather than spread the funds thinly so as many as possible could undergo the transplantation, I would rather suggest that they be selective on those who truly need the procedure most, including such factors as being breadwinner of the family, age and remaining productive years. But a long-term monitoring and assistance program should also be in place to ensure that all necessary treatments are sustained.

But all told, I’m happy about this program. The have-nots also deserve all the benefits that modern science can offer.