By Ramil Gulle
 |
| (Photos courtesy of HealthSolutions Enterprises) |
puzzled
her family.
Without a prior history of hypertension, diabetes, or heart
disease, Sheila nevertheless had a higher than normal blood pressure,
accompanied by bouts of nausea. Eventually
Menchie brought Sheila to the National Kidney and Transplant Institute (NKTI).
Menchie didn’t know anything about kidney disease in 2011,
especially not in November and December when she and Sheila struggled with the
latter’s symptoms. All she knew was that she didn’t want her daughter to die.
That’s why when the doctors at NKTI recommended that Sheila be put on dialysis,
she readily agreed.
Knowing that Sheila could die if she didn’t undergo dialysis,
Menchie did her best to give emotional support to Sheila, who was very
resistant of the process.
“Siyempre, hindi naman niya gusto yung nagda-dialysis dahil
mahirap nga naman ang titiisin. Masakit daw. Kaya lang, ako naman, sinasabi ko
sa kanya na kahit mahirap ay kailangan niya tiisin dahil gusto pa namin siyang
makasama nang matagal-tagal,” said Menchie. (Of course, she never liked going
through dialysis because of all the discomfort she has to endure. She said it
was painful. But I kept encouraging her, telling her that she has to hold on
and be strong, because we still want her to be with us for a longer time.)
A kidney transplant is, so far, the best medical treatment for renal failure today. The donor kidney may be taken from a deceased donor or a living relative.
It is best for a kidney transplant patient to get a kidney from
a living relative. Since a transplanted kidney is considered a foreign body by
the patient’s immune system, there’s always the chance that the patient’s
antibodies will attack the transplanted kidney and try to destroy it. This
process is called “transplant rejection.”
The adverse effects of transplant rejection may be reduced by 1)
The patient’s use of immune system suppressing drugs and 2) Finding the best
organ (in this case, the kidney) match between donor and recipient.
As mother and daughter, Menchie and Sheila have one of the best
donor-recipient matches possible. Still, Sheila would have to take immune
system suppressing drugs to prevent rejection of Menchie’s donated kidney. When
Menchie passed all her tests and work-ups and the doctors gave her their approval
to donate her kidney, she was so relieved.
“Kahit
buhay ko, ibibigay ko para sa anak ko. Tiwala rin naman ako sa mga doctor
namin. Kaya lang, hindi naman natin masasabi, di ba? Pwede namang halibawa,
habang inooperahan ka, hindi ka na magising, di ba? “Kaya ipinasa-Diyos ko na
lang. Nagdasal ako na sana naman po, Diyos ko, wag po muna akong mamamatay
dahil ang dami ko pang obligasyon sa mga anak ko,” said
Menchie, who has two other kids besides Sheila.
(I’m willing to lay down even my life for my daughter’s sake. I trust
our doctors, but we can never be sure, right? You can go to sleep on the
operating table and never wake up. That’s why I really prayed and asked
God to not let me die because I still have to take care of my children.)
A new
life, new challenges
Menchie and Sheila had their transplant surgery on May 22. At
the time of this interview, which was mid-June, Sheila is recovering well. She
has to take a strict regimen of antibiotics, immuno-suppressant drugs, and
vitamins for four months. She’ll be under careful observation for six months.
And she won’t be able to go back to school for at least a year.
The transplant procedure has given a new life to Sheila and her
family. Menchie is just thankful that her daughter has a chance to live normally,
without having to go through daily dialysis.
Menchie and Sheila do not come from a rich family. Their
only means of livelihood are farming and fishing, and most of their resources
were already used up for Sheila’s medical expenses. Fortunately, they were
chosen by PCSO to be a Donee under the PCSO KT Sponsored Case.
(Some
of our more generous, compassionate readers might like to extend financial aid
to Sheila, and they are encouraged to call (632) 981-0300 local 1078 to get
information on how to extend assistance).
Leading
kidney center in Asia
Sheila and Menchie are lucky to have been treated at The
National Kidney and Transplant Institute (NKTI), which is one of the leading
kidney transplant centers in Asia. For the past 30 years it has been the
foremost kidney transplant center in the Philippines, and is recognized in the
Asia-Pacific region for its successes in renal organ transplantation.
It marked its 2,000th kidney transplant operation in February
2002. It has the busiest organ transplantation program in the country not only
for kidney transplantation but also for pancreas, liver, bone marrow, islet
cell and stem cell.
The NKTI is also the first transplant center in Asia to perform
double transplants like liver-and-kidney, and pancreas-and-kidney transplant
operations. These were performed at NKTI long before any other transplant
centers in Asia would do it.
The NKTI is the first government hospital to be ISO-9001:2008
certified and is in the process of getting international accreditation.
It uses the most modern diagnostic techniques in kidney and other related
diseases, all modes of dialysis, minimally invasive surgery (Laparoscopy) and
surgical procedures, most notably, organ transplantation.
It is designated by the Department of Health as the reference
hospital for all other hospitals in the country when it comes to the diagnosis,
treatment, care and management of renal disease. This means that the NKTI sets
the benchmarks for other hospitals to follow when it comes to identifying,
treating and managing kidney disease.
Public
health
In order to reduce the number of end-stage renal disease among
Filipinos, NKTI has always been involved in educating the public on how to
prevent kidney diseases. The NKTI does this mainly through its public health
arm, the Renal Disease Control Program (Redcop). Redcop implements various
projects such as researches, training and advocacy for the prevention and
control of kidney diseases on a national scale. Other Redcop activities
include giving support to establishing a national organ donation program and
other outreach activities.
Continuous
growth
The National Kidney and Transplant Institute started out with
its forerunner, the National Kidney Foundation of the Philippines (NKFP). It
was formally created by Presidential Decree under the administration of
President Ferdinand Marcos on Jan. 16, 1981. At the time, the NKFP did not have
its own building and operated in Wing A3 and A4 of the Lung Center of the
Philippines.
As the NKFP’s operations and scope grew over the years, it went
through two more changes in its name. In Nov. 12, 1986, the NKFP was renamed as
the National Kidney Institute (NKI). In May 25, 1995, the NKI was renamed as
the National Kidney and Transplant Institute. It was then designated as the
Philippines lead medical facility for organ transplantation.
The need for more organ donors spurred the NKI to lead in
establishing an organ retrieval program. This was begun as the Cadaver Organ
Retrieval Effort (CORE), later renamed Human Organ Preservation Effort (HOPE)
in 1990. Today, HOPE is the leading organ procurement office in the
country and has pioneered advocacies in organ retrieval from cadaveric donors.
The main beneficiaries of this program are patients who have no living related
donors and would have organs harvested from deceased donors.
As the NKFP grew to become the NKI, and later, the NKTI, it
expanded from a smaller, specialty medical facility into a full-fledged
tertiary hospital. While its resources still make it the premier facility of
renal disease in the Philippines, it now treats various conditions through its
departments including: Adult Nephrology, Pediatric Nephrology, Urology,
Radiology, Internal Medicine, Anesthesiology, General Surgery, Laboratory
Medicine, Hematology and Stem Cell Transplantation, Nuclear Medicine,
Cardiovascular Medicine, Pulmonary Medicine, Neuro-Physiology, Physical
Medicine and Rehabilitation, Dialysis Center, and Vascular Surgery.
Specialty
centers
The NKTI has several specialty centers, including the Organ
Transplantation Center which provides transplantations of kidneys, pancreas,
liver, bone marrow and stem cells. Its Nephrology Center caters to both adult
and pediatric nephrology patients, while its Dialysis Center provides both
hemodialysis and peritoneal dialysis 24 hours a day, 7 days a week (24/7).
It also has a Chemotherapy, Transfusion and Pain Management
Section, which serves outpatients dealing with cancer, cancer pain and anemia.
Advanced
laboratories
The needs of transplant patients are most effectively addressed
by using the best diagnostics facility possible. Knowing this, the NKTI
Diagnostic Center uses state-of-the-art equipment and the most competent
personnel to address all diagnostic questions and dilemmas. It is the benchmark
in the Philippines for providing medical imaging and diagnostic services, and
is at par with the best in the world.
The NKTI Diagnostic Center offers Computed Radiography,
fluoroscopy, picture archiving and communication systems (PACS), ultrasound,
vascular ultrasound, digital mammography, computed tomography (CT) scan,
Magnetic Resonance Imaging (MRI), and radio frequency ablation (RFA).
The NKTI also has a highly-advanced Vascular Laboratory attached
to its Vascular Surgery Division. Using highly advanced imaging and diagnostic
equipment such as Plethysmography, Doppler Ultrasound, Duplex Ultrasound, and
Laser Doppler waveform and imaging, the Vascular Laboratory provides crucial
information on how to treat various vascular diseases.
Urology
center
According to Dr. Dator, the NKTI is building the Center for
Urology and Men’s Health (CUMH) which is the first in the country. This
facility, which will be housed within the NKTI complex, will focus on the field
of Urology and Andrology, which is a specialty that deals with male health problems,
particularly those affecting the male reproductive and urological tracts.
It is the counterpart of gynecology.
“Men have unique diseases and these are what the CUMH seeks to
address. If women have, for example, breast cancers, then men have prostate
cancer. Worldwide, one out of six to one out of eight men develops
prostate cancer. As average age of the male population increases, the
number also increases. The most number of cases occur in Western
countries while the Asia has lesser cases.
“However, the Philippines does not have the same prostate cancer
rate as Asia. Our prostate cancer incidence is either mid-way or moving closer
to that of Western countries. A factor in this is our adoption of a more
Westernized diet and lifestyle” said Dr. Dator.
Mandate
from the people
According to Dr. Dator, indigent patients like Sheila are the
ones that the NKTI is mandated to help.
Dr. Dator added that financially-challenged patients like Sheila
receive the same quality of treatment at NKTI as paying patients. He said that
there’s no separate area for patients like Sheila and those who are able to
pay. Their tests are conducted in the same world-class diagnostics lab and they
get treated by the same expert physicians and specialists.
He said that one of the challenges of NKTI is to increase the
number of transplants for Filipino kidney patients. “There is a huge
discrepancy in the number of Filipinos with end-stage renal disease who need
kidney transplants and the actual number of those who get transplants. In 2012,
there are 15,000 people registered with the Philippine Renal Disease Registry
(PRDR) who require transplant. However, an average of 350 transplants is
done per year.
This discrepancy is something that NKTI seeks to address. “The
quality of life of someone with a transplanted kidney is so much better than
that of someone who undergoes dialysis,” he said.
There is no cure for kidney failure. When it fails, the only
options are dialysis or kidney transplantation. Fortunately, early detection of
kidney disease can help in the prevention of kidney failure. It is important to
detect and manage acute kidney disease so it does not progress to chronic
kidney disease.
“Prevention and early management of kidney disease is part of
the mandate of NKTI. We are fulfilling that mandate by maintaining excellence
in patient care, service, training and research. These four aspects of our
mission are also the four key principles that guide our work and our policies,”
said Dator.
In the same report, Ona also said that, “For as long as there is
one Filipino sick and uncared for, our job is not done.”
With the NKTI determined to fulfill its mandate from the
Filipino people in the best way possible, more patients like Sheila Cuerdo will
have the chance to live and enjoy that life with their loved ones.
--------------------------
The national policy on organ donation and
transplantation
THE PHILIPPINES’ Department of Health is enforcing strict
guidelines in all hospitals in the country when it comes to the transplantation
of kidneys and other organs. These guidelines, issued through DOH
Administrative Order 2010-0018, constitute the national policy on living,
non-related organ donation and transplantation.
The DOH defines several types of organ donors. These include:
Living Related Donors – These are organ donors who are related
to the patient/recipient by blood up to the fourth degree of consanguinity.
These include parents, children, siblings, nephews and nieces, first cousins,
etc.
Living Non-Related Donors – These organ donors are not related
to the recipient by blood but are motivated to donate their organs for certain
reasons. The DOH further classifies Living Non-Related Donors into two types:
Voluntary
LNRDs and Commercial LNRDs.
Voluntary LNRDs are motivated by social and emotional ties
to donate a kidney or other organ to a recipient. Commercial LNRDs are donors
who offer their kidney and other organs for sale. Usually the services of a
broker or agent are used to facilitate the sale.
The DOH also has two other classifications of organ donors:
Directed and Non-Directed. A Directed Donor already has an intended recipient
of the organ being donated. A Non-Directed Donor offers an organ for donation
to the best matching recipient in a waiting list.
The DOH strictly prohibits organ donation in exchange for
payment. The use of Commercial LNRDs, including the operation of brokers and
agents to facilitate commercial transactions of organs, is illegal. This policy
conforms with international agreements prohibiting the sale of organs for
transplantation, and a national law against human trafficking .
THE FULL TEXT of the DOH General Policy Statements covering
organ donation and transplantation are as follows (Source: DOH Administrative
Order No. 2012-0018, “Revised National Policy on Living Non-Related Donation
and Transplantation and its Implementing Structure Amending for the Purpose
Administrative Order No. 2008-0004-A”):
As the mandated agency to promote and protect the health of the
Filipino people, the DOH adopts the following policies in the practice of
kidney transplantation from LNRDs. These policies shall cover the
transplantation of other organs where applicable.
1. The Department of Health is committed to abide by the WHO
Guiding Principles on Organ Transplantation, the Declaration of Istanbul on
Organ Trafficking and Transplant Tourism and RA 9208 (Anti-Human Trafficking
Act) and its Implementing Rules and Regulations.
2. The safety of both donor and recipient shall be given highest
consideration and transparency regarding the risks to both shall be pursued
rigorously.
3. Payment as a precondition for kidney donations and sale and
purchase of kidneys by kidney vendors/commercial donors are strictly
prohibited.
4. Kidney transplantation is not part of medical tourism.
5. Foreigners are not eligible to receive organs from Filipino
living non-related donors.
6. All health and health-related facilities and professionals
shall not allow the trade of kidneys.
7. Directed LNRDs are permitted only when it is voluntary and
truly altruistic, without any kind of compensation or gratuity package attached
to it. They must be screened and approved by the Hospital Ethics Committee.
Non-directed LNRD are not allowed to donate organs for transplantation. No
hospital, foundation, organization or agency, public or private, are allowed to
keep a list of potential non-directed LNRDs and to utilize non-directed LNRDs
for transplantation.
8. All health and health-related facilities shall implement and
adopt quality standards and practices in the medical and organizational
management of kidney transplantation. The DOH and The Philippine Health
Insurance Corporation (PHIC) shall enforce this Administrative Order and
monitor these facilities through their licensing and accreditation rules and
regulations to ensure accessibility, quality and sustainability of the
services.
9. All professional societies related to organ donation and
transplantation shall ensure that all their members comply with PODTP
[Philippine Organ Donation and Transplantation Program] guidelines relative to
the practice of organ transplantation. The members of professional societies
related to this practice shall likewise be accredited by the PHIC for purposes
of payment.
10. In no instance shall any kidney/organ be transported or
exported for transplantation abroad.
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