Call to offer kidney transplants on island
A local kidney transplant service would save lives and offer patients with chronic kidney disease a better quality of life, according to the Global Transplant Initiative.
The Norwegian company has proposed setting up a live-donor transplantation programme in Bermuda, which it said would also save millions of dollars in healthcare costs.
Transplant surgeon Tim Scholz told The Royal Gazette: “We feel it is time for the politicians to act.
“A steadily increasing number of patients with chronic kidney disease are suffering unnecessarily and they are a huge burden to the health budgets.
“If Bermuda is willing, we can deliver a cost-effective live- donor kidney transplant programme in Bermuda that will save many lives and millions from the health budgets in the years to come.”
It comes after the Bermuda Health Council announced it did not support on-island live-donor kidney transplantation “at this time” because of risks to patient safety and high costs.
Bermuda Hospitals Board also said it does not have the infrastructure to “safely develop or deliver this service at this time” but is open to revisiting the idea if the situation changes.
Christian Thjømøe, a chartered accountant with a masters in business administration, said: “A lot of people’s lives could be saved and they could get a better life”.
He added: “That is the main benefit, because if you have a local transplant programme with live donors in Bermuda that would be offered to patients who would never get the chance to get transplants in the US.”
Dr Scholz, who cofounded GTI with fellow surgeons Aksel Foss and Pål Foyn Jørgensen, said it would be impossible to start a live-donor kidney transplant programme in Bermuda tomorrow.
However, he felt the programme would be “perfectly feasible” as long as safety requirements are met.
He said: “Wherever in the world you would like to implement a new treatment modality, you have to start working on safety issues and establishing those facility needs at the hospital.”
After visiting the hospital and studying the infrastructure, Dr Scholz said they believe this could be done in less than a year.
He added: “There are lots of issues here that need to be discussed and solved before we can start, but to build the infrastructure in Bermuda is perfectly feasible and that is the important point.”
Dr Scholz said this would need to be done in conjunction with local kidney specialists and other professionals.
He added: “That’s where we would start working if Bermuda wants to see a transplant programme in one or two years from now.”
According to Dr Scholz, a transplant in Bermuda would cost around $250,000 once the programme is fully established. This would include work and six-month follow-up with GTI.
He added this would be paid back within “at least” two years because dialysis costs more than $200,000 per patient per year in Bermuda.
Mr Thjømøe, who co-owns GTI, said the net value of a transplant to Bermuda would be between $2½ and $3 million dollars because patients would be taken off the dialysis budget and could return to a normal working life and thereby contribute to society.
Dr Scholz said a local programme would also improve the island’s healthcare system because the procedures and tests could also be used for other diseases.
He added patients would also not have to pay for overseas travel, accommodation and other costs.
According to the Bermuda Health Council, there are 165 patients on dialysis and 971 patients with chronic kidney disease (prevalence).
The Council said the cost of related claims for dialysis was $24.9 million and there were four to five transplants annually, with typical waiting times of two to three years.
Mr Thjømøe said GTI believed about half of Bermuda’s dialysis patients could be transplanted locally, along with about 50 per cent of those who start dialysis every year.
He added at least 20 surgeries would be needed per year “just to reduce the current need”.
However, Dr Scholz said it would take several years to reach this volume.
Dr Scholz added that although it would be “quite easy” to find live donors in Bermuda, more public education would be needed on the possibility and benefits of a local service.
He explained that GTI proposes to start a pilot programme once the necessary requirements have been met and a list of donors and recipients has been created.
Dr Scholz said they would start with one or two transplants that would be evaluated before the programme is fully implemented.
He said surgeons would then take turns to come to Bermuda and perform four to six transplants over a two-week period.
The Bermuda Health Council published an opinion on creating a local transplant programme last month, with CEO Tawanna Wedderburn stating it was “too risky” at this time.
The opinion read: “In the meantime, more effort should be placed on preventing chronic kidney disease and ensuring better co-ordination when transplants are appropriate.”
The document outlined the local and global context, potential benefits, risks and concerns.
Ms Wedderburn said the Health Council was willing to explore on-island live-donor kidney transplantation in collaboration with local nephrologists, the health ministry, BHB, and patient advocates.
She added: “As stated in the Opinion, should new information become available, we can review and reissue our opinion accordingly.”
A BHB spokeswoman said the benefit of renal transplantation was well identified and would always be a goal in place of long-term dialysis.
But she added: “There is a well-developed pathway established between our local specialists and US partners to deliver this service currently.
“We do not have an infrastructure to safely develop or deliver this service at this time. New models of care are always being described and as such we are open to revisiting this issue if the situation or guidance changes.”
The full guidance document from the Health Council can be found at bhec.bm.
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