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Kidney disease: transplant is the best way forward

On December 4, The Royal Gazette issued a well-informed article on the opportunity to start a kidney transplant programme in Bermuda using live donors.

We are the three senior consultants within transplant surgery who founded and own 75 per cent of the Global Transplant Initiative. The rest is owned by an experienced entrepreneur within health-related services and other industries.

We would like to clarify and fill in some vital information beyond the scope of the article.

First, there exists consensus among health professionals that kidney transplantation is the best treatment for “end-stage kidney disease”. Dialysis is a necessary life-saving treatment, but does not affect ESKD. On the contrary, patients in chronic dialysis will get worse over time. Ideally, patients should therefore be transplanted before they need dialysis.

At present, Bermuda has about 165 patients in dialysis treatment for ESKD, and it is estimated that 20 more patients will need dialysis treatment annually.

Dialysis is not a curative treatment for ESKD, and is associated with a yearly mortality of 10 per cent 20 per cent in many reports, in addition to varying degrees of side effects to the patients. Dialysis is also a far costlier treatment compared with transplantation for ESKD patients.

The existing overseas kidney transplant programme is basically a deceased donor programme that will never reach an acceptable level for Bermuda — mainly because of the lack of available organs.

Sweden and Norway are recognised for providing some of the best health services in the world for their inhabitants. Kidney transplant programmes have been in place for nearly 50 years, and have among the highest kidney transplant ratios to the ESKD population in the world. In Norway, more than 70 per cent of the ESKD population lives with a transplant at all times. This has been a prioritised policy from the health authorities for many years, as it is a benefit both for the ESKD patients and the health economy.

The founders of GTI each have more than 25 years of experience with kidney, liver and pancreas transplantation, and each have performed close to a 1,000 transplants.

For ten years, the founders managed the transplant unit at the Oslo University Hospital, which is one of the largest transplant units in the western hemisphere, performing on average about 300 kidney transplants per year.

At present, the founders are engaged at the Uppsala University Hospital, which is the largest kidney transplant centre in Sweden. The surgeons have reached agreements to work part-time at the University Hospital to be able to share their vast experience elsewhere.

GTI has an extensive network of kidney transplant specialists who will be involved when needed. In co-operation with King Edward VII Memorial Hospital, and under the professional control of the Bermuda Hospitals Board and the Bermuda Health Council, the island has a very good basis of making safe and effective kidney transplants available for patients suffering from kidney failure.

Our experience and deep respect for patient safety and wellbeing will guarantee a top-class service for Bermuda.

Our proposed programme will be a supplement to the already established overseas transplant agreement, which will never be a realistic option for the majority of the ESKD patients in Bermuda.

Thus, if nothing is done the number of patients on dialysis will grow steadily. This will lead to more patients suffering and an increasing strain on the health budget in Bermuda over time.

Only family or close friends of the ESKD patients will be considered for kidney donation. To be a donor implies very little risk. Today, the operation is done by a laparoscopic procedure.

In average, a donor lives longer than his peer group. The reasons are that the approved donors have undergone thorough screening and in addition receive an annual medical checkup that may reveal other diseases at an early stage. GTI will offer educational programmes for patients and their families.

The patients eligible for transplantation will be worked up in accordance with strict guidelines. All transplants and donor operations are planned procedures well in advance.

After transplantation, they will be followed closely during the first three months. GTI will be taking responsibility for all medical follow-up in co-operation with KEMH and Bermudian-based nephrologists, who are well experienced in working with transplanted patients. We foresee that the GTI surgeons will be present on the island for long periods following each campaign of transplants.

On average, four to five patients receive kidney transplants every year. An estimated population of 50 kidney transplanted patients are followed up on the island and overseas. Transplanted patients need life-long medication and follow-up.

Bermuda already has a well-established regime for follow-up of transplanted and/or ESKD patients, managed by experienced nephrologists.

With a live donor kidney transplant programme in place in Bermuda, all medical follow-up may be done locally, saving the patients from having to travel to overseas hospitals regularly.

KEMH holds an impressive competence level and quite limited investments in equipment, and training of personnel are needed to enable safe and patient-friendly kidney transplants at the hospital.

GTI is a private firm, but unlike some health service firms, we are not focusing at maximising our profit: the offering is based on actual costs and includes standard hourly rates for medical personne.

Our fees will be 100 per cent transparent for the Bermuda health authorities. Bermuda’s health providers are experienced buyers of health services, thus reaching an agreement with GTI should be fairly straightforward.