Donating a kidney to a loved one is far from being an easy decision, you will agree with me. There is the initial hesitation that arises from a deep-rooted fear of the unknown.
The thought of parting with a kidney, no matter how generous the intending donor may be, is usually an uncomfortable one. More often than not, they have to decide whether to live with one kidney for the rest of their lives and risk possible life-threatening health complications in the future, or not.
Either way, the donor is likely to feel like a man standing between the devil and the deep blue sea. But what can he or she do if giving out a kidney is the only thing that will save the life of a loved one?
This was the kind of situation that 52-year-old Mrs. Balkis Adetokun, who resides in the Alagbado area of Lagos State, found herself when she had to donate a kidney to her ailing daughter, Ganiyat, who urgently needed a kidney transplant outside Nigeria, in 2017.
Mrs Adetokun was almost moved to tears as she recalled the moment when she had to make that tough decision to save Ganiyat from certain death by donating her kidney. It was a very emotional and truly testing moment, one that also awakened her motherly instincts.
Initially, one of her sons had volunteered to be the donor. Unfortunately, during the cross-matching, it was discovered his blood group did not match that of Ganiyat. Then the onus fell upon their mom to donate the vital organ.
Admitting that it was one of the toughest decisions she ever made in her life, in an interview with PUNCH, she said,
âOne of the joys of motherhood is to see our children prosper. No mother will ever pray to see her daughter die or suffer in sickness. I did not want to lose my daughter. I thank God that everything went well and the transplant was successful.â
Like most moms, Adetokun had to struggle to overcome her fear of the unknown on the eve of the transplant. She was afraid that something might go wrong during the surgical operation. It took the doctorâs warm and reassuring voice to banish her fears. She had felt better when the doctor told her there was nothing to be scared about. She continued:
âThe doctor advised me not to entertain any fear as nothing bad would happen, which strengthened my faith. I am a Muslim. I observe my prayers regularly and I believe there is nothing that happens without Godâs knowledge.â
More than a year after the kidney transplant, Adetokun sometimes feels a little guilty for ever entertaining fear about the surgery. Asked if she had had any complication after donating her kidney to Ganiyat, she said there was none.
Adetokunâs sacrifice does not only portray her as a heroine, but it also reflects the mindset of most other Nigerians who are willing to give out one of their kidneys to save a dying relative. Ganiyat, who is currently learning how to make dresses, said that she would forever be grateful to her mum for risking her life to donate a kidney to her.
âThe implication is that if she had refused to donate her kidney, I would have been dead,â she said.
Ganaiyat said the kidney transplant was done in India on April 13, 2017. Like her mum, she has yet to experience any complication so far. She added:
âIâm now very okay. I urinate very well and I eat well. There is no complication, except that I have to continue taking my prescribed drugs regularly, eat a balanced diet and drink clean water.â
Medication too expensive in Nigeria
Having undergone a successful surgery abroad, Ganiyat expected to have easy access to the drugs prescribed for her by the doctors at the Indian hospital where she had received treatment. To her surprise, she found that most of the drugs were not affordable in Nigeria and beyond her reach. To make matters worse, she could only buy the drugs, from India at affordable prices.
âI used to send somebody to buy the drugs from India. Since some of them are not available in Nigeria, I used to buy the ones that I needed for six months upfront at nothing less than N400,000.
It is quite expensive and the doctor said I would be on medication forever. There is nothing that we can do about it. I can only hope that the medication will reduce with time.â
While our correspondent found it difficult to obtain the data of more Nigerians who donate their kidneys annually to save a life, due to some factors, such as the culture of secrecy in this part of the world, statistics from the Pan African Medical Journal, published online in 2016, showed that the non-availability of donors was a small problem, compared to the financial constraints responsible for delays in kidney transplant.
Tales from other donors
Love and nothing else was the reason why Mrs. Islamiat Oyenuga donated a kidney to her older brother. She explained,
âOur parents gave birth to three of us. I was born after him. We couldnât afford to lose him. When he fell ill, we didnât know at first that it was a kidney problem. We had spent so much money before we discovered the nature of the ailment.
âInitially, my youngest sibling wanted to donate her kidney. But she chickened out and I had to I make up my mind to donate mine instead of losing him.â
Asked if her husband and kids discouraged her from making the decision, Oyenuga said she had a discussion with her husband and their children and got their support before going ahead with the donation. Like Adetokun, she has not experienced a complication till date.
Also, the wife of late music producer, OJB Jezreel, Mrs. Mabel Okungbowa, who had donated a kidney to her ailing husband, reportedly said she did not regret her action.
âI did it because I wanted to. I wasnât forced to do it. After all, he was my husband. I donât regret it,â she was quoted as saying.
OJB later passed on after a kidney failure on June 14, 2016.
Another donor, who posted his experience on an online platform, nairaland, with the username @diagro, recounted his experience. He said,
âI donated to a dear one, but before then I underwent an intensive medical check-up, long orientation and then, documentation. The first set of the medical check-up was to ensure that I match with my receiver (blood group and all).
The second set was also to make sure that I was healthy enough to donate a kidney. The purpose of the orientation was to ensure that my decision to donate was informed. Then, the documentation included a court affidavit and personal data filing.
On the day of the surgery, I was placed on anaesthesia during which I lost consciousness completely. It gave me an idea of what death would look like.
I was asked not to eat for some hours before the surgery. Then after the operation, I did not eat anything for 24 hours. I wasnât even hungry because I was often placed on a drip. I was in the hospital for post-surgery medication for two weeks before I left.â
Kidney dialysis and transplant centres in Nigeria
In the past, there were just a few dialyses and transplant centres in Nigeria. Today, the number has increased across the country.
Our correspondent visited Kidney Solution, Ikeja, St. Nicholas Hospital, Ikoyi and the Lagos University College of Medicine, Ikeja, to get some data on kidney donors. At Kidney Solutions, he was informed that kidney patients were accepted through dialysis and prepared for transplant.
Some clinical service personnel at St. Nicholas Hospital boasted that the hospital had successfully carried out many kidney transplants, but she was not willing to give out information on the affected patients, according to her, it is against the policy of the hospital.
The Lagos University Teaching Hospital, Ikeja, also has a facility for kidney transplant and it has been carrying out this surgical procedure.
âWhy we have rejection in kidney transplantâ
Explaining the reason for rejection in kidney transplant, a nephrologist at LASUTH, Prof. Olugbenga Awobusuyi, says it occurs when the human body recognises a transplanted kidney as being foreign and mounts an immune attack. He says,
âThe rejection can be immediate and it can occur within a short period of time after transplant. It could also occur over a long period of time by those people that have done transplant after five years or more.
âThe one that occurs rapidly is usually as a result of antibodies that have formed even before the transplant and when the transplant is done. The antibodies recognise that tissue as foreign and immediately they attack it. It is like transfusing blood over the ABO blood group barrier.â
Awobusuyi also says that the necessary tests, such as DLA matching, cross-matching and checking of the donorâs antibodies and others, are compulsory before transplant to guard against rejection.
âThere are times when we donât have a perfect match. It is usually seen in identical twins. One can also occasionally spot it in members of one family because siblings would have received half from their father, half from their mother.
âIn a family, there are chances that you can have a perfect match. That means siblings can have 25 per cent match. The mother can have a 50 per cent match and the dad another 50 per cent match. The more the matching, the less likely that person will reject,â he adds.
Awobusuyi also explains that when acute rejection occurs the kidney can still be rescued by using medicine to subdue the reaction.
âBut in case of total rejection, the kidney is not useful for the donor and the recipient,â he says.
Another nephrologist at the Federal Medical Centre, Abeokuta, Dr. Kayode Oluyinka, says that donating a kidney will not reduce the lifespan of the donor. According to him,
âWe have two kidneys and one is needed to survive. The second kidney is called physiological reserve in medicine.
âMost of the time, our patients have to be on dialysis before a transplant, though there is what we call pre-empting transplant, which means that someone doesnât have to go through dialysis. He would just go for a straight transplant.
âThe reason is obvious: the longer a patient stays on dialysis, the worse the outcome of the transplant. Also, the shorter one stays on dialysis, the best the outcome.
âBefore the transplant, we have to be sure that the two kidneys of the donor are working perfectly because there are some people who were born with one kidney and they are not in the hospital because that one kidney is working very well.
âSo, we subject donors to an ultrasound scan to check if he or she has two functional kidneys.
âAt the point of donation, if we discover the donor has only one kidney, we tell him or her about ineligibility to donate. We also do some other tests so that we would be sure the donor is not having an infection that can be transmitted to the recipient.â
A medical journal, Kidney International Supplements, Volume 3, Issue 2, May 2013, Pages 241-245, focuses on Kidney Transplants in Nigeria between 2000 and 2010.
According to the journal, a total of 143 kidney transplants were performed in five transplant centres, some of which were recently opened. One-year graft and patient survivals were 83.2 per cent and 90.2 per cent, respectively, while the 5-year graft and patient survival was 58.7 per cent and 73.4 per cent, respectively.
Mortality was reported in 38 recipients. The complications recorded included acute rejection episodes in 15-30 per cent, chronic allograft nephropathy in 21 and malignancies, particularly Kaposi Sarcoma, which was reported in 8 recipients.
Dr. LongJohn Adonye, a nephrologist at Kidney Solutions Limited, Ikeja, advises Nigerians to be wary of eating too much salt and cooking additives, as they are one of the major causes of kidney disease.
Also, Mr. Adebayo Sokunbi, MD/CEO of Kidney Clinics Nigeria, Abeokuta, while speaking, advocates the inclusion of kidney dialysis and transplant in the National Health Insurance Scheme because of the high cost of dialysis, medication and transplant.
