1. KIDNEY TRANSPLANTATION in the CARIBBEAN -2019
Lesley Roberts
January 19th 2019

2. CONTENTS
Introduction
Status
Challenges
Next Steps

3. Including Guyana
Caribbean Islands, a massive archipelago of islands that are divided into 4 groups. For the purpose today , English Dpeaking Islands, lie in Caribbean Sea, including Guyana and members of CARICOM

4. First transplant done in Barbados in 1987
First successful transplant performed
by Prof Lawson Douglas 13th Sept 1970
123 TRANSPLANTS DONE
14 Transplants done

5. TRANSPLANT ACTIVITY in the CARIBBEAN
LIVING DONOR
DECEASED DONOR
HD. FACILITIES
PDFACILITIES
ANTIGUA
YES NO N0
BARBADOS
BAHAMAS
DOMINICA
GRENADA
GUYANA
SKNF
ST. LUCIA
ST. VINCENT
TRINIDAD & TOBAGO
JAMAICA

6. Transplants

7. ACTIVE TRANSPLANT ACTIVITY -2017-2018
ANTIGUA
BARBADOS
GUYANA
JAMAICA
TRINIDAD AND TOBAGO
TRANSPLANTS
PERFORMED 6
1case from the Philippines in 2018
5 (1,4)
14 (7,7) 9
19 (8,11)
SURGEON
Surgical Team from
University of Toledo
Combined Surgical Team
TLC and Local Surgeon
Local Team with oversight from University of Calgary
TLC and Local Surgeons
Local Team
PHYSICIAN
Local Nephrologist caring for 11pts
Local Nephrologist caring for 13pts
Transplant Surgeon caring for 14 pts.
Local Nephrologist
DONOR STATUS
Only Living Donor
A paired Exchange-7/18
Living and Deceased Donors (8D)

8. 2017 -2018 TRANSPLANT ACTIVITY cont’d
ANTIGUA
BARBADOS
GUYANA
JAMAICA
TRINIDAD AND TOBAGO
CROSS
MATCHING
Off Island /Miami
Off Island/UK
Off Island/Miami
Locally
FINANCIAL INPUT
Government and Renal Society of Antigua and Barbuda
Government
Facility Administration and External Agencies
POSITIVE
ASPECT
Improvement of Care for the ESRD patient
Public more aware of the benefits of transplant.
Public trust gained ; no mortalities
Sustainability achieved.
Corporate Sponsorship-Repsol Foundation

9. OUTCOMES 1yr 5yr NIGERIA Patient 90.2% 73.4% Graft 83.2% 58.7%
TRINIDAD and TOBAGO
98%
75%
93%
73%
Guyana
100%

10. GREATEST CHALLENGES CHALLENGES PROPOSED SOLUTIONS
Lack of resources for support services for follow up post op.
Establish Regional Centres of Excellence; Involvement of NGO’s and CBO’s
Not performing enough Transplants
Employ Strategies for increasing LDKT
Unwillingness of Donors to come forward
Education and Research
Not increasing the nos. of transplants performed
An analysis of where the gaps occur.
Reintroduce incentives for Transplantation
Absence of “on island” Tissue Typing and Drug Level testing
Establish Regional Centres of Excellence

11. CHALLENGES Number of Cases Performed Donor Pool needs to be increased
Deceased Donation
Public Awareness and Education
Healthier Nations
Recipient Care
Early detection of Progressive CKD;
Need for Registries and Data Bases
Encouraging Pre Emptive Transplants and Dialysis Centre Education

12. Challenges Cont’d
Lack of Service Support with an increasing programme size
Establish transparent, documented policies for the conduct of Transplant Services
Match services with your intentions!
Allocation of Beds, theatres and slots for investigations
On going reviews of the necessary infrastructure required for programmes.
Build Capacity within the region for adequate follow up services.
Specialized services follow up such as Transplant biopsy interpretations, Immunology follow up. Video conferences with discussions.
Protocols re follow up care, return to Dialysis, second transplants, care for the Donor

13. CHALLENGES (cont’d) Financial Support
Additional non governmental sources of funding required to ensure sustainability of service.
Role of NGOs , CBOs
Insurance providers
Corporate Partners
WHO/PAHO – Resource Personnel, Bulk buying of pharmaceuticals
Proper Financial Planning
Assessment of Donor and Recipient Finances
“Ring Fencing” Budget for Transplant Services . Appropriate accountability!

14. THE WAY FORWARD An increased Donor Pool
Implementing Strategies to increase Living Donor Kidney Transplantation
Paired Exchanges
Sophisticated Cross Matching
Public Education/ Awareness Drive/ More involvement of NGO’s/ CBO’s and Foundations
Deceased Donation
Legislation
Training

15. THE WAY FORWARD (cont’d)
TRANSPLANT RESOURCES must be made available
Pharmaceuticals – Bulk Buying for the Region PAHO/WHO Involvement
Ability to do Therapeutic Drug levels
Involvement with the Region’s thrust for Non Communicable Disease
ACKNOWLEDGEMENT and COMMITTMENT that RENAL TRANSPLANT is the OPTIMAL WAY to treat ESRD
Incentives for Transplantation
Targeted out reach programmes, professionals, dialysis centres
Succession Planning

16. Future Research to define effective strategies to improve access to LDKT.
Education and Outreach
Removal of disincentives
Evaluation efficiency
Patients with kidney failure
Potential living donors
Social Networks
Dialysis Units
General public
Research needed to optimize
Frequency
Content
Delivery modalities
Uncompensated costs for donors
Travel
Medications
Lost time from work
Dependent Care
Complex donor evaluation process
Delays may discourage donors and necessitate recipients starting dialysis
Adherence to standard guidelines for assessment allowing for transparency and completion of complete risk assessment
Research needed to:
Define donor evaluation efficiency
Scope and precision of long term risk
CJASN12, Sept.17

18. THE END.