When Pigs Don’t Fly, Transplant Matters — Dr Ghazali Ahmad

In Malaysia, except in the final quarter of 2021, when a handful of kidney and liver transplants were performed, all organ transplant programmes stopped for the rest of the year, and also 2020.

The recent short-term success of a pig-to-human xeno-heart transplant in the United States is an exciting scientific breakthrough that follows multiple past failed attempts to break the immunological barriers involving the human immunological system.

The reported successful xenotransplantation followed the publication of an article on breakthroughs in the understanding and advances in Immune and genome engineering by J Elisseeff in the New England Journal of Medicine in December last year.

Past attempts to transplant either pig or baboon livers and hearts into humans in need of replacement organs had ended in failure, either due to hyper-acute or severe acute xenograph rejection.

The breakthrough took place against a backdrop of an increasing global organ shortage for human transplantation needs. Globally, many committed scientists and transplant professionals will continue to be busy to find ways and means to procure human organs, to perform more transplants from both live and deceased human donors, while adhering to general and specific ethical principles in the process.

These efforts went on during the Covid-19 pandemic, though modifications and adjustments in protocols and clinical management were needed to ensure safe and effective outcomes.

In Malaysia, except in the final quarter of 2021, when a handful of kidney and liver transplants were performed, all organ transplant programmes stopped for the rest of the year, and also 2020.

Regardless of the pandemic, advocates for transplants in other countries remain committed to providing adequate funding and human resources, and facilitating policies to ensure that scientific research on overcoming transplant immunology barriers goes on.

These measures included making available new, safer, and more effective chemical compounds or biologicals to improve short-term and long-term allograft and patient survival, also making available new diagnostics and therapeutics for the management of post-transplant infections and other possible complications.

In Malaysia, health care providers work on the principles of “seperti pahat dengan pemukul”, and “no one discipline is more important than another”, but actually ended up with “no one can be or can become important”.

When the main task of the Ministry of Health (MOH) is to simply issue daily statements and handle press conferences on Covid-19 and other related matters, then we know what is the only important health issue to them.

Compare this to what the Papal Academy of Sciences did in June last year in the midst of the Covid-19 chaos, which was to organise the Workshop on the Role of Science in the Development of International Standards of Organ Donation and Transplantation in Rome, italy, on June 21 and 22, 2021.

One may be forgiven to think that the Holy See only deals with communion and baptism issues. And note that this was held in the midst of a lifet-hreatening pandemic.

Some Malaysian transplant professionals who are stuck with low transplantation rates think that we can get procure more organs and perform more transplants consistently and incrementally by opening more transplant centres, including in supposedly more efficient and receptive private facilities.

In Australia, former prime minister Kevin Ruud did much to push the national transplant agenda, eventually resulting in a significant increase of the country’s organ donation and transplantation rate.

Indeed, the true professionals out there are not resting on their laurels. They are just not going to wait and see.

Human lives have been at stake well before Covid-19 rudely stole the limelight. They are driven by true professional interests to save lives and to narrow the widening gap between the need for transplants and the legitimate and ethical supply of organs. 

They are exploring ways to provide safe and effective treatment options, not just for patients experiencing kidney failure, but more importantly, for patients experiencing end-stage heart, liver and lung failure.

In Malaysia, the latter two conditions are frustratingly becoming more irrelevant to health care professionals, unless the bureaucrats move beyond their “wait and see” policy.

The news about the breakthrough porcine xeno-heart transplant is a wake-up call for health care authorities and transplant professionals, and should remind them that thousands of patients out there continue to be in need of life-saving organ transplants.

The present health care system must come up with better solutions to deal with the perpetual and increasing gap between the need and supply of organs for transplantation in Malaysia.

This need will remain unfulfilled for some time while health care authorities and professionals figure out ways and means to reduce the national health burden related to non-communicable diseases (NCDs) affecting millions of people.

A reduction in the incidences and prevalence of NCDs may not happen anytime soon. It did not happen before Covid-19 hit Malaysia. And it will not happen now, when many other health care needs are sidelined or pushed aside because of the pandemic.

One may say it will not even happen when the Covid-19 pandemic eventually ends. But let us wait and see.

Dr Ghazali Ahmad is a consultant nephrologist, a past president of the Malaysian Society of Transplantation, and the current president of the Asian Society of Transplantation.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.

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