DR GHAZALI AHMAD. MBBCh Hons, MMed (Int Med),FRCPI
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Dr Ghazali graduated from the Royal College of Surgeons in Ireland with MB BCh Honours degree awarded by the University of Ireland in 1984. Completed a Masters degree in Internal Medicine in the National University of Malaysia ( 1991) and underwent subspecialty training in nephrology in Hospital Kuala Lumpur and Newcastle Upon Tyne , England. Served as the president of the Malaysian Society of Nephrology (2000-2002) ,council member of the Malaysian Society of Transplantation , member of the International Society of Nephrology , American Society of Nephrology , Malaysian representative to the Asia Pacific Society of Nephrology and Oceania-South East Asia committee of the of the International Society of Nephrology Global Outreach (ISN-GO) program and a Fellow of the Royal College of Physicians of Ireland .
Currently ,the President of the Postgraduate Renal Society of Malaysia, Chairman of the Advisory Committee of the National Renal Registry, Malaysia , Chairman of the Nephrology Subspecialty Training Committee , Ministry of Health Malaysia, member of the National Accreditation Committee for Nephrology Subspecialty (Academy of Medicine), Head and Senior Consultant , Department of Nephrology Hospital Kuala Lumpur and National Head of nephrology services, Ministry of Health , Malaysia. Since 2011 , he has also served as an advisory committee member of the Washington based Doctors Against Forced Organ Harvesting (DAFOH) which champions the cause for integrity and high ethical standards in organ transplantation program worldwide.
Medical safety and ethical issues of organ transplantation abroad.
Inside Stories of Organ Transplantation
Overseas and Patient safety
Overseas and Patient safety
By
Ghazali Ahmad. MBBChHons, MMed,FRCPI.
Department of Nephrology
Hospital Kuala Lumpur
The progressive expansion of the solid organ transplantation was catalysed by the first successful kidney transplantation involving a haploidentical twin pair of Herrick Brothers in Boston in 1954 . The ground breaking efforts of the pioneering team led by Dr Joseph Murraywas eventually recognised with the subsequent Nobel Peace Price award . Improved understanding of the subject of tissue compatibility/incompatibility, alloreactive processes and pathways coupled with the eventual discovery of more effective immune suppressive agents, the use of better combination regimens with specific therapeutic drug monitoring protocols and more effective organ maintenance –preservation techniques have led to worldwide proliferation of solid organ transplantation beyond kidney transplantation program to include heart, lung ,heart-lung, liver,pancreas, intestine and other tissues.
Due to the universal phenomena of mismatches between the increasing number of patients with end stage organ failure requiring organ transplant and the scarcity of available organs either from live or deceased organ donors, ripe circumstances prevail which stimulate the unethical and unprofessional activities to source and supply organs through inhumane, illegal ways and means.
Transplantation program meant to save lives and improves the quality of life in patients with end stage organ failure , became hijacked by individuals who capitalised on the misery , fear and anxiety of the affected patients and their loved ones to create a paradox.
Instead of generatinghuman organs through love and sacrifice in altruistic manner , a price tag is generated in the process to pay to the donor and extract payments from the recipients. Instead of identifying a potential live kidney donor who is perfectly healthy with two normal functioning kidneys to be able to donate a kidney safely , an unfortunate person became a victim of circumstances , greed and tricks resulting with the removal of one of his/her kidneys even though it was unsuitable or dangerous for the kidney removal to be performed . Instead of allocating the organ to the patient who is in highest needs based on clinical justifications , the transplantation is performed on individuals with connectivity and ability to pay making such a complex and challenging life saving clinical procedure akin to a commodity being auctioned at a trading counter to be awarded to the highest bidder. Instead of performing a thorough health screening of potential donor to ensure his utmost health and absence of transmissible infective diseases, the process is short changed and bypassed . As a result , instead of having 2 healthy living individuals ,a few months after organ donation and transplant surgery, double tragedy ensues with resultant two ill and miserable individuals – not to mention their family members who had wished for a happy conclusion to their pre transplant ordeals. Cases of kidney donors suffering from multiple morbidities ,even mortalityafter manipulated or forced organ donation are abound. Unsuitable selection of transplant recipients based on `who can pay’ practices rather than who is most clinically suitable had resulted in equivalent numerous clinical complications including death in such patients. Transfer of infectious agents from inadequately screened organ donors to the unsuspecting organ recipients are not uncommon , given the nature of the donor evaluation and hurried transplant surgery processes involved.
In addition to the aforementioned abhorrent practices and the adverse outcomes on both organ recipients and donors, further complexity arises with regard to the ability and capacity of the local transplant clinicians in their efforts to provide optimal continuity of care once the recipients of organs from such clandestine operations return to their original country. A truly professional and ethical practice will call for patients who require such a transfer of clinical care after an important and complex surgery, to have as much details or summary of the clinical information , procedures, medications and investigation results be made available to the referred clinicians. A distinct characteristic of such illegal transplant process in recent years will be a complete absence of such customary professional courtesy making the required seamless and optimal continuous care impossible to achieve and management of complications upon returning home a clinical nightmare for the receiving transplant service team.
Vivid examples of such unsafe and unethical transplant practice seen in Malaysian patients returning from abroad shall be highlighted and further discussed .
