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HI EVERYONE I'M DR. ANDREW
REDD HEAD INTERNATIONAL VIROLOGY
UNIT AT NIAID.
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THE END OF THE PRESENTATION.
TODAY WE'RE EXCITED TO HAVE
DR. ELMI MULLER PRACTICES
UNIVERSITY OF STEWELL, LEN
BOSCH SOWING AFRICA AND HIGHLY
SOUGHT AFTER TRANSPLANT SURGEON.
SHE EARNED HER MASTERS AND
Ph.D. AND SURGERY AT THE
UNIVERSITY OF CAPE TOWN AS WELL
AS MBA AT THE UNIVERSITY OF
STELLENBOSCH.
DR. MULLER IS BEST KNOWN ARK
ROUND THE WORLD FOR HER
PIONEERING WORK FROM HIV
POSITIVE TO HIV POSITIVE TRAN
PLANT ORGAN TRANSPLANTATION
EMPLOY SHE WAS THE FIRST DOCTOR
TO TRANSPLANT A KIDNEY FROM AN
HIV DONOR TO A REIENT.
SHE ACCOMPLISHED THIS DESPITE
EXTRAORDINARY PUSH BACK FROM HER
INSTITUTE AND FROM HER CAREER:
MOST NOTABLY BY LEADING THE WAY
FOR THE PASSAGE OF THE HIV
POLICY OR EQUITY HOPE ACT THAT
WAS PASSED BY THE U.S. CONGRESS
IN 2013 WHICH ALLOWS FOR ORGAN
TRANSPLANTATION FROM HIV
POSITIVE DONORS TO RECIPIENTS
LIVING WITH HIV.
IN 2015, I BEGAN COLLABORATING
WITH ELMI AND HER TEAM IN SOUTH
AFRICA TO INVESTIGATE SOME OF
THE VIROLOGY AND CLINICAL
QUESTIONS, THAT THESE UNIQUE
ORGAN RECIPIENTS POSE SUCH AS
EXAMINING FOR THE PRESENCE OF
HIV SUPERINFECTION AND WE
CONTINUE TO WORK TODAY THROUGH A
UR1 GRANT FUNDED THAT IS FUNDED
THROW THE U.S. SOUTH AFRICA
PROGRAM FOR COLLABORATIVE
BIOMEDICAL RESEARCH.
FROM 2012 TO 2021, PROFESSOR
MULLER SERVED AS THE HEAD OF THE
TRAN PLANT UNIT AT
[INDISCERNIBLE] HOSPITAL IN CAPE
TOWN AND FROM 2017-2021 SHE
SERVED AS THE HEAD OF THE
HOSPITALS DIVISION OF GENERAL
SURGERY, IN 2022, SHE WAS
APPOINTED DEAN OF THE FACULTY OF
MEDICINE AND HEALTH SCIENCE AT
STELLENBOSCH UNIVERSITY, 1 OF
THE LARGEST TRAINING
INSTITUTIONS FOR HEALTHCARE
PROFESSIONALS ON THE CONTINENT.
A SOUGHT AFTER EXPERT, SHE HAS
WORK AS A VISITING PROFESSOR AT
HARVARD AND AS A FELLOW AT
NORTHWESTERN UNIVERSITY AND
RECEIVED NUMEROUS AWARDS WARDS D
HONORS FOR HER WORK.
SHE PLAYED A CRITICAL ROLE FOR
TRANSPLANTEURISM, SINCE 2018
SHE'S SERVED AS A PART OF THE W.
H. O. TRANSPLANTATION TASK FORCE
AND IN 2021 SHE WAS NOMINATED TO
THE DRUGS AND CRIME ECPETTER
GROUPOT VERY LONG AND
PROSECUTION OF TRAFFICKING
PERSONS FOR ORGAN REMOVAL EMPLOY
AFTER WORKING WITH ELMI FOR
ALMOST A DECADE NOW I CAN SAY
THAT WITHOUT A DOUBT SHE IS 1 OF
THE MOST INNOVATIVE, DARING AND
PASSIONATE CLINICIAN SCIENTISTS
I'VE HAD THE PRIVILEGE OF
WORKING WITH AND I THINK AS YOU
WILL SEE TODAY, SHE IS 1 OF THE
RARE GROUP OF PEOPLE WHO TRULY
THINK OUTSIDE OF THE BOX TO
SOLVE THE PROBLEMS THAT WE FACE
AROUND THE WORLD TODAY.
FRAMING TODAY'S PRESENTATION, A
PROGRESSIVE EFFORT TO IESHES
DENTIFY GAPS IN INFRASTRUCTURE
AND RESOURCES TO DRIVE
TRANSPLANTATION IN APRICKA AND
HER POLICY WORK RELATED TO
TRANSPLANTATION AND ORGAN
DONATION SERVES AND LOW AND
MIDDLE INCOME COUNTRIES.
PLEASE WELCOME PROFESSOR MULLER
WHO WILL PRESENT THE TALK
ENTITLED TRANSPLANTATION AND
DIALYSIS AND LOW AND MIDDLE
INCOME COUNTRIES TIME TO RETHINK
THE LANDSCAPE.
ELMI.
[ APPLAUSE ]
>> THANK YOU FOR SUCH A
WONDERFUL INTRODUCTION AND
OPPORTUNITY.
I DENTY HAVE ANY FINANCIAL
DISCLOSURES AND I WILL NOT BE
DISCUSSING ANY UNAPPROVED OR
OFF-LABEL DRUGS TODAY.
OUR LEARNING OBLIGATIONS
YECTIVES FOR TODAY'S TALK,
PERHAPS TO UNDERSTAND SOME OF
THE ISSUES THAT WE SEE WHEN WE
DRIVE TRANSPLANTATION PROGRAMS
AND ALSO DRIVING THE PROGRAM,
ESPECIALLY FOR THE HEALTHCARE
SECTOR IN GENERAL BUT ALSO FOR
THE COUNTRY THE WAY WE'RE
DIDDING IT, UNDERSTAND THE ROLE
OF TRANSPLANTATION IN EMERGING
ITS OF SUSTAINABLE DEVELOPMENT
GOALS AND THEN I WILL END UP
WITH SOME BARRIERS SITTING UP
TRANSPLANT PROGRAMS IN LOW AND
MIDDLE INCOME COUNTRIES.
THE FIELD OF TRANSPLANTATION HAS
MADE MODERN STRIDES IN
TRANSPLANTATION ENCLUEDING LARGE
QUANT, AUTONOMY, OFFERING HOPE
AND A SECOND CHANCE AT LIFE TO
MILLIONS OF INDIVIDUALS WORLD
WIDE EMPLOY ORGAN AND TISSUE
TRANSPLANTATION HAS EVOLVED INTO
A CRITICAL COMPONENT OF
HEALTHCARE ESPECIALLY ADDRESSING
NONCOMMUNICABLE DECEASES SUCH AS
KIDNEY FAILURE AND TERMINAL
STAGES OF HEART, LIVER AND LUNG
DECS.
THE CONTRIBUTION OF
TRANSPLANTATION EXPANDS THROUGH
HUMAN CELL AND PRANS PLANTATION
AND MANIFESTATIONS OF
NONCOMMUNICABLE DISEASES, MANY
FOR CONGENITAL DISEASES ISSUES
STROMA OR THE INCREASING NEEDS
OF A FLOABALLY AGING POPULATION.
MORE OVER TRANSPLANTATION PLAYS
A PIVOTAL ROLE IN ADVANCING THE
GLOBAL GOAL OF UNIVERSAL ACCESS
TO HEALTH.
ON THE SLIDE YOU CAN SEE AN
ESTIMATE OF TRAN PLANTS THAT'S
HAPPENING WORLD WIDE PER YEAR.
AS YOU CAN SEE, SOME AREAS HAVE
GOT MORE TRANSPLANTS AND SOME
HAVE LESS, SO I'M JUST GOING
SHOW YOU 2 REGIONS THAT ARE
SITTING ON THE LOWER END OF THE
SPECTRUM.
IN THIS GRAPH, WE SEE THE TOW
TOTAL TRANSPLANTATION NUMBERS IN
SOUTHEAST ASIA OVER A 20 YEAR
PERIOD.
ALTHOUGH THE RATE OF
TRANSPLANTATION HAS GROWN TO
JUST OVER 6 PER MILLION
POPULATION, THAT'S ALMOST 15,000
SOLID ORGAN TRANSPLANTS PER
YEAR, THIS IS STILL COMPLETELY
INADEQUATE FOR THE REGION.
WHILE TISSUE AND CELL
TRANSPLANTATION THRIVES IN MORE
DEVELOPED AREAS OF THE WORLD AND
WITH ITS CONTRIBUTION FULLY
RECOGNIZE, THERE ARE CLEAR GAPS
FROM PROGRAM ANDS ACCESS IN THIS
REGION.
REDUCED OR ABSENT HUMAN TISSUE
TRANSPLANTATION ACTIVITY IN ANY
COUNTRY OR REGION SHOULD NOT BE
INTERPRET AS A LACK OF NEED FOR
HUMAN TRANSPLANTATION AND HUMAN
ISSUE CELL, RATHER IT SIEWCIALLY
SKTAS AND INDICATES THAT THE
BENEFITS OF DONATION, TISSUE
BANKING AND TRANSPLANTATION HAVE
NOT BEEN FULLY RECOGNIZED.
AND THAT THE TRAN PLANT
AVAILABILITY HAS NOT COMPLETELY
BEEN ADDRESSED.
HOWEVER, IF WE LOOK AT AFREK ARK
THE SITUATION IS MUCH MORE
DISMAL.
TRANSPLANTATION NUMBERS ARE LESS
THAN 1 PER MILLION POPULATION
AND THE TOTAL NUMBER OF
TRANSPLANTS ON THE CONTINENT IS
LESS THAN A THOUSAND PER YEAR.
SO WHAT ARE THE RISKS WHEN HAVE
YOU THESE VERY LOW TRANSPLANT
NUMBERS IN ESPECIALLY THE
DEVELOPING WORLD.
I WANT TO LOOK AT THESE RISKS
FROM 3 DIFFERENT VIEW POINTS.
FESTERLY FROM A PATIENT
HORRTALLITY POINT OF VIEW,
SECONDLY FROM ORGAN TRAFFICKING
POINT OF VIEW, AND THIRDLY, I
WANT TO TALK ABOUT THE FINANCIAL
RISK THAT WE HAVE WHEN WE SEE
DIALYSIS PROGRAMS THRIVING.
PATIENT DEATH IS THE EASIEST TO
UNDERSTAND BECAUSE ORGAN
TRANSPLANTATION IS SUCH A
TREATMENT MODALITY FOR PEOPLE
WITH END STAGE DISEASE.
IT'S USUALLY A LIFE SAVING
DISEASE BUT IT CAN BE A LIFE
ENHANCING TREATMENT MODALITY AS
WELL DEPENDING ON WHICH ORGAN IS
AFFECTED AND WHETHER THERE IS
REPLACEMENT THERAPY AVAILABLE
FOR THE ORGAN.
SO WITHOUT A TRANSPLANT, A
PATIENT MIGHT EITHER DIE, OR
MIGHT HAVE A VERY POOR QUALITY
OF LIFE.
THE INTERESTING 1 IS TO THINK
ABOUT THIS LOW TRANSPLANTATION
NUMBERS AS A RISK FOR ORGAN
TRAFFICKING AND MEDICAL TOURISM.
WE KNOW THAT ORGAN TRAFFICKING
CAN LEAD TOCCATA STROPHIC
FINANCIAL EXPENSES, FOR
POTENTIAL RECIPIENTS WHO WANT TO
BUY A KIDNEY AND SO NO OTHER
OPTION.
WE ALSO KNOW THAT ORGAN
TRAFFICKING ALSO RESULTS IN A
CRIMINAL RECORD FOR THE PERSON
WHO HAVE BEEN PROVIDING A
KIDNEY.
LASTLY THERE ARE PUBLIC HEALTH
RISKS WHEN WE THINK ABOUT
COMMERCIAL TRANSPLANTATION
ESPECIALLY IN TERMS OF SAFETY
AND I WILL SAY A LITTLE BIT MORE
ABOUT THIS NOW.
WHEN WE LOOK AT ORGAN
TRAFFICKING THERE ARE 3 THINGS
THAT HAS TO BE IN PLACE TO MAKE
ORGAN TRAFFICKING POSSIBLE, THE
INFRASTRUCTURE NEEDS TO BE GOOD
ENOUGH FOR TRANSPLANT TO HAVE
UPON, SO YOU NEED A REASONABLY
GOOD HOSPITAL, AND HEALTHCARE
WORKERS.
THE OVERSIGHT HAS TO BE POOR, SO
USUALLY IT HAPPENS IN COUNTRIES
WHERE THERE'S POOR LEGISLATION
AND LIMITED LEGAL ACTION
AVAILABLE.
AND THIS HAS TO BE COMBINED WITH
POVERTY, WHERE WE CAN HAVE
POTENTIAL DONORS WHO COME AND
GIVE THEMSELVES UP AND PROVIDE A
KIDNEY FOR PAYMENT.
HERE I WILL SHOW YOU 2 EXAMPLES
OF WHERE WE KNOW ORGAN
TRAFFICKING IS STARTING TO BE A
BIG PROBLEM.
FOR MANY YEARS, SYRIAN REFUGEES
HAVE FLED TO TURKEY DONATING AN
ORGAN IN A SMECIAL SETTING CAN
PROVIDE TEMPORARY FINANCIAL
RELIEF TO A FAMILY EMPLOYOT
SLIDE IS AN EXAMPLE OF AN
ADVERTISEMENT THAT WAS PLACED IN
TURKEY TO POTENTIAL ORGAN
PROVIDERS.
THIS CAN BE A DISMAL WAY TO
RECEIVE QUITE A SMALL AMOUNT OF
MONEY AT THE COST OF YOUR
LONG-TERM HEALTH.
THIS CASE REPORT FROM UKRAINE
EXAMINES THE INITIAL EXPERIENCE
OF POLAND IN RESPONDING TO THE
CURRENT REFUGEE CRISIS TRIGGERED
BY THE UKRAINIAN WAR.
IN THE FIRST 2 MONTHS OF THE
CRISIS MORE THAN 3 MILLION
REFUGEES FLED TO POLAND.
THE LARGE INFLUX OF REFUGEES
RAPIDLY OVERWHELMED THE LOCAL
SERVICES AND LED TO A COMPLEX
HUMANITARIAN SITUATION.
IT WAS TO ADDRESS BASIC HUMAN
NEEDS SUCH AS SHELTER,
INFECTIOUS DISEASE, HELT CARE
ACCESS BUT IT HAS EVOLVED INTO
KIAL SIS, TRANSPLANTATION,
NONCOMMUNICABLE DEC AND
PROTECTION.
THIS NECESSITATED A WHOLE OF
SOCIETY RESPONSE IF INVOLVING
MULTIPLE AGENCIES AND CIVIL
SOCIETY.
EMERGING LESSONS LEARNED INCLUDE
THE NEEDS FOR ONANYTHING NEEDS
ASSESSMENTS, ROBUST DISEASE
MONITORING AND SURVEILLANCE AS
WELL AS FLEXIBLE MULTISECTORRAL
RESPONSES THAT ARE CULTURALLY
SENSITIVE.
POLAND'S EFFORTS TO INTEGRATE
REFUGEES MAY HELP MITIGATE SOME
OF THE ADVERSE CONSEQUENCES OF
THIS RELATED MIGRATION.
HOWEVER, IT REMAINS A BIG
PROBLEM NOT ONLY IN THESE PARTS
OF THE WORLD BUT IN MANY OTHER
PLACES IN EUROPE WHERE THEY ARE
NOT ENOUGH ORGAN TRANSPLANTATION
AND DIALYSIS FACILITIES
AVAILABLE.
IN INDIA WE KNOW THAT THERE IS A
LARGE MEDICAL TOURISM INDUSTRY
HAPPENING.
MANY PEOPLE FROM AFRICA AND LOW
AND MITSD INCOME COUNTRIES
TRAVEL TO INDIA FOR THE
TRANSPLANTS.
AND THAT IS A PROBLEM FOR
DRIVING LOCAL PROGRAMS IN THESE
COUNTRIES AND I WILL SAY A
LITTLE BIT MORE ABOUT THIS
SHORTLY.
WHEN YOU LOOK AT COMMERCIAL
TRANSPLANTATION THERE ARE
SERIOUS PUB LIAISON HEALTH
ISSUES THAT NEED TO BE TAKEN
UNDER CONSIDERATION, 1 OF THIS
IS INFECTION, THE TRANSPLANTS
THAT COME FROM THESE DONORS WHO
ARE ORGAN TRAFFICS OFTEN COME
ALSO WITH A CHRONIC INFECTION
FOR INSTANCE TUBERCULOSIS, VIRAL
HEPATITIS, HIV, MALARIA, AND
OTHER BLOOD BOARN INFECTIONS.
SO AFTER TOURISM ACTIVITY A
DONOR DERIVED EARLY OR LIGHTING
INFECTION IS SOMETHING WE NEED
TO CONSIDER AND OBVIOUSLY IF
THESE PATIENTS TRAVEL, THEY WILL
SPREAD THE INFECTION TO THE
ENVIRONMENT WITH WITHOUT COMING
BACK TO.
THERE ARE OTHER INFECTIONS AS
WELL, SO IT'S NOT ONLY DONOR
DERIVED.
REMEMBER, OFTEN THESE
TRANSPLANTS TAKE PLACE IN TOOR
OPERATING ROOM CONDITIONS, LACK
OF SURGICAL SKILLS, THEY ARE NO
PREOP KREENING AND ABSENCE OF
PROPHYLAXIS GIVEN.
SO PEASHTS CAN COME BACK WITH
NEWEL ACQUIRED INFECS WHICH CAN
BE COMMUNITY OOH QUIREDDER
HOSPITAL ACQUIRED OR
OPPORTUNISTIC AND ONCE AGAIN I
WANT TO MAKE THE POINT THAT
BECAUSE WE DON'T HAVE ENOUGH
LEGAL AND GOOD PROGRAMS ACROSS
THE WORLD, THESE PRACTICES ARE
TAKING PLACE AND PUTS US ALL
INTO A HIGH RISK SITUATION.
IT'S ALSO VERY CHALLENGING
BECAUSE OFTEN THESE PAGES COME
BACK WITH SURGICAL WOUND
INFECTION.
THEY ARE IMMUNE SUPPRESSED SO
IT'S VERY DIFFICULT TO MAKE
DIAGNOSIS.
WE SEE A LOT OF MULTIRESISTANT
ORGANISMS IN THESE PATIENT
GROUPS.
WHICH IS BECOMING A PUBLIC
HEALTH RISK.
IN THE GRAY BOX, I WANT TO
EMPHASIZE THAT IF YOU LOOK AT
TOURISTS, THIS IS NONTOURIVE
TRANSPLANTS, THE RATE OF
INFECTION IS AS HIGH AS 54%
AFTER ORGAN TRAFFICKED
TRANSPLANTS SO THAT IS AN 85
FOLD INCREASE IN INFECTIOUS
RISK.
THE THIRD RISK OF HAVING THESE
LOW TRANSPLANT NUMBERS IS AROUND
FINANCIAL IMPLICATIONS.
AND IT IS AROUND HOW WE DEAL
WITH THE MONEY THAT WE ARE
SPENDING FOR END STAGE RENAL
FAILURE.
AND IF WE ARE SPENDING SO MUCH
MONEY ON DIALYSIS, IT TAKES AWAY
FROM THIS POTENTIAL MONEY POOL
FROM MORE COST EFFECTIVE
TREATMENT WHICH WILL BE
TRANSPLANTATION AND I THINK THIS
IS A SERIOUS RISK AS WELL.
BECAUSE IF YOU LOOK AT DIALYSIS
ACTIVITY AND REMEMBER THIS SLIDE
I SHOWED YOU RIGHT IN THE
BEGINNING IN EMERGING ITS OF
TRANSPLANTATION ACTIVITY, YOU
CAN SEE HERE THAT THE BEST
COUNTRIES PROVIDE DIALYSIS AT
THE RATE OF OVER 600 PERMILLION
POPULATION, BUT IN THE LOW%
INCOME COUNTRIES WHICH HAD
ALMOST NO TRANSPLANTATION,
DIALYSIS IS PROVIDED AT 108 PER
MILLION POPULATION.
SO THE DIALYSIS IS IN A
COMPLETELY DIFFERENT PLACE IN
TERLS OF NUMBERS THAN
TRANSPLANTATION.
WHY IS THIS?
I THINK THERE A SIGNIFICANT
IMBALANCE IN THE UTILIZATION OF
DIALYSIS AS THE PRIMARY RENAL
REPLACEMENT THERAPY COMPARED TO
KIDNEY TRANSPLANTATION.
BECAUSE DIALYSIS REQUIRE FEWER
HUMAN RESOURCES, FEWER STAFF,
IT'S EASIER TO IMPLEMENT, MUCH
EASIER THAN A TRANSPLANT PROGRAM
AND IT'S FAIRLY EASY TO KALE IT
ACCORDING TO NEED.
BUT APPROXIMATE WE THINK ABOUT
IT, THERE IS SO MANY GOOD
ADVANTAGES TO KIDNEY
TRANSPLANTATION TREMAINS FOR ME
A QUESTION WHY THIS IS
HAPPENING.
WE KNOW THAT ANNUALLY, ACROSS
THE WORLD, THERE ARE MORE THAN
5 MILLION PATIENTS PER YEAR ON
DIALYSIS, BUT ONLY ABOUT 5-10%
OF THESE PATIENTS RECEIVE A
TRANSPLANT.
NOW, I WANT TO MAKE AN IMPORTANT
STATEMENT HERE AND THAT IS THAT
I THINK KIDNEY TRANSPLANTATION
NEEDS TO BE PUT BACK ON TO THE
HEALTHCARE AGENDAS OF OUR
MINISTRIES OF HEALTH AND OUR
DECISION MAKERS FOR THE
FOLLOWING REASONS: FIRSTLY, IT
IS THE MOST COST EFFECTIVE
TREATMENT.
AND THIS HAS BEEN SHOWED IN MANY
PARTS OF THE WORLD WHERE, IN
EUROPE AND AMERICA BUT IT'S ALSO
BEEN SHOWED IN LOW AND MIDDLE
INCOME COUNTRIES LIKE THE STUDY
I'M SHOWING YOU HERE FROM CHINA
WHERE YOU CAN SEE THE COST OF
HEMODIALYSIS, AND THE COST OF
PERO TON EEL KIAL SIS IN THE TOP
2 ROWS AND THEN THE COST OF
KIDNEY TRAN TRANSPLANTATION IN
THE FIRST YEAR VERSUS
SECURITIZATION. YEAR AND YOU CAN
IMMEDIATELY SEE IT'S DROPPING
DOWN IN THE SECOND YEAR TO BE
EQUAL TO HEMODIALYSIS AND IN THE
LONG RUN BECOMES CHEAPER AND
CHEAPER.
HOWEVER, PROBABLY THIS IS AN
IMPORTANT RESEARCH AREA THAT
NEEDS TO BE FULLY EXPLORED
BECAUSE WE DON'T HAVE SO MANY
MODELS IN LOW AND MITTED INCOME
COUNTRIES SHOWING THAT IT'S MORE
COST EFFECTIVE.
BUT WE DO HAVE MANY STUDIES
SHOWING THAT PATIENTS ON
DIALYSIS ARE A WORST OUTCOME IN
EMERGING ITS OF SURVIVAL
COMPARED TO KIDNEY TRANSPLANT
PROGRAMS, SO FOR THAT REASON, WE
CAN ALSO THINK ABOUT KIDNEY
TRANSPLANTATION AS THE PRIORITY
TREATMENT OPTION.
AND THIRDLY, FOR QUALITY OF
LIFE, YOU CAN IMAGINE THE
DIALYSIS THAT TAKES PEOPLE OUT
OF THE WORK SITUATION, WASTES A
LOT OF TIME IN THE SOCIOECONOMIC
PERSON GIVES A MUCH POORER
QUALITY OF LIFE THAN A KIDNEY
TRANSPLANT.
SO TO SUMMARIZE SYDNEY
TRANSPLANTS SHOULD BE
PRIORITIZED BECAUSE OF COST
EFFECTIVENESS, SURVIVAL RATES,
ENHANCED QUALITY OF LIFE,
ACCEPTABILITY, FAIRNESS,
FEASIBILITY, AND SUPERIOR
CLINICAL OUTCOMES AT A LOWER
COST.
WHY IS IT NOT HAPPENING?
IT IS IMPORTANT TO THINK ABOUT
WHAT IS DRIVING DIALYSIS.
WELL IS A BILLION DOLLAR
INDUSTRY DRIVING DIALYSIS.
THE MARKET SIZE IS ESTIMATED TO
BE 99.3 BILLION DOLLARS IN 2019
AND ESTIMATED TO REACH 177
BILLION DOLLARS BY 2027, THIS IS
A GROWTH RATE OF 7.7% ISSUES
WHICH IS HUGE.
THIS COMES FROM THE FORTUNE
BUSINESS INSIDES.
AND WHAT ARE THE BIG CUTCHES
PROVIDING DIALYSIS FOR INSTANCE
LIKE FORZENIA, THEY HAVE OVER
2800 PEOPLE ON DIALYSIS, DAVITA,
2400 PEOPLE ON DIALYSIS, SO IT'S
VERY DIFFICULT WHEN YOU HAVE
THIS INDUSTRY DRIVING THE
TREATMENT OPTION AS THE
PREFERRED OPTION AND PUTTING A
LOT OF MONEY INTO THIS TO MAKE
THE CASE FOR TRANSPLANTATION AND
TO MAKE SURE THAT PEOPLE PUT
TRANSPLANTATION AS A FIRST
OPTION FOR KIDNEY TRANSPLANT.
BUT I ALL THINK WE HAVE TO
UNDERSTAND WHAT ARE THE OTHER
THINGS THAT MAY BE PLAYING A
ROLE AND I THINK IT IS TRUE THAT
THERE IS A LACK OF LEADERSHIP,
ESPECIALLY OUTSIDE OF THE
CLINICAL REALITY, WHEN WE HAVE
MEETINGS WITH THE MINISTERS OF
HEALTH FOR INSTANCE IN AFRICA,
THEY DO FOCUS ON THE EVEN THINK
ABOUT KIDNEY TRANSPLANTATION,
THEY ONLY THINK ABOUT DIALYSIS.
THERE IS A LACK OF STRATEGIC
DECISION MAKING AROUND THE
PREFERRED TREATMENT FOR KIDNEY
TRANSPLANT AND THEN PATIENTS
NEED TO BE EDUCATED BECAUSE SOME
OF THEM THINK DIALYSIS IS AN
EASIER OPTION, IT IS LESS
INVASIVE AND THEY MAKE A CHOICE
FOR DIALYSIS, SO THIS IS HUGE
REASONS AND HUGE THOUGHTS THAT
WE AS CLINICIANS NEED TO THINK
ABOUT.
THEN THERE'S ALSO THE WAY WE
ORGANIZE OUR CLINICAL PRACTICE.
SO, USUALLY IN MOST PLACES
PATIENTS PRESENT WITH RENAL
FAILURE, THE DOCTORS WORK THE
PEASHT UP, THEY RECEIVE
DIALYSIS, THEY GET ON A TRAN
PLANT LIST AND IF THEY'RE LUCKY
THEY WILL RECEIVE A TRAN PLANT.
I THINK IT'S TIME FOR US
ESPECIALLY IN LOW AND MIDDLE
INCOME COUNTRIES TO RETHINK THE
ORDER IN WHICH WE OFFER TREME.
SHOULD WE SAY TO A PATIENT WHO
PRESENTS WITH RENAL FAILURE THAT
A KIDNEY TRAP PLANT IS YOUR BEST
OPTION, THAT YOU SHOULD BRING
FORWARD SOME OF YOUR FAMILY AND
FRIENDS TO BE A POTENTIAL LIVING
DONOR THAT WE IMMEDIATELY
PRIORITIZE PEASHTS ON THE
DECEASED DONOR'S WAITING LIST
AND OHM USE DIALYSIS AS A
BRIDGING METHOD FOR THESE PATES
I BELIEVE WE WILL SAVE A LOT OF
MONEY AND PROROADWAY A MUCH
BETTER QUALITY OF LIFE.
BUT THE SECOND PART OF MY TALK I
WANT TO ALSO PLACE
TRANSPLANTATION INTO YOUR MIND
IN TERMS OF THE SUSTAINABLE
DEVELOPMENT GOALS AND I HAVE
QUITE A LOT OF THINGS THAT I
WANT TO EMPHASIZE ON THIS SLIDE.
SO FORGIVE ME FOR TAKING A BIT
OF TIME ON THIS EMPLOY
SUSTAINABLE DEVELOPMENT GOAL 3
FOR GOOD HEALTH AND WELL BEING,
I WILL TALK ABOUT THIS IN MORE
DETAIL NOW, BUT WE ALL KNOW THAT
TRANSPLANTATION PROMOTES WELL
BEING WITH A FOCUS ON REDUCED
MORTALITY, IMPROVING QUALITY OF
LIFE, SO IT IS--IT IS A VERY
LOGICAL THING THAT
TRANSPLANTATION SITS IN THAT
GOAL.
BUT IT ALSO SITS IN SOME OF THE
OTHER GOALS FOR INSTANCE, GOAL
NUMBER 8, THIS PROMOTES
SUSTAINED INCLUSIVE ECONOMIC
GROWTH ISSUE FULL AND PRODUCTIVE
EMPLOYMENT, DESCENT WORK
EXPERIENCE FOR ALL, IT IS VERY
DIFFICULT TO HAVE THIS IF YOU
ARE ON DIALYSIS BUT
TRANSPLANTATION PROVIDES YOU
WITH THE OPPORTUNITY TO REMAIN
ECONOMICALLY PRODUCTIVE THROUGH
THE RETURN OF YOUR AUTONOMY.
IT IS VERY EASY TO WORK AFTER A
TRANSPLANT BUT IT'S VERY
DIFFICULT TO WORK IF YOU ARE ON
A RESOURCE AND TIME CONSUMING
TREATMENT AND TO HOLD A
FULL-TIME JOB WITH DIALYSIS.
IF WE LOOK AT SUSTAINABLE
DEVELOPMENT GOAL NUMBER 9, WE
KNOW THAT TRANSPLANTATION HAS
THE OPPORTUNITY TO STIMULATE
GROWTH IN THE SECTOR INDUSTRY,
SO, TRANSPLANTATION DEMANDS A
SKILLED WORKFORCE AND A
DEVELOPMENT INFRASTRUCTURE INTO
THE HEALTHCARE SETTING.
IF WE WANT TO HAVE SUCCESSFUL
OUTCOMES IN ORGAN AND TISSUE
TRANSPLANT WE NEED BIOENGINEERS.
WE NEED ORGAN SUBSTITUTES, WE
NEED BETTER MEANS FOR ORGAN
PROFUSION AND TRAN SPORT
SYSTEMS, WE NEED TO DEVELOP OUR
CELL THERAPIES, SO ONCE AGAIN
THIS FITS IN VERY WELL WITH
SUSTAINABLE DEVELOPMENT GOAL 9
WHICH DIALYSIS SIMPLY DID NOT DO
AND THEN IF WEB CONNECTED LOOK
AT THE 2 GOALS AROUND
INEQUALITY, 5 AND 10, 1 IS
EQUALITY IN GENERAL AND THE
OTHER 1 SPECIFIC LOW AROUND
GENDER INEQUALITY, WE KNOW THAT
THE EQUALITY IN TRANSPLANTATION
IS A VERY IMPORTANT PART OF HOW
WE THINK AND HOW WE PRIORITIZE
TO PATIENTS THE TREATMENT
OPTIONS.
WE ALSO THROUGH TRANSPLANTATION
ADDRESS THE CULTURAL DISPARITIES
RELATED TO GENDER AND
MINORITIES.
WE MAKE ONGOING MODIFICATIONS IN
SECURING 4 LOCATION POLICIES FOR
ORGANS AND THEN CAN THEN SERVE
AS AN EXAMPLE IN SOME OF THE
OTHER FIELDS ESPECIALLY WITH
WHEN WE ARK --APPLY TO
MINORITIES.
WHEN WE LOOK AT THE NEXT 1,
TRANSPORTATION PROVIDES USE OF
WATER AND LESS WASTE WATER WHICH
IS DRICH QUITE DRAMATIC
REDUCTIONAT BEINGLY BY DIALYSIS.
THERE'S ALSO THIS PLASTIC WASTE
CONSERVING RESOURCES AND
PROMOTING SUSTAINABLE PRACTICES.
IN TERMS OF GOAL 18,
TRANSPLANTATION HAS GOT
ADVANTAGE THAT IT HAS NO IMPACT
ON GREENHOUSE GAS EMISSIONS FROM
WASTE MANAGEMENT AND IT ALSO IS
BUILDING RESILIENCE IN
HEALTHCARE WHICH I WILL TALK
ABOUT A LITTLE BIT AT THE END.
IN TERMS OF PEACE ISSUES JUSTICE
AND STRONG INSTITUTIONS, WE HAVE
SOMETHING THAT IS BUILT FOR ALL,
OOSKTIVE AND,A COUNTABLE ASK
INCLUSIVE TO ALL INSTITUTIONS.
THE YESTERDAY AND EQUITY
PRINCIPLES UNDERPIN ORGAN TISSUE
AND CELL DONATION PRACTICES,
ADVANCING SOCIAL AND FINANCIAL
CREDIBILITY BY DELIVERING HIGH
QUALITY HEALTHCARE IN A
TRANSPARENT AND ACCOUNTABLE
MANNER BY COUNTERING TRANSPLANT
TOURISM ALIGNS WITH THIS
SUSTAINABLE DEVELOPMENT GOAL.
FOLLOWING THE DECLARATION OF
ISTANBUL, THIS IS JUSTICE,
ALLOCATION AND STRENGTHENING OF
LENL SLAIGZ ADDRESSING ORGAN
TRAFFIC IN THIS SEVERAL
COUNTRIES SUGGIESTING PROGRESS
HAD BEEN MADE TOWARDS THIS GOAL.
THE PRINCIPLES OF
SELF-SUFFICIENCY AND FINANCIAL
NEUTRALITY ARE SUCH IMPORTANT
PRINCIPLES IN TRANSPLANTATION
AND ONCE AGAIN FITS WELL INTO
THIS GOAL.
AND THEN LASTLY, PARTNERSHIP FOR
THE GOALS, THERE IS NO BETTER
PARTNERSHIP EXAMPLE THAN
TRANSPLANTATION, WE SHARE
TECHNOLOGY, WE SHARE NOVEL
THERAPY, IMPROVED STANDARDS IN
OUR TISSUE TYPING AND OTHER
LABS, IT FOSTERS COOPERATION
AMONG GOVERNMENTS, AMONG
BUSINESSES, AMONG INDIVIDUALS,
SCIENTISTS, CIVIL SOCIETY, AND
PROVIDE A SUSTAINABLE NATIONAL
AND REGIONAL PROGRAM.
BUT IT IS TRUE, THAT THE MOST
IMPORTANT PLACE FOR
TRANSPLANTATION IS AROUND GOOD
HEALTH AND WELL BEING.
AND THERE ARE SEVERAL TARGET 4
TO PREVENT PREMATURE MORTALITY
FOR NONCOMMUNICABLE DECS, TARGET
8 TO HAVE FINANCIAL RISK
PROTECTION TO PATIENTS, ACCESS
TO QUALITY AND ESSENTIAL
HEALTHCARE SERVICES
RECOMMENDATION C SUBSTANTIALLY
INCREASE HELT CARE FINANCING,
RECRUITMENT, DEVELOPMENT,
TRAINING AND RETENTION OF THE
HEALTH WORKFORCE, AND
RECOMMENDATION D, STRENGTHENING
THE CAPACITY OF ALL COUNTRIES IN
PARTICULAR DEVELOPING COUNTRIES
FOR EARLY WARNING, RISK
REDUCTION, AND MANAGEMENT OF
NAGGAL AND GLOBAL HEALTH RISKS.
THE BURDEN OF NONCOMMUNICABLE
DEC HAS BECOME A CRITICAL
CONCERN IN THESE DEVELOPING
COUNTRIES AS THEY TRANSITION
FROM LOW, LOW INCOME COUNTRIES
TO MIDDLE INCOME STATUS, THIS
TRANSITION IS A ACCOMP PANIED BY
BY GLOBALIZATION WHICH RESULTS
IN AN AGING POPULATION.
SIGNIFICANTLY NONCOMMUNICABLE
DISEASES OFTEN AFFLICT WORKING
AGE INDIVIDUALS CAUSING A
PROFOUND SOCIAL AND ECONOMIC
IMPACT.
THIS INCLUDES SUBSTANTIAL
PROCESSES IN PRODUCTIVITY,
PEOPLE EXITING THE WORKFORCE,
SPOUSES LEAVING THEIR YOBS TO
CARE FOR ILL FAMILY MEMBERS, ET
CETERA.
THE COMMISSION HAS GOT A VERY
INTERESTING REPORT WHICH I'M
GOING TO SHOW YOU SOME OF IN MY
NEXT SLIDE ALSO IN WHICH THEY
ARE STATING THAT TRANSPLANTATION
THERAPY IS THE MOST COST
EFFECTIVE AND SOMETIMES THE ONLY
AVAILABLE TREATMENT OPTION FOR
THOUSANDS OF PATIENTS FACING
ORGAN FAILURE, CANCER, AND OTHER
CONDITIONS STEMMING FROM NCDs.
AND THEY HAVE MADE A VERY
IMPORTANT POINT ALSO AROUND THE
INTERSECTORRAL POLICIES THAT
HAVE TO BE DRIVEN AND THIS HAS
TO DO WITH PREVENTION AND I
THINK THAT IS ALWAYS IMPORTANT
FOR US WHEN WE TALK ABOUT A HIGH
LEVEL TREATMENT OPTION LIKE
TRANSPLANTATION, TO ALSO TALK
ABOUT PREVENTION.
PREVENTION THEN CAN HELP US TO
BE MORE SELF-SUFFICIENT BECAUSE
LESS PEOPLE WILL GET END STAGE
ORGAN FAILURE.
THIS IS AN INTERESTING EXAMPLE
OF A LOW MITTED INCOME COUNTRY
WHO HAVE DONE QUITE WELL IN
TERMS OF DRIVING TRABZ PLANT
PRACTICE, DR. RISVE RUNS A
TRANSPLANT NOT FOR PROFIT CENTER
IN PAKISTAN.
THEY'RE DOING ABOUT 6-8
TRANSPLANTS PER WEEK WHICH COMES
TO QUITE A LOT OVER A WREER AND
1 OF THE MOST ACTIVE TRANSPLANT
DRUG PROGRAMS IN PAKISTAN AND
WHAT IS INTERESTING ABOUT THIS
PROGRAM IS THAT IT HAS A GOOD
FINANCIAL MODEL, COMBINING
FINANCIAL SUPPORT FOR THE
GOVERNMENT WITH CONSTRUCTIONS
FROM THE COMMUNITY, SO THESE
GRANT FINDINGS FROM COMMUNITY
AND FROM THE PUBLIC IN
COMBINATION WITH THE PROVENTIAL
BUDGET MAKES THIS AREA
COMPLETELY ACCESSIBLE AND FREE
FOR PATIENTS IN THIS REGION
EMPLOY SO IT'S NOT ACROSS
PAKISTAN BUT IT IS AN
INTERESTING EXAMPLE OF HOW
PEOPLE COME TOGETHER TO CREATE
SOMETHING THAT IS SUSTAINABLE
EMPLOY AND THEN I JUDGE UOF THE
WANT TO SAY SOMETHING ABOUT THE
SUSTAINABLE DEVELOPMENT GOAL
NUMBER 13 WHICH IS A LITTLE BIT
MORE THAN WHAT I SAID BEFORE AND
REMEMBER THAT HEALTHCARE IN THE
GENERAL CONTRIBUTES TO FOSSIL
FUEL EMATIONS AND THE CLIMATE
CRISIS.
IF HEALTHCARE WAS A COUNTRY IT
WOULD BE THE FIFTH HIGHEST
EMITTER WORLD WIDE EXCEEDING
AIRPLANE TRAVEL, THIS SUGGESTS
THAT THE HEALTHCARE SECTOR IS
NOW RESPONSIBILITY FOR 5.2% OF
THE TBLOABAL FOSSIL FUEL
EMISSION AND THE DIALYSIS IS
PROBABLY 1 OF THE BIGGEST
DRIVERS WITHIN HEALTHCARE FOR
THIS PROCESS, IT HAS A VERY
LARGE CARBON FOOTPRINT AND
FIRSTLY IN TERMS OF WATER, CAN
YOU SAY THAT ABOUT 120 LITERS OF
PURIFIED WATER S&P USED DURING A
4-HOUR DIALYSIS SESSION.
IN TERMS OF ENERGY, 1 4-HOUR
SESSION REACHES THE TOTAL ENERGY
OF A TOTAL HOUSEHOLD PER DAY
EMPLOY A HUGE AMOUNT OF MEDICAL
WASTE, SO WE'RE THINKING
DIALYSIS, AV TUBING SETTING,
NEEDLES, SODIUM CARTRIDGES,
BAGS, BI CARBONATE, ACID
SOLUTIONS, ENDOTOXINS CULTURES,
TRANSPORTATION AND MATERIAL, SO
THE USUAL TRANSPORTATION WASTES
AND PATIENTS TRAVELING WITH
LOCAL FACILITY AND SO CURRENTLY
IT'S ESTIMATE THAD WE HAVE MORE
THAN 600 MILLION HEMODIALYSIS
SESSIONS EVERY YEAR WORLD WIDE.
AND THE NUMBER OF PATIENTS HAD
ARE STILL GROWING.
SO JUST FROM THAT POINT OF VIEW,
TRANSPLANTATION IS SUCH AN
IMPORTANT PART OF WHAT WE HAVE
TO DRIVE FOR OUR PATIENTS AND
FOR OUR PLANET.
BUT IF WE DID THIS RIGHT WHAT
WOULD BE THE FURTHER ADVANTAGES
FOR OUR HEALTHCARE CASES.
TRANSPLANTATION REALLY HAS GOT
AN IMPORTANT IMPACT ON A
HEALTHCARE SYSTEMS RESILIENCE.
THE TRANSPLANTATION OF VITAL
ORGANS LIKE THE HARE, KIDNEYS,
LIVERS AND LUNGS HAS A PROFOUND
IMPACT NOT ONLY ON THE
INDIVIDUAL'S HEALTH BUT ALSO ON
THE BROADER HEALTHCARE SYSTEM.
THE IMPACT IS MULTIFACETED AS
TRANSPLANTATION NOT ONLY ADDRESS
NONCOMMUNICABLE DISEASE AND
UNIVERSAL ACCESS TO HEALTH BUT
ALSO POSITIVELY INFLUENCE
HEALTHCARE IN A MORE GENERAL
SENSE.
IT INVOLVES INTRICATE MEDICAL
PROCEDURES, IMMUNE SUPPRESSIVE
TREATMENTS, LIFE LONG MONITORING
WHICH INTRODUCE A COMPLEXITY
INTO THE HEALTHCARE SYSTEM, IN
PLACE OF DRUGS FOR INSTANCE
RAISES CONCERNS ABOUT SIDE
EFFECTS AND INCREASE OF
INFECTION, THIS LAYER OF
COMPLEXITY HELPS TO IMPROVE
SURGICAL PROCEDURES, COUNTRIES
WITH ESTABLISHED TRANSPLANT
PROGRAMS HAVE AN ENHANCED
HEALTHCARE SYSTEM COMPARED TO
COUNTRY WHO IS DON'T HAVE IT.
EXPERTISE AND KNOWLEDGE AROUND
INFECTION MANAGEMENT IMPROVE
LABORATORIES UNDERSTAND BETTER
HOW TO DO POST OPERATIVE AND
SCREENING, PHARMAICOLOGICAL DRUG
SCREENING AND THIS DOESN'T
HAPPEN IN THE PROGRAM.
WHILE IT IS IN MANY PLACES IT IS
OFTEN NOT STREAMLINED TO WORK
TOGETHER EFFICIENTLY.
TRANSPLANTATION REQUIRES THESE
THINGS TO WORK TOGETHERENTIOUS
FICIENTLY AND THEREFORE BENEFIT
ALL PATIENTS, NOT ONLY THOSE
WHORY CEIVE A TRANSPLANT.
ACHIEVING RESILIENCE IN A
HEALTHCARE SYSTEM COULD REFER TO
CREATING SOME FORM OF
COMPREHENSIVE HEALTHCARE SYSTEM
THAT COVERS THE COST OF YOUR
TRANSPLANT, REDUCE FINANCIAL
BARRIERS FOR PATIENTS.
THAT'S INSURING THAT IT IS
ACCESSIBLE TO EVERYONE
REGARDLESS OF THE ABILITY TO PAY
AND INSURING EQUITABLE ACCESS TO
TRANSPLANTATION REGARDING YOUR
SOCIOECONOMIC STATUS.
RISWRELIENCY BEING MEAN BUILDING
A ROBUST SYSTEM THAT CAN
WITHSTAND CHALLENGES AS WE
RECENTLY EXPERIENCED DURING THE
COVID PANDEMIC AND AS WELL AS
HAVING THE ABILITY TO ADAPT AND
CHANGE VERY EFFECTIVELY.
IT MAY INCLUE DEVELOPING BETTER,
FAIRER AND MORE TRANSPARENT
ORGAN LOCATION SYSTEMS TO
ENHANCE RESILIENCY IN GENERAL,
BUT ESTABLISHING CLEAR CRITERIA
FOR ORGAN DISTRIBUTION AND
PRIORITIZING PATIENTS, PATIENTS
ON MEDICAL NEED RATHER THAN
FINANCIAL RESOURCES FOR EXAMPLE
THAT WAY WE PROMOTE EQUITY AND
REDUCE DISPARITY.
AS MENTIONED ENCOURAGING
COLLABORATION AND NETWORKING
BETWEEN TRANSPLANT CENTERS,
HEALTHCARE PROVIDERS AND
RESEARCHERS ALLOWS FOSTERING OF
KNOWLEDGE SHARING AND
DEVELOPMENT OF BASED PRACTICES.
THIS CAN HELP HOLD A RESILIENT
TRANSPLANT ECOSYSTEM THAT CAN
ASHES DATA PROTECTION TO
CHALLENGES AND PROVIEDMAN A BEST
POSSIBLE CARE FOR PATIENTS.
INVESTING IN RESEARCH AND
INMODEL CITIZENIVATION IS
ESSENTIAL FOR ENHANCING
RESILIENCY IN ORGAN
TRANSPLANTATION WITH ENGEAJING
ADVANCEMENT IN REGENERATIVE
MEDICINE, IMMUNE SUPPRESSIVE
THERAPY, ORGAN PRESERVATION
TECHNIQUES, IMPROVED OUTCOME,
EXPAND THE POOL OF VIABLE ORGANS
SO WE WILL ALSO THROUGH THIS
RACE, PUBLIC AWARENESS AND
INCREASE DONATION RATES.
EDUCATION TO THE PUBLIC ABOUT
THE BENEFITS, RISKS AND
PROCEDURES INVOLVED IN
TRANSPLANTATION CAN ADDRESS
MISCONCEPTIONS AND PROMOTE MORE
INFORMED DECISION MAKING IN
GENERAL.
SO I WANT TO END MY TALK BY
SHOWING YOU SOME OF THE BARRIERS
WHY LOW AND MIDDLE INCOME
COUNTRIES ARE NOT MANAGING TO DO
THIS DESPITE ALL THE GOOD
REASONS I'VE GIVEN YOU.
WHEN WE TALK ABOUT THE DISEASE
DONATION, THERE ARE SPECIFIC
BARRIERS, OF COURSE DISEASE
DONATION, WE NEED INFRASTRUCTURE
AND TISSUE TYPING AND LABORATORY
FACILITIES.
FURTHER MORE DECEASED DONATION
ALLOWS THE PUBLIC TO BUY INTO
THE INFORMATION AND FOR THEIR
FAMILY TO BE DONORS SO THAT IS A
FURTHER IS IT EPI-BLAST THAT IS
REQUIRED AND OFTEN IF THESE
THINGS ARE NOT AVAILABLE,
COUNTRIES ARE NOT ABLE TO DRIVE
FOR THE DECEASE DONATION
PROGRAM.
I'VE TALKED ABOUT COST AND I'VE
SHOWN YOU A STUDY IN CHINA BUT I
THINK THAT WE ARE OFTEN QUOTING
HIGH INCOME COUNTRIES WHEN WE
DISCUSS COST OF TRANSPLANTATION.
IN AFRICA AND SOME OF THE LOWER
MIDDLE INCOME COUNTRIES ISSUES
THE COST OF FOLLOW UP CARE AND
THE PARTICULARLY THE COST OF
IMMUNE SUPPRESS IS VERY HIGH AND
WE HAVE TO REALLY DO SOME WORK
TO LOOK AT THE COST OF MINE
TAINING A FUNCTIONING GRAFT
VERSUS DIALYSIS.
AND IF THERE IS A BIG
DISCREMANCY WE FEED TO WORK ON
THAT COST BECAUSE IT SHOULD NOT
BE SO EXPENSIVE.
GOVERNMENT SUPPORT FOR
TRANSPLANT PROGRAMS IS VERY
IMPORTANT, IT IS VERY DIFFICULT
FOR AN INDIVIDUAL PROFESSIONAL
TO DRIVE A TRANSPLANT PROGRAM IF
THERE ISN'T GOVERNMENT SUPPORT
AND I WILL GIVE AN EXAMPLE OF A
PLACE WHERE GOVERNMENT SUPPORT
IS A PROBLEM, FOR INSTANCE IN
TANZANIA RECENTLY THEY ARE BUSY
CHANGING THAT, THEY WOULD
SUPPORT A PATIENT ON DIALYSIS,
THEY WILL SUPPORT A PATIENT WHO
RECEIVE A TRAN PLANT USUALLY IN
INDIA TO GO AND GET THE
PROCEDURE BUT WHEN THE PATIENT
COMES BACK, THEY WOULD NOT PAY
FOR THE IMMUNE SUPPRESSION.
THAT MEANS THAT PATIENT PAYS
THIS OUT OF POCKET AND FOR THAT
PATIENT DIALYSIS IS FREE BUT THE
TRANSPLANT WILL COST ME A
MONTHLY MEDICATION BILL AND
THEREFORE I CAN'T HAVE A
TRANSPLANT.
SO THOSE ARE ILLOGICAL THINGS
WHICH I SAID IN THE BEGINNING
THERE'S A LAGE OF STRATEGIC
LEADERSHIP SOMETIMES TO MAKE
THESE DECISIONS.
WE NEED PROFESSIONALS TO DRIVE
PROGRAMS AND THERE'S A LOT OF
DRIVING BETWEEN TRAINING AND
EXPERTISE WHICH IS DONE AND THEN
WE HAVE A HUGE PROBLEM WITH
BRAIN DRAIN.
SO PROFESSIONALS ARE FREE PEOPLE
AND THEY DON'T HAVE TO COME BACK
WHERE THEY COME FROM, AND I
RESPECT THAT BUT 1 OF THE THING
WE NEED TO DO IS MAKE IT
ATTRACTIVE FOR PEOPLE TO RETURN
TO THEIR HOME COUNTRIES SO THEY
CAN GO BACK AND START THEIR OWN
PROGRAMS,ENTIOUS SPECIALLY
NERMALS OF SURGICAL EXPERTISE
AND WHEN WE TALK ABOUT SOMETHING
LIKE LIVING DONORS WHO WE REALLY
CANNOT ARK FORD FOR ANYTHING TO
GO--OFORD FOR ANYTHING TO GO
WRONG THERE.
I SPOKEN ABOUT INDIA'S MEDICAL
INDUSTRY AND I WAS IN INDRALAST
WEEK FOR A MEETING AND IT WAS
VERY CLEAR TO ME THAT THE
FEELING THERE IS THAT WE CANNOT
DISCUSS THIS BECAUSE THEY ARE
PROVOIDING A SERVICE AT A VERY
GOOD STANDARD AND THEY ARE DOING
IT AT A GOOD COST AND THEREFORE
THEY CANNOT SEE WHY THIS IS A
PROBLEM BUT THEY'RE SAYING
AFRICAN PATIENTS SHOULD NOT BE
TRAVELING TO INDIA FOR THEIR
TRANSPLANTS.
HOWEVER, WHAT IS HAPPENING IN
AFRICA IN SWRIM BAB WEB
CONNECTED WHERE THEY START A
TRANSPLANT PROGRAM AND THEY HAD
THE NECESSARY EXPERTISE AND
PATIENTS WERE SAYING WE WOULD
RATHER GO TO INDIA BECAUSE WE
KNOW WE'RE GOING TO GET BETTER
SERVICE.
THIS IS PART OF PUBLIC
PERCEPTION.
IT MAKES IT VERY DIFFICULT TO
LET THE LOCAL PROGRAMS THRIVE IF
THE PUBLIC STILL BELIEVES THIS
AND OF COURSE WITH MARKETING IN
THE INDIAN ENVIRONMENT WHERE
THERE'S QUITE A LOT OF MONEY, A
VERY GOOD MARKETING GOES TO THE
PUBLIC AND THE CLINICIANS, IT
BECOMES VERY DIFFICULT TO SHOW
PEOPLE THAT THEY SHOULD DRAW THE
SUPPORT OF THEIR LOCAL
TRANSPLANT PROGRAM.
SO TRAVEL FOR TRANSPLANTATION IS
NOT ONLY AROUND THE ISSUES
AROUND MEDICAL TOURISM AND ORGAN
TRAFFICKING BUT IT ALSO BECOMES
A PROBLEM IN TERMS OF DRIVING
THE LOCAL PROGRAM.
SO WE CREATED THIS SHEET AND I
DON'T WANT TO GO INTO IT IN MUCH
DETAIL BUT THINK ABOUT IT FOR
WHAT DO WE NEED FOR A TRANSPLANT
PROGRAM, SO FOR INSTANCE DO YOU
HAVE A CRITICAL CARE OR HIGH
CARE FACILITY.
DO YOU PERFORM VASCULAR SURGERY
AND GENERAL SURGERY IN YOUR
INSTITUTION, DO YOU HAVE
INTERVENTIONAL RADIOLOGY LIKE CT
SCANS, DO YOU HAVE THE LABS FOR
SCREENING AND DRUG LEVELS, AND
THEN 1 CAN SORT OF SAY, OKAY, IF
YOU HAVE THESE THINGS, CAN YOU
START WITH EITHER A DECEASED OR
LIVING DONOR PROGRAM BUT OF
COURSE A LIVING DONOR PROGRAM IS
LOGISTICALLY SO MUCH EASIER.
BUT FOR US IN TERMS OF DRIVING
TRANSPLANTATION IN AFRICA AND
LOW AND MIDDLE INCOME COUNTRIES,
IT IS AROUND AND THAT'S KREBS
CYCLE I'M SHOWING THIS, IT'S
AROUND EVERY BLOCK IN THIS THING
TO TRY AND THINK, WHAT IS THE
BARRIER, CAN WE ADDRESS IT, WHAT
IS THE BARRIER CAN WE ADDRESS
IT, CAN WE HELP, CAN WE
COLLABORATE AND THERE ARE MANY
EXAMPLES WHERE PEOPLE ARE DOING
THAT SUCCESSFULLY.
BUT DESPITE THAT THIS IS JUST A
SURVEY I DID VERY RECENTLY.
QUITE AN INFORMAL SURVEY WHICH I
SENT TO MY PERSONAL CONBEING
TAKEN--THEYS TOW ASK THEM HOW
MANY PATIENTS ARE STILL
TRAVELING OUT OF THE COUNTRY FOR
A TRANSPLANT, YOU CAN SEE IT'S A
LOT, TANSIA, MORE THAN 50, IN
INDIA TRAVELING MORE THAN 50,
KENYA IT'S HIGH, NIGERIA,
RWANDA, SENEGAL, SUDAN, THEY ARE
TRAVELING OUT OF THEIR COUNTRY
BECAUSE THEY DON'T HAVE ACCESS
IN THEIR OWN COUNTRY.
SO WHAT DO WE NEED IN THE LONG
RUN?
WE NEED TO UNDERSTAND WHAT IS
HAPPENING.
WE NEED TO UNDERSTAND WHERE
PATIENTS ARE GOING AND WHERE
PATIENTS ARE RECEIVING THE
TREATMENT.
WE NEED TO UNDERSTAND COSTING
BETTER, AND THE CURRENT COSTING
LOW AND MIDDLE INCOME COUNTRIES.
WE NEED TO ALWAYS FOCUS ON
STAINING PREVENTION PROGRAMS AND
THERE ARE MULTIPLE OPPORTUNITIES
TO DRIVE SOME OF THESE QUESTIONS
AND LOOK AT SOME OF THESE
QUESTIONS BECAUSE THAT IS WHY
IT'S BEEN SO HELPFUL FOR ME TO
WORK WITH ANDREW AND HIS TEAM,
IT REALLY BROUGHT TO US A LITTLE
OF RESEARCH EXPERTISE THAT WE
DID NOT HAVE AVAILABLE IN SOUTH
AFRICA AND THAT IS THE TYPE OF
PARTNERSHIPS THAT WE NEED TO
CONTINUE TO BOLT AND COLLABORATE
TOGETHER.
SO THANK YOU VERY MUCH FOR THE
OPPORTUNITY TO TALK TO YOU AND
I'M HAPPY TO ANSWER ANY
QUESTIONS.
[ APPLAUSE ]
>> SO THANKS A LOT.
THAT WAS FASCINATING.
OBVIOUS 3 IF THERE'S QUESTIONS
COME TO THE MIC HERE EMPLOY 1 OF
THE QUESTIONS WE HAD ONLINE WAS
GIVEN THE ECONOMIC DISPARITY,
AND THEY WERE ASKING IN THE
UNITED STATES BUT ALSO MAYBE IN
SOUTH AFFRIC AWHY DO YOU THINK
THE NATIONAL HEALTHCARE
PROVIDERS HEALTH INSURANCE,
THINGS LIKE THAT AREN'T DOING
MORE TO PUSH FOR TRANSPLANTATION
GIVEN THE COST OF DIALYSIS AND
THINGS LIKE THAT?
>> I THINK WE'RE NOT TARGETING
THEM ENOUGH TO MAKE THIS CASE.
CERTAINLY IN SOUTH AFRICA OUR
HEALTHCARE PROVIDERS ARE NOT
CONITANTLY THINK BEING THIS AND
DIALYSIS HAS COME JUST RUN O%
THE MILL THING THAT EVERYBODY
GOES TO, SO I THINK IT IS A LACK
OF CONVERSATION AND EDUCATION
THAT'S HAPPENING IN THIS
REALITY, WHICH OF COURSE PUTS
THE OWENESS BACK ON TO OFFICIALS
TO ADDRESS THIS BECAUSE FOR MOST
ECONOMIC POINT OF VIEW, IT
DOESN'T MAKE SENSE THAT THEY
SHOULD PAY FOR DIALYSIS.
>> HI, I REALLY ENJOYED YOUR
PRESENTATION.
I WAS JUST WONDERING HOW WILL
WE--CAN I MAKE THIS HIGHER, HOW
WOULD WE BETTER COMBAT THE
AMOUNT OF BRAIN DRAIN THAT
HAPPENING FOR PROFESSIONALS IN
LOW AND MIDDLE INCOME COUNTRIES.
BECAUSE I KNOW SOME
PROFESSIONALS WOULD GO AND STUDY
IN A MORE WEALTHIER COUNTRY AND
SPLIT THEIR TIME FROM THAT
COUNTRY WITH THEIR COUNTRY OF
ORIGIN OR ANOTHER REGION O I WAS
JUST WONDERING HOW WE BEING MAKE
OR PUT IN TO MAKE IT MORE
ATTRACTIVE TO HELP LOWER INCOME
COUNTRIES.
>> IT'S A VERY DIFFICULT THING,
IN THE SOUTH AFRICAN CONTEXT,
THE GOVERNMENT MADE IT
COMPULSORY FOR PEOPLE TO REMAIN
IN THE COUNTRY 2 YEARS AFTER
THEY QUALIFIED AND WORK IN A
STATE HOSPITAL, SO EVERYBODY IN
QUALIFIES IN SOUTH APRICKA HAS
TO DO THAT AND THEN IT BECOMES
VERY DIFFICULT BECAUSE YOU CAN'T
MAKE RULES ABOUT THE WAY PEOPLE
CAN GO BECAUSE THAT WOULD BE
UNFAIR TO THE INDIVIDUAL AND
PEOPLE HAVE VERY SPECIFIC
PERSONAL CIRCUMSTANCES WHY THEY
LEAVE COUNTRIES AND WHY THEY
MOVE, SO I DON'T THINK 1 CAN DO
IT WITH RULES OR WITH
LEGISLATION SO YOU HAVE TO DO IT
BY CHOICE OF COURSE IF YOU GET A
COMMONWEALTH SCHOLARSHIP IN
OXFORD, YOU SIGN A DECLARATION
THAT YOU WANT TO GO TO YOUR HOME
COUNTRY AND YOU WILL GO TO YOUR
HOME COUNTRY AND IT'S PART OF
YOUR [INDISCERNIBLE], SO IF YOU
DON'T DO IT, YOU PAY THE MONEY
BACK, BUT THAT'S 1 THING YOU CAN
DO BUT OF COURSE, CAN YOU GO
BACK FOR 2 YEARS OR SO AND YOU
CAN DO WHATEVER YOU WANT, SO I
THINK IT IS AROUND TRYING TO
CREATE THE INFRASTRUCTURE THAT
PEOPLE NEED TO HAVE OPTIMAL WORK
ENVIRONMENT IN THE PLACE YOU
WANT THEM TO TO BE EMPLOY THAT'S
WHAT WE WANT THEM TO DO EMPLOY
WE HAVE TO HAVE A OPTIMAL
INSTANCE IN KENYA OR NIGERIA
WHERE THE WORKFORCE WANTS TO
WORK, WHERE THEY'RE PAID WELL,
WHERE THE INFRASTRUCTURE EXISTS
BECAUSE IT'S NOT FEASIBLE FOR
SOMEBODY TO GO AND GET TRAINED
TO DO A PROCEDURE AND THEY WANT
TO GO BACK AND THEN THERE'S NO
INFRASTRUCTURE TO DO IT.
SO I THINK THERE'S A LOT OF WORK
THAT NEEDS TO GO INTO THAT AND A
POT OF THE PROBLEM IS THE LACK
OF COLLABORATION THAT SOMETIMES
HAPPEN BETWEEN THE PROFESSIONALS
AND THE GOVERNMENT, AND THEN WE
HAVE THESE MEETINGS AND WE ALL
TESTIMONY CATEGORY AND SAY LET'S
TRAIN A SURGEON FROM GANNAA AND
WE DO IT BUT GANA BUT THE
GOVERNMENT AND PEOPLE WHO FUND
THE HOSPITAL ISN'T IN THE ROOM
SO WHEN THE PERSON GOES BACK,
THERE ISN'T AN INFRANCIS COLLINS
STRUCKURE AND I THINK THAT WE
NEED TO BE BETTER ORGANIZED.
>> THANK YOU FOR YOUR TALK, I AM
FROM PAKISTAN AND I HAVE SEEN
PATIENTS FOR TRANSPLANT AND I
FEEL LIKE YOU COVERED ALL THE
POINTS AND LMIC, THE BARRIERS
WERE VERY WELL DESCRIBED AND
THANK YOU FOR THAT EMPLOY MY
QUESTION IS TO MY UNDERSTANDING
1 OF THE OTHER REASON FOR ORGAN
TRAFFICKING IS ORGAN CHART, SO
DO YOU SEE LIKE THE--TO DO
RESEARCH GOING ON, LIKE TAKING
ORGANS FROM PIG OR OTHER GENETIC
AS A SOLUTION FOR ORGAN SHORTAGE
IN THE LONG-TERM?
>> ABSOLUTELY, I THINK WE HAVE
TO USE INNOVATION AS FAR AS WE
CAN, WHETHER IT'S XEEN O
TRANSPLANTS, BIOENGINEERING
MODELS, WE HAVE TO USE THOSE
THINGS AND WE HAVE TO DEVELOP
THEM AND THAT'S WHY THAT
RESEARCH IS SO IMPORTANT.
WE ALSO HAVE TO MAKE SURE WE USE
EVERY AVAILABLE ORGAN THAT COMES
OUR WAY AND WE ALSO HAVE TO MAKE
SURE THAT WE GET THE PUBLIC'S
BUY-IN BECAUSE IT'S NO USE, YOU
DIE WITH YOUR ORGANS AND WE HAVE
TO EDUCATE THE PUBLIC SO THAT WE
WORK ON ALL THE STREAMS BUT IT
IS ABSOLUTELY TRUE TAKEN--THEY
ORGAN SHORTAGE IS DRIVING ORGAN
COMMERCIALIZATION AND ORGAN
TRAFFICKING AND IF WE'RE NOT
GOING TO ADDRESS ORGAN SHORTAGE
WE WILL NOT GET TO THE ROOT
CAUSE OF THE PROBLEM.
>> THANK YOU.
>> THANK YOU FOR PRESENTATION.
SO, ON THE CLINICAL FELLOW HERE
AND I ALSO INTERNED BACK IN
NIGERIA, SO WHEN YOU'RE TALKING
ABOUT THE INDIAN EXPERIENCE 1
THING THAT JUMPED AT ME WAS
ISSUES I COULD REMEMBER I
VISITED A CENTER [INDISCERNIBLE]
TRANSPLANTS BUT I THINK IT'S
ACTUALLY A PRIVATE ORGANIZATION
AND THE COST OF DOING THIS AT
THAT TIME IS ACTUALLY MORE
EXPENSIVE THAN IF YOU FLY BO
INDIA AND DO THE SAME PROCEDURE
SO IT BECOMES A QUESTION OF
[INDISCERNIBLE] I THINK IS INDIA
IT'S [INDISCERNIBLE] OR SO, BUT
I AM THINKING HOW DO YOU PITCH
THIS TO THE GOVERNMENT TO SORT
OF SUBSIDIZE THIS PROCEDURE TO
INSURE THAT PATIENTS GET TO STAY
TO DO IT AND THEN THEY DO NOT
DECIDE TO TRAVEL FOR THE RISK
IN.
>> THIS IS WHAT WE WANT TO TALK
TO THE INDIAN PEOPLE ABOUT,
BECAUSE OBVIOUSLY THEY HAVE AN
ECONOMY OF SCALE EMPLOY SO
THEY'RE DOING THOUSANDS OF
TRANSPLANTS AND THEY'RE DOING IT
CHEAP AND EFFICIENTLY AND YOU
KNOW WE WERE THINKING PERHAPS WE
COULD GET THEM TO HELP US TO
DRIVE LOCAL PROGRAMS SO FOR
INSTANCE INSTEAD OF THEM GOING
TO INDIA, TRAIN PEOPLE, HELP THE
AFRICAN PEOPLE TO DO IT BUT FOR
THAT IT'S A DIFFERENT MIND SET
BECAUSE THAT CURRENT MODEL IN
INDIA IS A BUSINESS MODEL, AND
THE MIND SET WE'RE GOING TO GO
OUT AND TRAIN PEOPLE IN AFRICA
IS MORE ANN ACADEMIC MODEL, SO I
HAVE TO SAY, I DON'T KNOW WHAT
IS THE SOLUTION BECAUSE I KNOW
IT'S VERY, VERY DIFFICULT, AND
THE ONLY WAY WE WILL PROBABLY
ADDRESS IT IS IF WE LOOK AT ONCE
AGAIN BRINGS DOWN COSTS SO WE
HAVE TO GO AND LOOK WHAT ARE THE
REAL COST DRIVERS THAT'S MAKING
IT SO EXPENSIVE IN NIGERIA, IS
IT A LACK OF GORCHANCE IN TERMS
OF THE DRUGS AND THE SALARIES,
IS IT THE FACT THAT THERE'S SO
FEW TRANSPLANTS?
WE KNOW ANYTHING YOU DO AT A
SMALL VALIUM IS MORE EXPENSIVE?
SO IT WILL BE EXPENSIVE IF WE DO
MORE?
WE NEED TO LOOK AT THE ISSUE
BECAUSE WE DON'T HAVE THE
ANSWERS.
>> THANK YOU.
>> THANK YOU FOR YOUR
PRESENTATION.
MY QUESTION IS AROUND THE FIRST
POINT, THE FIRST BARRIER THAT
YOU MENTIONED ABOUT DEVOAS
CEASED OWNERS, I WAS WONDERING
OBVIOUSLY THAT HAS A LOT OF
IMPLICATIONS ON CULTURAL
UNDERSTANDINGS AND SENSITIVITY
AND ALL OF THAT, AND LIKE,
MOTORUARYY PRACTICES AND
BELIEVES IN SAIRCHGHTITY OF THE
BODY AND THINGS LIKE THAT, HAVE
YOU ENCOUNTERED SITUATIONS WHERE
THAT BECAME YOU KNOW A BIG
BURDEN ON THE HEALTHCARE SYSTEM
AND HOW DID HEALTHCARE PROVIDERS
COME ABOUT KIND OF ADDRESSING
THAT SENSITIVELY.
>> DEFINITELY IT IS A BIG BURDEN
AND A BIG PROBLEM, IN SOUTH
AFRICA FOR INSTANCE WE HAVE
CERTAIN GEOGRAPHICAL AREAS WHERE
THE TRANSPLANT COORDINATORS SAY
IN OUR AREA PEOPLE DON'T DONATE.
AND IT'S VERY MUCH PERCEPTION
THAT IS THERE, IF YOU GO TO THE
INDIVIDUALS AND YOU TALK TO THEM
AND YOU EXPLAIN IT TO THEM, SOME
OF THOSE PEOPLE THAT'S BEEN
LABELED NONDONORS WILL GIVE
PERMISSION.
IT IS TRUE FOR CERTAIN
RELIGIONS, IT IS TRUE FOR PEOPLE
WHO ARE VERY SPIRITUAL AFRICAN
PEOPLE WHO STILL BELIEVE IN A
LOT OF THE AFRICAN TRADITIONAL
THINGS, BUT USUALLY, CAN YOU
ADDRESS IT WITH THE GOOD
EDUCATIONAL APPROACH.
BUT WHAT YOU'RE SAYING IS
ABSOLUTELY TRUE AND I THINK THE
OTHER THING IS THAT YOU HAVE TO
BE CULTURALLY SENSITIVE, SO FOR
INSTANCE IN OUR SETTING, WE ARE
TRYING TO GET PEOPLE WHO HAVE
SIMILAR BACKGROUND AND A SIMILAR
RELIGION TO TALK TO THOSE PATES
AND THAT DOES MAKE A BIG IMPACT,
BUT OF COURSE THAT ALSO NEEDS
MONEY AND MORE PEOPLE AROUND AND
SO ON.
BUT IT IS--IT IS A BIG PROBLEM.
INTERESTINGLY FOR INSTANCE IN
THE MIDDLE EAST, TO HAVE QUITE A
HIGH DECEASED DONATION RATE BUT
WHEN YOU GO AND LOOK AT IT IN
MORE DETAIL, YOU WILL SEE THAT
IT'S ACTUALLY A LOT OF THE
PEOPLE WHO ARE IMMIGRANTS IN THE
MITSD EAST WHO BECOME THE DONOR
WHO SAY YOU HAVE TO INTERPRET
THAT DATA VERY CAREFULLY.
>> THANK YOU.
>> THAT WAS FANTASTIC ELMI,
THANK YOU SO MUCH FOR COMING AND
ALL THOSE VIEWING ONLINE AND
GIVE AROUND OF APPLAUSE AND
THANK YOU FOR A GREAT TALK
EMPLOY IT WAS GREAT.