Barely a year ago, an Independent expert group of the United Nations expressed their concerns over what they termed as organ harvesting perpetuated against minority groups in china.
This week has seen yet another revival of the subject of organ harvesting when the story of Ike Ekweremadu – a Nigerian Senator – took center stage in the United Kingdom. Whilst the convoluted story brews further, it raises pertinent issues worth the attention of policy makers in Ghana.
For the avoidance of doubt, let us situate the discourse in a lucid framework. The International Society for Human rights defines organ harvesting “as essentially “killing on demand” which is the selling and transplantation of the organs of victims”.
Whilst this practice casts a nefarious shadow over this illegal procedure, organ transplantation on the other hand have proven to be lifesaving by improving the quality and duration of life of beneficiaries.
In 2007, the World Health organization in collaboration with the Spanish Transplant Organization, Organización Nacional de Trasplantes (ONT) developed what is today the Global database on donation and transplantation (See http://www.transplant-observatory.org). The database serves as a comprehensive repository of organ transplantations and donations as reported by official sources in various countries.
Ulasi et al (2020) intimated insightfully in Organ Donation and Transplantation in Sub-Saharan Africa: Opportunities and Challenges that Ghana was amongst the countries in Sub-Saharan Africa with a functional transplantation programme from living donors. This is in addition to the growing number of kidney centers heavily concentrated in Greater Accra and Kumasi.
Under the legal requirement section for transplantation programmes in sub-Saharan Africa, Ulasi et al. noted that like Namibia and Rwanda, Ghana had authorization for both the import or exports of organs even though Government is yet to adopt new legal requirements. As the authors rightly observed – Ghana thus had authorization for transplantation services. Osafo et al (2018) affirmed this when in 2008 – the Korle Bu Teaching Hospital – Ghana’s premier hospital performed its first kidney transplant with the support of the Transplant Links Community and the Queen Elizabeth Hospital in Birmingham (see also https://kbth.gov.gh/korle-bu-to-perform-kidney-transplantation/).
Currently, the only organ transplant option accessible in Ghana is kidney transplantation using live donor organs. That said, Dr. Elliot Tannor – Senior Nephrologist at the Komfo Anokye Teaching hospital in Ghana opined in his 2021 presentation (Prevention and Early Detection of Kidney in Africa) on the Africa Healthcare Network about the affordability constraints of more than ninety five percent (95%) of patients with End Stage Kidney Disease in Africa. He lamented morbidly that “we practically watch patients die daily!!!”.
In Ghana, Tannor touts the Chronic kidney disease situation as a ‘neglected’ non-communicable disease. The proceeding facts bare him out. In 1984 Dr. M. O Mate-Kole and Dr.R. K Affram started a renal clinic in Ghana. Prior to the commencement of the clinic, a worker of the Volta Aluminium Company (VALCO) who needed dialysis necessitated the installation of a dialysis machine. Dialysis is one of the options for renal replacement therapies in addition to kidney transplantation. Boima et al in Renal Replacement Therapy in Africa indicated that only a select few of countries in Africa carry out kidney transplant procedures.
These include South Africa, Algeria, Egypt, Libya, Mauritius, Morocco, Nigeria, Sudan, Tunisia, Kenya and Ghana. Dialysis costs between 300-400 Ghana cedis per session. Patients require an optimal frequency of three sessions per week which means parting away with between 900-1200 Ghana cedis every week absent cost of medicines and other indirect costs including but not limited to transportation. This is done on the backdrop of a current minimum wage of $1.69.
Even though kidney transplant serves as the ultimate modality for the management of End Stage Kidney disease – dialysis sessions seem to hold sway here in Ghana. Transplant per head as reported by Boima (2019) in his work -Willingness to accept and pay for kidney transplant among chronic kidney disease patients attending Korle Bu Teaching Hospital – reported 60,000 Ghana cedis even though India serves as the transplant destination for most Ghanaians.
Situating the monetary demands of both dialysis and transplant sessions in the context of quotidian earnings of Ghanaians reveal an urgent need for a national conversation on funding and more proactively public awareness programmes to avert these situation where possible.
Beyond the aforementioned barriers of cost in the management of kidney related issues is the legal lacuna. Whilst Ghana can now boast of a recently published Ghana Renal Registry- a first annual report in the African Journal of Nephrology, more can be done in legalism to consolidate these gains. Banyubala has already laid the foundation in his 2014 Doctor of Philosophy thesis (ORGAN TRANSPLANTS IN GHANA: FINDING A CONTEXT-APPROPRIATE AND PRACTICALLY WORKABLE ETHICO-LEGAL POLICY FRAMEWORK) submitted to the University of Manchester.
Banyubala equally explicated the posthumous regime of Organ retention and use in Ghana. To avert ‘human (organ) stoway’ alleged in the Ekweremadu case, Ghana needs as a matter of urgency a National organ Transplant Act or better still a Uniform Anatomical Gift Act to cater for the absence of consent in posthumous tissue or organ harvesting for the advancement of medical study.
This reflections is a preliminary dig about what pertains in the remit of the organ donation and transplantation in Ghana compared to other jurisdictions. It highlights the critical gaps in public health sensitization and more importantly the absence of a legal framework to address the key issues raised.
The authors herein call for stakeholders (Including but not limited to the Ministry of Health, Ghana Medical Association, Ghana Pharmaceutical Society and other allied professional groups, the managers of the National Health Insurance Scheme and the Honorable House of Parliament to as a matter of urgency put certain measures in place to make renal replacement therapy readily available and affordable.
About the authors
1. Dr Stepharie Aba Kum-Amissah (Medical Doctor)
2. Reginald Sekyi-Brown (Pharmacist)
Both authors are passionate about public health advocacy