By Richard Bhainie
THE much-needed human tissue transplant legislation is a revolutionary piece of document that will completely overhaul and improve the health sector, while providing a gamut of benefits for persons requiring organ transplant.

Dr. Kishore Persaud, Head of Department, Multi-Organ Transplant and Vascular Access Surgery at the Georgetown Public Hospital Corporation (GPHC), is one of the key stakeholders in the drafting of the legislation.

During an interview with the Sunday Chronicle, Dr. Persaud noted that there are currently patients in Guyana as young as 10 years old, and many others below the age of 20, who suffer from kidney failure but cannot undergo a transplant because they do not have a compatible donor. With the absence of the legislation to allow for the transplant of organs from ‘brain-dead’ individuals, patients with kidney failure have to undergo dialysis – one of the most expensive treatments.

The Human Tissue Transplant legislation will provide the regulatory framework which will enable Guyana to perform cadaveric transplantation; this is the transplant of tissue from ‘brain dead’ individuals, or cadaver as they are referred to, to living persons. Currently, there is no legislation governing this area in Guyana, which means there is no legally provided criteria for identifying and labelling someone as ‘brain-dead’, whether a ‘brain-dead’ person can be removed from a ventilator and the method and procedure on how to do so.
It would also provide systematic regulations and guidelines to govern living donor transplants, which is the only type of transplantation currently performed in Guyana, along with a section pertaining to blood transfusion.

“The hospital did corneal transplants in the past; however, those corneas were donated because we cannot harvest our own due to lack of legislation. We’re only doing living donor kidney transplant and that’s when someone has kidney failure, we have to get someone to donate a kidney to him/her; so if no one donates, that person dies or has to stay on dialysis until they die,” Dr. Persaud said.

The legislation would allow the family of ‘brain-dead’ individuals to donate the organs of the individual, once they have been legally determined ‘brain-dead’. It would also allow persons to register if they want to donate their organs when they die.
The term ‘human tissue’ is used to describe how cells, the building blocks of life, are grouped together in an organised manner according to specific structure and function. These groupings of cells form tissue structure, which then make up organs and various parts of the body. The legislation was titled the ‘human tissue’ legislation so that it can be far-reaching; it would encapsulate various human transplantations and not be restricted to a certain group of tissues or organs.

In this regard, it would open the door for the advancement of medicine in Guyana. Specialist doctors would have to be trained in a gamut of medical fields to provide different transplants, expanding the arena of medicine in Guyana and improving the quality of service.

“It will also widen the access of care the ordinary citizen can get; the laboratories will have to develop to compensate for the transplant legislation; the administrative component of the hospital will have to develop, and the facilities offered by the hospital will automatically develop,” Dr. Persaud explained.

He highlighted that there is a high demand for organ transplantation in Guyana, which would allow hundreds of persons to live healthy and productive lives.
“We have a significant amount of our population that is diabetic and hypertensive; the main cause of kidney failure is diabetes and high blood pressure. We have over 150 patients on dialysis that desire a transplant or can benefit from transplant,” he said.
Dr. Persaud explained that dialysis is one of the most expensive treatments in the world, and once someone assumes the treatment, one has to remain on it for the rest of one’s life, unable to work or live productive lives.

“With a patient getting a transplant, they don’t have to do dialysis; they require minimum medication to stay alive. They go back to work and they’re able to live a healthy productive life.”
The legislation is also being drafted to protect against trafficking in persons and the illegal harvesting of organs. The legislation would only permit for the harvesting of the organs once someone is declared legally brain dead and the hospital would not be able to store any organs.

“Patients are prepared when they are in need of a transplant, so if someone is ‘brain-dead’ in the Intensive Care Unit (ICU), they will call us and indicate whether the organ can match and then we do the transplant,” Dr. Persaud said.

Further, to aid in these efforts, the legislation provides for a fixed team, appointed by the Ministry of Health, which will be authorised to be part of the transplantation process.
“So, if a transplant is happening in Guyana, it is only happening by a specific group of persons and no other person – so it protects the ordinary man so no one can do a transplant through the back door,” Dr. Persaud explained.
With this legislation, it is expected that some burden will be removed from the public health sector.

“This is something I have been pushing for because of the benefits. Every sector of this country will benefit from this legislation, it’s something we need. Every other Caribbean country has this type of legislation, so it will put us on par with our neighbours and help us to improve the quality of care offered to the entire country,” Dr. Persaud emphasised.

The draft bill is currently at the Attorney-General Chambers for revision. On January 20, 2021, the Attorney General and Minister of Legal Affairs, Anil Nandlall, S.C. met with Dr. Persaud and his team along with members of the Guyana Medical Council to discuss the legislation.
The bill is expected to be presented in Parliament on or before May 2021.