A lifeline in waiting

The rising prevalence of end-stage kidney disease in Barbados, exacerbated by the increasing rates of non-communicable diseases (NCDs) such as diabetes, hypertension, and obesity, is placing tremendous pressure on the island’s healthcare system. Dialysis remains a vital lifeline for many patients, but it is neither a sustainable nor a cost-effective long-term solution. For countless individuals, a kidney transplant represents a far more viable hope for a longer and healthier life.

The costs associated with dialysis tell the story of another source of strain on the island’s healthcare system. Dr Margaret O’Shea, a transplant surgeon at the Queen Elizabeth Hospital (QEH), recently revealed that dialysis accounts for approximately 12 per cent of the QEH’s annual budget, costing between $60 000 and $70 00 per patient each year. In contrast, a kidney transplant offers a far more cost-effective long-term solution. The first-year cost of a transplant is approximately $50 000, with annual post-transplant care dropping to around $20 000—a stark contrast to the ongoing expenses of dialysis. Despite these clear financial and health advantages, kidney transplants remain an elusive option for the majority of those in need.

The issue is not one of feasibility. Since 2015, Barbados has successfully carried out 16 kidney transplants, all with a 100 percent donor survival rate. Unfortunately, the limited number of living donors means that many patients continue to wait—sometimes in vain—for the organ they so desperately need.

With over 400 Barbadians reliant on dialysis and a growing number of individuals awaiting kidney transplants, the need for a deceased organ donation programme—a system that allows organs to be donated from people who have died—has never been more urgent. A well-regulated programme would ease the chronic shortage of available organs and provide a lifeline for many suffering from kidney failure.

The proposed Human Tissue Transplant Bill, which would enable the donation of organs from deceased individuals, is currently on pause in Parliament. It was withdrawn from the House of Assembly on October 19, 2024, and is to be introduced in the Senate.

This crucial legislation promises to alleviate the strain on the healthcare system, save lives, and offer hope to countless Barbadians.

Though it has been just a few months since the bill’s withdrawal, we suggest that it should not remain in limbo for much longer. The government must take action to push the legislation forward, ensuring that the bill is passed and enacted without unnecessary delay.

During a July 2023 St George Parish Speaks town hall meeting, Prime Minister Mia Mottley emphasised the potential benefits of the Human Tissue Transplant Bill.

Acknowledging that it could benefit hundreds of dialysis patients for whom kidney donation would be a better alternative, the country’s leader declared: “I will tell you straight that if something happens to me tomorrow and I am brain dead, make sure [you] take every organ out of my body and give it to somebody who needs it… Because there is no sense in letting my organs go down in the earth with me when I can be of use to somebody else who wants life. It is a conversation that families must have.”

This brings us to another pivotal consideration: education. While the passage of the Human Tissue Transplant Bill is undeniably critical, it represents only a first step. For a deceased organ donation programme to thrive, the government must commit to a robust national education campaign. This initiative must confront and dispel the misconceptions and anxieties surrounding organ donation, ensuring that Barbadians are not only informed but also fully aware of the life-saving potential it holds.

As Dr O’Shea has pointed out, countries such as Spain have successfully implemented deceased donor programmes by fostering an open, nationwide dialogue on the topic. Through educational initiatives, community engagement, and conversations in schools, churches, and civic organisations, Spain has normalised organ donation. The Barbados Kidney Association has already pledged its support for such educational efforts, and the authorities must leverage that.

The Human Tissue Transplant Bill is not merely a policy initiative; it is a critical opportunity to address a national healthcare crisis, save lives, and reduce the financial burden on the healthcare system. Legislators must move forward with this bill, ensuring a future where organ donation becomes a life-saving norm for all Barbadians.