Remarks by His Honour the Vice President of the Republic of Botswana, Lt. General Mompati S. Merafhe, MP, at the launch of the Organ Donor Trust Fund

source: Republic of Botswana (6/12/08): TAUTONA TIMES no 40 of 2008
The Weekly Electronic Press Circular of the Office of the President “Democracy, Development, Dignity and Discipline”

B4) 3/12/08: REMARKS BY HIS HONOUR THE VICE PRESIDENT OF THE REPUBLIC OF BOTSWANA, LT. GENERAL MOMPATI S. MERAFHE, MP, AT THE LAUNCH OF THE ORGAN DONOR TRUST FUND:

[Salutations]…Ladies and Gentlemen;

1. I am very delighted and proud to be here this evening to launch the Organ Donor Trust Fund.

2. It has become increasingly clear that as a Government, we are faced with a difficult challenge of dealing with requests to cover medical expenses for citizens in need of organ transplants. While the dignity of life of our people forms one of the cornerstones of our vision, recognising and acting to pursue this vision and balancing that against the ever increasing national health budget is a mammoth challenge facing Government. As a matter of fact, the current financial resource constraints and high cost of specialised health care services have made it difficult for Government to sustain expenditure on referrals for major organ transplants, such as for the liver, heart and kidney.

3. To assist the Government in addressing this critical challenge an Organ Donor Trust Fund Committee was recently constituted by the Minister of Health. This Committee will assist the Government through the Ministry of Health to raise funds for the exclusive coverage of medical costs for patients in need of organ transplants. I am pleased to present to you the members of this Committee and they are:

• Mr. Satara Dada, Chairperson
• Mr. Kagiso Mmusi, Member
• Mr. Igbal Chand, Member
• Mr. Peter Stevenson, Member
• Dr. Kolaatamo Malefho, Member.

In their various capacities these gentlemen are men of courage who have distinguished themselves in service to this nation.

4. I would like to take this opportunity to express my profound gratitude to them for having answered the call to serve the nation in this very important assignment. Among other core functions the Committee will perform the following:

• To raise community awareness about issues related to Organ Transplant, with special emphasis on cost implications. • To scale-up fund-raising to assist Government and patients in need of Organ Transplant. • To develop strategic partnerships with potential donors locally and internationally and carry out any other duties to advance the cause for Organ Transplant

5. Directors of Ceremonies, major organs that are commonly covered by transplant programmes include kidneys, heart, liver, lungs, bone marrow, pancreases and intestines; while minor ones are the cornea, bone marrow and skin. Of these, the kidney transplant is the most common worldwide.

6. Research results about transplants undertaken in western countries and in the region indicate that the rate of chronic kidney failure is approximately 80 people in (1) one million per annum in societies such as ours. This suggests that 100 to 120 patients in Botswana may come for medical attention each year with chronic renal failure.

7. Not all these cases though will be candidates for organ transplant. Old age, major medical conditions such as diabetes, hypertension and the presence of HIV and AIDS infection may not be candidates for transplants although they remain challenges in health care delivery.

8. One may ask the question “where are we going to get the organs?” In developed countries, where the concept of “organ donation” is widely accepted and services well established, cadaver organs are a major source of transplanted kidneys.

9. Cadaver donation occurs when a patient at the penultimate moment of his/her life graciously pledges an organ which becomes available at short notice and needs to be used at once. Donors of these are usually young adults.

10. Ladies and Gentlemen, there are of course medical and ethical issues to be addressed; for example, how are we going to convince people to accept these new life saving programmes. Usually, organ donation is requested on non-conditional basis. This means that neither the donor nor their family can have any influence over who receives the organ. Donors are also not expected to specify the recipient on the basis of sex, age, religion, race or nationality.

11. Consent is another issue to be addressed. In many countries, people who wish their organs to be used after their death to save lives will carry a purpose-designed “organ donor card” in their purse or wallet together with their driver’s licence. In other countries the consent is reflected in the national identity card. As Batswana we are still to make up our minds about the options to adopt for use in our country.

12. Directors of Ceremonies, it is important to appreciate that the costs of Organ Transplant vary with the clinical diagnosis and condition of the patient; the pre-operative complications and the complexity of the surgery; the organ and the post-operative treatment regime. For example, bone marrow transplant can cost R12000.00 (twelve thousand Rands), while a liver transplant will require between R200,000 (two hundred thousand) and 500,000.00 (five hundred thousand Rands) at South African medical centres. These are conservative figures based on the assumption that there will be no complications in the operation.

13. A series of post-operative complications can result in a lengthy stay in the Intensive Care Unit (ICU) with major cost implications.

14. Some conditions such as heart transplants are even more expensive. Indeed, there are many other secondary charges I have not highlighted such as the costs of haemodialysis which can be as high as P250, 000.00 (two hundred and fifty thousand Rands) in one year for a single patient.

15. Directors of Ceremonies, it is important to note that the provision of services for transplant surgery involving kidneys, livers, lungs and hearts are highly specialised endeavours. The critical mass of expertise needed includes the full range of services provided by highly trained physicians in renal medicine, hepatology, pulmonary medicine and cardiology.

16. At present we do not have any of these specialist units in our facilities. Therefore, for Batswana to access organ transplants there are two possible ways to achieve this for now:

• Either to refer patients to already existing and functioning organ transplant programmes in other countries, especially South Africa; or
• To initiate a programme of providing these services in our country.

17. The latter is a medium to long-term strategy and requires development of specific legislative instruments as well as availability of specialized equipment and human resources. I must however, indicate that some simple transplant procedures such as skin and corneal transplants can be suitably performed in Botswana. The choice to continue doing donor kidney transplants in South Africa may be the feasible option because we are getting good results. This option would require the following interventions, among others:

• The commitment of Government to fund or establish haemodialysis in Botswana;
• Government-to-government agreement to allow South African organs to be implanted into Batswana;
• Government of Botswana’s commitment to fund supply of organs to selected South African transplant centres; • Arranging air ambulance flights to carry organs at short notice;

18. Government is in the process of developing legislation to address issues around organ transplants. The real issue here is the escalating costs and sustainability of such a programme. The Ministry of Health continues to look at various ways of financing health care programmes in this country, and the range of services that can be provided in Government, Missions and Mine hospitals.

19. Directors of Ceremony, before I conclude, I must thank Mme Mma Motsumi for appointing the Organ Donor Trust Fund Committee. Minister, our expectation is that your office will give this Committee the necessary support to facilitate the smooth running of the Trust.

20. I have no doubt that the Committee members we are parading at this launch will be equal to the task in discharging the onerous responsibility bestowed on them.

21. In conclusion allow me to officially launch the Organ Donor Trust Fund. I thank you all for the courtesy of your attention. PULA!