The President of the Nigerian Association of Nephrology and Transplant Association of Nigeria, Prof Jacob Awobusuyi, has emphasized the concerted efforts being made by nephrologists and transplant experts to ethically enhance the availability of organs for transplantation.

This statement comes amidst the backdrop of organ harvesting controversies in Nigeria and the challenges highlighted by the pig-to-human kidney and heart transplant procedures conducted in the United States of America.

The advancements occurring in the realm of organ transplantation, particularly the utilization of genetically modified pig organs, have generated substantial interest and dialogue within the medical fraternity.

In March 2024, the Massachusetts General Hospital marked a landmark event by transplanting a genetically modified pig kidney into a living recipient for the first time. Prior to this groundbreaking procedure, temporary pig kidney transplants had reportedly been conducted on brain-dead donors.

Shortly thereafter, in April 2024, a woman in New York, USA, became the second individual to undergo a genetically modified pig kidney transplant. While initial reports indicated the patient’s favorable recovery, the first recipient of the same transplant, Rick Slayman, tragically passed away a few weeks post-surgery.

Contrary to previous speculations, the US hospital responsible for Slayman’s transplant declared that his demise was not attributable to the transplant procedure, as reported by the British Broadcasting Service.

In a separate medical feat in September 2023, a 58-year-old man named Lawrence Faucette received a genetically modified pig heart transplant, becoming only the second patient worldwide to undergo such a procedure, as documented by the Voice of America.

Due to the global scarcity of organ donors and prolonged waiting periods endured by patients in need of transplants, innovative scientific breakthroughs in organ transplantation have emerged as a potential solution.

According to the National Kidney Foundation, the transplantation of non-human tissues or organs to treat human medical conditions is referred to as Xenotransplantation. Pigs are preferred over other animals for kidney transplants due to their widespread availability, anatomical kidney similarities with humans, and a low likelihood of disease transmission.

Moreover, pigs used for transplants are cultivated in laboratories, with their genetic makeup deliberately edited to mirror human genetics.

Despite the initial challenges encountered, scientists and nephrologists acknowledge the necessity for further research to address these concerns in the field of organ transplantation.

Individuals with end-stage renal disease or chronic kidney disease necessitate kidney transplants for optimal health outcomes. In the United Kingdom alone, approximately 5,000 individuals annually await kidney transplants.

Tragically, as per statistics from the National Kidney Foundation, a significant number of patients with chronic kidney disease in the United States are in dire need of kidney transplants, with a considerable disparity between those in need and those who ultimately receive transplants.

Alarmingly, each day sees 12 individuals on the transplant waiting list succumb to their condition, underscoring the urgency of addressing the global shortfall in organ availability.

While there is a lack of comprehensive national data concerning kidney transplant demand in Nigeria, a review conducted on transplants between 2000 and 2010 revealed that 143 kidney transplants were conducted during that period, with 70% being carried out in private facilities.

Recent developments in chronic kidney disease have brought to light suspicions of organ trafficking within the country, as reported by Wakadaily.

Prof. Awobusuyi denounced the illicit activity of organ harvesting, particularly targeting minors and economically vulnerable individuals.

Moreover, Wakadaily learnt that, the NAN-TAN president expressed reservations regarding the feasibility of adopting genetically modified pig organ transplants into humans, citing concerns surrounding ethical considerations, genetic editing requirements, organ failure post-transplantation, and the prohibitive costs associated with the procedure.

He stated, “Let me say, it’s a welcome development, but it’s not as easy. The pig’s organs are very similar to what we have as humans, so it’s utilisable, but there are many issues. What has made it possible is development. So, they are not just pigs that are out there, they are, in a way, humanised.

“And what do I mean by that? Their genes have been edited. In the last transplanted kidney, about 69 alterations were made to the pig’s genes to make it slightly compatible with humans. Pigs have some genes that code for carbohydrates, making their genes and tissues highly antigenic.

“That is, if you just take any pig and you transplant the tissue, our body will reject it almost immediately because of antigens that are on the surfaces of the pigs. So, they’ve modified by substituting some elements of human genes into them. And then, also, there is this aspect of some viruses that pigs carry, and they also altered that.

“And a couple of other alterations, you know, were done. So, it’s not just a pig as it were, but it’s a genetically modified pig. Not only that, the pigs for that purpose, whether it’s a heart transplant or whatever transplant, must be raised in a germ-free environment. We don’t want the infections that occur in pigs to be transferred to humans. We call them zoonotic infections. So, right from birth, those pigs will be reared in germ-free environments until their organs are about the same size as we have in human beings.”

According to Awobusuyi, Nigeria has made some progress in addressing organ donation needs, but still faces significant challenges. Currently, the only available organs for transplantation in Nigeria come from living donors.

He highlighted that kidney, bone marrow, and cornea transplants have been successfully performed in the country, with kidney and bone marrow transplants relying on living donors, while cornea transplants have been done using imported corneas from deceased donors abroad.

This reliance on imports puts Nigeria at a disadvantage, emphasizing the need for a more sustainable and local solution.

The kidney transplants and the bone marrow are from living donors and that’s usually how it is anywhere in the world. The cornea, of course, has to be from a deceased donor, from dead people and the cornea transplants that have been used and done so far, are imported, so that puts us at a disadvantage,” the Nephrologist added.

He further mentioned that TAN was considering the possibility of developing the deceased donor transplant programme in Nigeria.

Awobusuyi stated, “What we are trying to do as the Transplants Association of Nigeria is to see whether we can develop a deceased donor or transplant programme in Nigeria. The deceased donor is a dead patient, and that is what constitutes the majority of transplants done abroad.

“So, what that would do is to increase the number of available organs for transplantation. It’s not as easy as living donor transplantation, because it involves a lot of organisation, collaboration, structure, legislation and law enforcement being put in place so that we don’t end up with sharp practices, which has a lot of implications.

“So, we are trying to see if we can look at a few government hospitals, and maybe one or two private hospitals, that can collaborate in terms of discussing the possibility, organising their intensive care units, having their transplant team in place, looking at where we’ll do the cross-matching and the laboratories that we can use.

“The idea, or the main thing, is to establish a firm in Nigeria, in a technically-conditioned environment. We know that it will require a lot of government input and we are also talking to the ministry in terms of developing guidelines. About three months ago, we were having meetings with the Ministry of Health, and that went on for close to two months. We have some kind of reports providing guidelines on how to improve transplantation in the country.

“We are working hard to improve the availability of organs ethically. We hope that this will encourage other transplants to take place in the country.”

The don also clarified that organ donation from seriously ill patients or those in the Intensive Care Unit was only after the patients had been clinically certified brain dead before any form of organ removal may be done.

“We test for function of the brain and when the ventilator is removed, you just see that there’s no effort to breathe by that patient. So the brain is dead and technically, that patient is dead,” he explained.

The NAN-TAN president expressed optimism that the potential growth of organ transplantation in Nigeria could lead to life-saving treatments for numerous individuals struggling with organ failure, particularly for vital organs like the heart, lungs, and liver, which are crucial for survival.