ResearchGate, an international academic research organisation, has recognized the work of former Health and Child Care Minister Dr Obadiah Moyo on kidney transplantation versus dialysis in Zimbabwe.
In Zimbabwe, the population of patients with chronic kidney disease is rising, putting a strain on the nation’s few dialysis treatment centres, whether Government or private.
Government covers the whole expense of dialysis in its facilities, increasing the financial burden.
Patients from both public and private dialysis units opting for kidney transplant are referred abroad at high foreign currency costs.
Moyo’s study focused on reviewing the economic advantage of kidney transplant in relation to renal dialysis as a means of establishing a kidney transplant programme in Zimbabwe.
Economic advantage studies for kidney transplants versus renal dialysis were obtained using various digital resources.
In studies where cost-effectiveness between a kidney transplant and dialysis was compared, it was shown that a kidney transplant is a cheaper solution with a higher quality of life compared to dialysis.
It was also shown in most of the studies that among the dialysis modalities, haemodialysis was more expensive than peritoneal dialysis.
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In one of the studies, the cost values were US$37 395 for haemodialysis, US$27 007 for peritoneal dialysis, and US$11 426 for a kidney transplant.
The transplant had the best quality of life, while hemodialysis had the worst.
As far as cost-effectiveness and raising the health status, wellness level, good living, and survival, kidney transplantation is rated highly and a better modality than dialysis.
While examining the obstacles to the launch of a kidney transplant program in Zimbabwe, Dr Moyo emphasised the necessity of the program. Due to factors like diabetes, hypertension, and population aging, the number of chronic kidney failure cases in Zimbabwe is increasing and currently stands at approximately 1 000 cases per million annually.
This results in a high requirement for dialysis therapy in public and commercial dialysis facilities across the nation.
In order to replace the only option of sending transplant patients abroad with their donor—typically a family member—the government has indicated political willingness to support the development of a living donor-related kidney transplant program.
But major investments will be required to set up the infrastructure of skills, testing, tissue typing and the like required before the actual transplants can be performed in Zimbabwe.
The cost-effective data of kidney transplant-related procedures has not been thoroughly studied in Zimbabwe.
A thorough analysis of all kidney transplant-related cost-utility analysis findings will assist the Government in identifying the most cost-effective approaches that have the most value for investment.
There will be need for personnel skills development and wages, consultations, medical and surgical costs, imaging, and diagnostic tests such as tissue typing, immunosuppressive, and essential medications.
The expenses of infrastructure building and restoration are equally significant.
In order to establish a kidney transplant program in Zimbabwe, Dr Moyo’s study sought to ascertain the financial benefits of kidney transplantation over dialysis.
When chronic kidney disease cases reach end-stage renal failure and become symptomatic, they will require to be placed on dialysis.
There are two main kinds of treatment applied when kidney failure sets in. These are kidney transplantation and dialysis.
However, due to limited donations, dialysis becomes relevant for those patients who cannot get kidneys for transplant.
In contrast to the high risk of infection associated with the vascular and peritoneal access required for dialysis treatment, there is conclusive evidence that individuals who have received a kidney transplant have higher survival rates and are less likely to require hospitalisation due to a lower risk of infection.
The chances of kidney transplant recipients having many problems that are usually associated with dialysis are minimised. For instance, dialysis patients are confined to strict dietary control and fluid intake and have the inconvenience of attending remote dialysis centres. An effective kidney transplant might be a blessing of freedom from dialysis equipment and reliance upon everyone else.
Furthermore, kidney transplant recipients have substantially fewer cardiovascular complications than patients on dialysis treatment. The usual fear with a kidney transplant is rejection. However, there is now minimal rejection with the invention of new immuno-suppressive regimens.
The current dialysis program in Zimbabwe consists of HD (95 percent) and PD (5 percent). Dialysis in public health institutions is provided for free while the private centres charge. Zimbabwe is a low-income country, and the rate of dialysis is 29 percent per million population. The activities of the renal programme in Zimbabwe can be divided into three categories.
First, treatment of patients with potentially reversible renal failure. Such acute kidney disease may affect patients with severe malaria, other severe infections after trauma or major surgery, after ingestion of traditional drugs or other toxic substances. These patients need short-term (1–6 weeks) support with dialysis, while a healing process occurs in the kidneys.
Second, treatment of patients with chronically progressive kidney disease leading to chronic, irreversible renal failure.
Such disease may be due to inflammatory or infectious disorders or inherited degenerative processes. High blood pressure, which is the cause of 33 percent of all instances of end-stage renal disease in Zimbabwe, has been linked to significant renal deaths.
Other causes include diabetes mellitus, herbal intoxication, glomerulonephritis, and schistosomiasis-related occlusion.
These patients need lifelong treatment with dialysis. The third category is the treatment of specific groups of patients with or without kidney disease where the equipment of dialysis may be used, for example, severe intoxications, which may be treated with hemoperfusion. While a transplant program was initiated in 1992, this has, however, not been active.
There is currently no exit for patients on dialysis except through receiving transplants abroad at high costs, which are met by families and, in some cases, with some support from the medical insurance companies.
The problem with foreign kidney transplants is the lack of proper follow-up of the recipients and donors on return from the countries where the operation would have been done.
Government’s current policy is to meet the full costs for dialysis and provide the foreign currency through the Reserve Bank of Zimbabwe for all patients, who travel to receive kidney transplantation abroad.
This foreign transplant element, which entails hospitalisation abroad for the donor and recipient and hotel fees for an additional relative, is consuming excessive funds that could create an effective kidney transplant programme if used locally.
It also just benefits a few well-to-do patients and neglects the socially disadvantaged majority.
With the outcome of this review demonstrating that kidney transplants are a less costly procedure than dialysis and all the benefits that come with it, the necessity to reintroduce kidney transplantation in Zimbabwe becomes critical. However, some key issues would need to be put in place to remove the barriers. There is a shortage of skilled workforce to provide the necessary care to the end-stage renal disease patients and the lack of training programmes in kidney transplantation surgery and postoperative care for doctors, nurses, pharmacists, and scientists.
To align with the planned modernised transplant program and provide a safe backup plan for patients who will need to be referred to dialysis in the unlikely event of graft rejection, the current dialysis program itself will require additional upgrading.
There is a need for community education aimed at awareness and acceptance of kidney transplants and donation of organs. Preventative measures against chronic kidney disease need to be stepped up with the commencement of an intensive preventative and early treatment and education programme for the presently known causes of renal failure: hypertension, diabetes mellitus, schistosomiasis, and herbal toxicity.
A renal registry would need to be set up to capture epidemiological data regarding the incidences and severity of these causes and transplant data. There is, therefore, a need to strengthen the management and coordination of the programme.
A partnership with a foreign institution of higher learning and a hospital that is already involved in kidney transplantation would need to be established to kick-start the programme. Similar partnerships have been successfully set up in other areas of health.
The first kidney transplantation operation was carried out in 1992, and another updated unit with the relevant infrastructure is available for use. The government’s thrust is to see an improved health delivery system in Zimbabwe.
However, it is widely accepted that a significant impediment to this drive is the lack of adequate funding. However, it is to see how a lack of appropriate finance has moulded the health-care public–private partnership debate. The public–private partnership model is in keeping with national and global developments, and it will help the country strengthen its medical facilities and service delivery.
The collaborative regulatory framework is now at the heart of the leadership’s desire to achieve because it will be consistent with the state’s concept of implementing good medical services.
The collaboration will establish a strong, profitable scenario where both players are guaranteed to equally benefit, thus greatly improving patient care, and upgrading the centre’s capability into a global player in kidney transplantation.
On the one hand, the government guarantees to provide an enabling environment for the private partner to get a return on its investments through revenue collected from the activities. The Government’s key objective is that socially disadvantaged patients will receive treatment without any prejudice and that legal compliance of the partnership process is adhered to.
Moyo has won several international awards in recognition of his contribution to the international society in nephrology, and he has helped shape public policy in the care of patients with end-stage renal disease and he set up a state-of-the-art kidney transplantation unit at Chitungwiza Central Hospital in 2015. He also holds a Post Graduate Diploma in Kidney Transplantation Science and a Masters degree in Organ (Kidney) Transplantation from the University of Liverpool UK, which he passed with a distinction. Dr Moyo qualified with another Post Graduate Diploma leading to a Master’s degree in Renal Medicine from the University of South Wales UK. He completed a Master’s degree in Chemical Pathology from the University of Zimbabwe, he is a Fellow of the Royal College of Pathologists (UK) and a holder of a Doctor of Medicine Degree from the College of Medicine and Health Sciences, St Lucia, West Indies.
ResearchGate, an international academic research organisation, has recognized the work of former Health and Child Care Minister Dr Obadiah Moyo on kidney transplantation versus dialysis in Zimbabwe.
In Zimbabwe, the population of patients with chronic kidney disease is rising, putting a strain on the nation’s few dialysis treatment centres, whether Government or private.
Government covers the whole expense of dialysis in its facilities, increasing the financial burden.
Patients from both public and private dialysis units opting for kidney transplant are referred abroad at high foreign currency costs.
Moyo’s study focused on reviewing the economic advantage of kidney transplant in relation to renal dialysis as a means of establishing a kidney transplant programme in Zimbabwe.
Economic advantage studies for kidney transplants versus renal dialysis were obtained using various digital resources.
In studies where cost-effectiveness between a kidney transplant and dialysis was compared, it was shown that a kidney transplant is a cheaper solution with a higher quality of life compared to dialysis.
It was also shown in most of the studies that among the dialysis modalities, haemodialysis was more expensive than peritoneal dialysis.
In one of the studies, the cost values were US$37 395 for haemodialysis, US$27 007 for peritoneal dialysis, and US$11 426 for a kidney transplant.
The transplant had the best quality of life, while hemodialysis had the worst.
As far as cost-effectiveness and raising the health status, wellness level, good living, and survival, kidney transplantation is rated highly and a better modality than dialysis.
While examining the obstacles to the launch of a kidney transplant program in Zimbabwe, Dr Moyo emphasised the necessity of the program. Due to factors like diabetes, hypertension, and population aging, the number of chronic kidney failure cases in Zimbabwe is increasing and currently stands at approximately 1 000 cases per million annually.
This results in a high requirement for dialysis therapy in public and commercial dialysis facilities across the nation.
In order to replace the only option of sending transplant patients abroad with their donor—typically a family member—the government has indicated political willingness to support the development of a living donor-related kidney transplant program.
But major investments will be required to set up the infrastructure of skills, testing, tissue typing and the like required before the actual transplants can be performed in Zimbabwe.
The cost-effective data of kidney transplant-related procedures has not been thoroughly studied in Zimbabwe.
A thorough analysis of all kidney transplant-related cost-utility analysis findings will assist the Government in identifying the most cost-effective approaches that have the most value for investment.
There will be need for personnel skills development and wages, consultations, medical and surgical costs, imaging, and diagnostic tests such as tissue typing, immunosuppressive, and essential medications.
The expenses of infrastructure building and restoration are equally significant.
In order to establish a kidney transplant program in Zimbabwe, Dr Moyo’s study sought to ascertain the financial benefits of kidney transplantation over dialysis.
When chronic kidney disease cases reach end-stage renal failure and become symptomatic, they will require to be placed on dialysis.
There are two main kinds of treatment applied when kidney failure sets in. These are kidney transplantation and dialysis.
However, due to limited donations, dialysis becomes relevant for those patients who cannot get kidneys for transplant.
In contrast to the high risk of infection associated with the vascular and peritoneal access required for dialysis treatment, there is conclusive evidence that individuals who have received a kidney transplant have higher survival rates and are less likely to require hospitalisation due to a lower risk of infection.
The chances of kidney transplant recipients having many problems that are usually associated with dialysis are minimised. For instance, dialysis patients are confined to strict dietary control and fluid intake and have the inconvenience of attending remote dialysis centres. An effective kidney transplant might be a blessing of freedom from dialysis equipment and reliance upon everyone else.
Furthermore, kidney transplant recipients have substantially fewer cardiovascular complications than patients on dialysis treatment. The usual fear with a kidney transplant is rejection. However, there is now minimal rejection with the invention of new immuno-suppressive regimens.
The current dialysis program in Zimbabwe consists of HD (95 percent) and PD (5 percent). Dialysis in public health institutions is provided for free while the private centres charge. Zimbabwe is a low-income country, and the rate of dialysis is 29 percent per million population. The activities of the renal programme in Zimbabwe can be divided into three categories.
First, treatment of patients with potentially reversible renal failure. Such acute kidney disease may affect patients with severe malaria, other severe infections after trauma or major surgery, after ingestion of traditional drugs or other toxic substances. These patients need short-term (1–6 weeks) support with dialysis, while a healing process occurs in the kidneys.
Second, treatment of patients with chronically progressive kidney disease leading to chronic, irreversible renal failure.
Such disease may be due to inflammatory or infectious disorders or inherited degenerative processes. High blood pressure, which is the cause of 33 percent of all instances of end-stage renal disease in Zimbabwe, has been linked to significant renal deaths.
Other causes include diabetes mellitus, herbal intoxication, glomerulonephritis, and schistosomiasis-related occlusion.
These patients need lifelong treatment with dialysis. The third category is the treatment of specific groups of patients with or without kidney disease where the equipment of dialysis may be used, for example, severe intoxications, which may be treated with hemoperfusion. While a transplant program was initiated in 1992, this has, however, not been active.
There is currently no exit for patients on dialysis except through receiving transplants abroad at high costs, which are met by families and, in some cases, with some support from the medical insurance companies.
The problem with foreign kidney transplants is the lack of proper follow-up of the recipients and donors on return from the countries where the operation would have been done.
Government’s current policy is to meet the full costs for dialysis and provide the foreign currency through the Reserve Bank of Zimbabwe for all patients, who travel to receive kidney transplantation abroad.
This foreign transplant element, which entails hospitalisation abroad for the donor and recipient and hotel fees for an additional relative, is consuming excessive funds that could create an effective kidney transplant programme if used locally.
It also just benefits a few well-to-do patients and neglects the socially disadvantaged majority.
With the outcome of this review demonstrating that kidney transplants are a less costly procedure than dialysis and all the benefits that come with it, the necessity to reintroduce kidney transplantation in Zimbabwe becomes critical. However, some key issues would need to be put in place to remove the barriers. There is a shortage of skilled workforce to provide the necessary care to the end-stage renal disease patients and the lack of training programmes in kidney transplantation surgery and postoperative care for doctors, nurses, pharmacists, and scientists.
To align with the planned modernised transplant program and provide a safe backup plan for patients who will need to be referred to dialysis in the unlikely event of graft rejection, the current dialysis program itself will require additional upgrading.
There is a need for community education aimed at awareness and acceptance of kidney transplants and donation of organs. Preventative measures against chronic kidney disease need to be stepped up with the commencement of an intensive preventative and early treat
