Year : 1994 | Volume
: 5 | Issue : 2 | Page : 190--192
An Overview of Renal Replacement Therapy in Algeria
Service de Nephrologie, Universitaire de Beni Messous (Alger), Beni Messous, Algeria
Service de Nephrologie, Universitaire de Beni Messous (Alger), Beni Messous
|How to cite this article:|
Salah H. An Overview of Renal Replacement Therapy in Algeria.Saudi J Kidney Dis Transpl 1994;5:190-192
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Salah H. An Overview of Renal Replacement Therapy in Algeria. Saudi J Kidney Dis Transpl [serial online] 1994 [cited 2020 Aug 7 ];5:190-192
Available from: http://www.sjkdt.org/text.asp?1994/5/2/190/41348
Algeria is a country with one of the highest population growth rates in the world. The population increased from 9.5 million in 1962, to 27 million in 1987. About 75% of the population are aged less than 30 years and 50% are below 15 years of age.
The incidence of chronic renal failure in Algeria has been estimated as 34 per million population per year. This amounts to nearly 1000 new patients each year. The mean age of these patients is 40 years (Salah H et al, Resultats preliminaries d'une enquete sur l'insuffisance renale chronique dans le Secteur Sanitaire Universitaire de Cheraga (Alger), Premiere Journee Algerienne De Nephrologie Alger Le, Octobre 06, 1984).
The Algerian government has invested a large sum of money in health care development. There are 31 university hospitals, dozens of departmental hospitals, subprefectoral hospitals, polyclinics and health centres in the country. However, a large number of patients with end-stage renal disease (ESRD) still cannot be offered dialysis treatment mainly due of the economic restraint.
Renal Replacement Therapy (RRT) in Algeria was first initiated in 1963, when dialysis treatment became available for treatment of acute renal failure. Dialysis for ESRD patients began in the beginning of the seventies. However, only very few patients could be treated. An expanded dialysis program to take care of a larger number of ESRD patients was started in 1977. Since then it has shown considerable development. Till now, around 1700 patients have been started on treatment by regular hemodialysis in 32 centres. Besides in-centre hemodialysis, 15 patients have also been started on home dialysis.
Peritoneal dialysis (PD) program was started in 1978. Initially only intermittent peritoneal dialysis (IPD) was available. Continuous ambulatory peritoneal dialysis (CAPD) was started in 1979 and till now 200 patients have been put on treatment with this modality of RRT. CAPD is available in eight dialysis centers in Algeria.
Till date, a total of 40 renal transplants have been performed in Algeria. All were performed using kidneys from living related donors. In addition, 250 patients have undergone cadveric donor transplantation abroad, mainly in France and Belgium. These were made available through a program of medical cooperation between these countries and Algeria.
Religious Aspects of Transplantation
Algeria is an Islamic country and the religious aspects had to be clarified whether there were any objections to transplantation program from the Islamic point of view. For this, several scientific and religious conferences were organized with religious leaders from Algeria as well as other Islamic countries. The religious leaders from Algeria were in favour of kidney donation and the issue was clarified in 1985.
Ethics and Legal Aspects
Ethics is not different from religious morality and is based on the idea "give a chance for a man who is about to die". This gives kidney donation a moral value substantially higher than that for a technical procedure. In Algeria, the ethics of transplantation require free donation of the organs. It is forbidden to sell or buy organs. Removal of kidneys for transplantation has been made legal in Algeria by Law Number 85-05, dated 16th February 1985, and modified in 1990. The main principles of this law are;
The organs should be donated without any payment involved, in cash or kind. Assent of the recipient should be obtained.For ex-vivo renal removal, assent of the donor and the pertinence of the act are necessary.The ex-mortuo kidney removal is allowed after proper certification of death by a doctor.Any person is considered as a potential organ donor if he/she has not declared his/her objection when alive. Organ donation from an underaged person is prohibited.The law requires that the transplantation must be carried out in a public hospital where proper and modern facilities are available.
Despite these developments one wonders why the transplantation program has not progressed well in Algeria and only 40 transplantations have been performed within the country from 1986 to 1993. The same question also arises about the dialysis program which once was more advanced in comparison with other countries with a similar economical level and comparable life style.
We will try to give some clarifications in this regard, especially about the following three issues namely, socio-cultural aspects of our population, structure and organization of our health care system and the current status and future prospects.
We have previously studied the social and psychological aspects of renal transplantation in Algeria, by a questionnaire designed for two groups of people (Salah H et al, Renal Transplantation: Social and Psychological Aspects, First MESOT Congress, Ankara, 1990). The first group consisted of relatives of dialysis patients waiting to be transplanted. 120 persons were selected as potential donors among 1380 relatives of our dialysis patients. Only six persons (5%) were looking forward to donate a kidney, and among them, five were females.
In the second group, none of the persons questioned had any relatives with ESRD. About 50% of the questioned were in favor of kidney donation to a relative if the need arose and about 60% were ready to accept a kidney either from a living related donor or from a cadaver. The responses were not influenced by the individual's sex, the number of siblings, the profession and the religious practice. But the population living in urban areas, having a higher level of education and a lesser number of children seemed to favour kidney donation more than those living in rural areas having a lower level of education and a larger number of children.
Thus, the opinion of the general population was in sharp contrast to the opinion of the potential donors. This study illustrates the complexity of the emotional factors related to organ donation from living related persons, especially in males. Thus, in addition to technical and logistic problems, one can expect to encounter socio-cultural and psychological difficulties.
Structure and Organization of Health System
There are several inadequacies in the efforts of our government in running the health care system. The health administration had made the transfer of patients abroad easier through a medical collaboration paid for by the Algerian government, instead of improving the facilities in the hospital and the working conditions of medical staff (physicians, nurses and technicians). Obviously, the patients prefer to be treated abroad in better conditions in a developed country, and that too at the government's expenses. The matter of kidney donation in Algeria was therefore pushed to a position of secondary importance by patients and their families.
Other inadequacies of our health system are also to be taken notice of. Firstly, the allocated budget for the treatment of ESRD patients is not adequate and is often not managed properly by the authorities. Several problems in the organization and coordination are often encountered. Secondly, a real cadaveric renal transplantation program has never existed in our country in spite of the available means, both manpower and materials as well as the passing of congenial government laws. Lastly, the proposed collaboration with the hospitals in France and Belgium also has not been efficiently and fully exploited.
Current Status and Future Prospects
The Algerian budget for health has been significantly reduced due to the current economic crisis. The number of the patients, being transferred abroad has also been reduced. Also, the number of hemodialysis centers has not increased since 1986. The existing 32 hemodialysis centres cannot afford to take any more patients while the CAPD program is also saturated, leading the patients and their families to a deadlock.
In this new context, and an increasing number of relatives, conscious of the unavailability of dialysis, is coming forward for kidney donation to their relatives. Unfortunately, the current economic crisis has also hit the public hospitals where the transplantation surgery is officially permitted to be carried out.
We feel that the patients and their families are now ready for a transplantation program but the public hospitals at present do not have the means. We think that a transplantation program can succeed in Algeria if the following are carried out:
i) The government must release the load of the dialysis patients to semi-private and private clinics and hospitals.
ii) The government must promise to help the public hospitals ethically and financially for the transplant program and must provide better conditions for the patients and medical staff.
iii) The government must initiate an educational campaign about organ donation and renal transplantation to increase the awareness among the public about their responsibility in making such a program successful.