Saudi Journal of Kidney Diseases and Transplantation

LETTER TO EDITOR
Year
: 2006  |  Volume : 17  |  Issue : 3  |  Page : 399--400

Kidney Transplantation in Iraq


Usama Nihad Rifat 
 Kidney Transplant Unit, Adnan Khayralla Hospital, University of Baghdad, Baghdad, Iraq

Correspondence Address:
Usama Nihad Rifat
Kidney Transplant Unit, Adnan Khayralla Hospital, University of Baghdad, Baghdad
Iraq




How to cite this article:
Rifat UN. Kidney Transplantation in Iraq.Saudi J Kidney Dis Transpl 2006;17:399-400


How to cite this URL:
Rifat UN. Kidney Transplantation in Iraq. Saudi J Kidney Dis Transpl [serial online] 2006 [cited 2022 Jul 3 ];17:399-400
Available from: https://www.sjkdt.org/text.asp?2006/17/3/399/35775


Full Text

Kidney transplantation began in Iraq in the 1970's. A few cases were performed in private hospitals. It was in 1985 when I started kidney transplantation in the Ministry of Health. Our hospital is the main teaching hospital of the University of Baghdad. Long before that, the first dialysis unit was started after I had completed a one-year post residential fellow­ship in the New York University Medical Center and Bellevue Hospital.

I worked under Dr. Salah Al-Askari and Dr. Felix Rappaport. Returning home I started performing arteriovenous fistulae [1] and shunts. The patients were maintained on hemodialysis using the old simple Travenol machine. In the early 1980's, I introduced CAPD catheters with the help of Dr. Oreapoulus from Canada. [2]

The first transplants were performed using living related donors exclusively. Immuno­suppression was maintained with azathioprine and steroids only, because cyclosporine was not available. Later cyclosporine was intro­duced to practice.

Legislation which permitted organ donation from living and deceased donors was approved in 1985. Brain death was clearly defined; nevertheless, this concept did not gain popularity because of cultural disapproval.

Due to the shortage of kidneys and the presence of familial renal diseases, limited and monitored unrelated donation was introduced in 1996. Unrelated donors must satisfy certain requirements. A committee meets weekly to interview potential unrelated donors. It is an adhoc committee with a jury-like style. Members are usually physicians, senior technicians and laypersons including relatives of previous patients. Points considered in evaluating reci­pients of living unrelated transplants include previous transplants, previous related donations, availability of potential related donors, job of the recipient, relationship of the donor to the recipient, social class of the donor, monthly income of the donor, availability of care to the donor after the donation, willingness of the donor to be compensated, the opinion of the donor's spouse, information available to family members of the recipient, the opinion of the donor's closest relative. The verdict is passed usually within a week. We believe that this procedure preserves the dignity of the patient, the doctor and of the institute.

There are many hardships in the post-war era due to sanctions. [3] Immunosuppressive drugs and other operative equipments were scarce. For example, Ringer's solution was used instead of Collin's or University of Wisconsin solutions. Simple disinfectants like Glutaraldehyde may not be available for months. The one-year graft survival rates for transplants performed at Adrian Khayralla Hospital averaged 74%. Five-year results aredifficult to provide because of the problems in following up patients in the post-war era. I am afraid that I cannot contribute the correct number of transplants done throughout. There is another Ministry of Health transplant center in Baghdad but presently the whole hospital is under constructive maintenance and will start functioning soon.

The other crippling fact is the involvement of some private hospitals with commercial renal transplantation. [4] This has been signi­ficantly curtailed after the reinforcement of the legislation that prohibits these practices.

Finally, we are trying hard to ameliorate our graft survival figures and hope to do so with improving conditions and the easing of sanctions.

References

1Rifat UN, Al Ani MS, Salman AM, Al Naman YD. Operation and maintenance of arterio-venous fistula for chronic hemo­dialysis. Zeniralbl Chir 1977;102:476-9.
2Rifat UN, Oerry F. Experience with peritoneal catheters in Iraq. Perit Dial Int 1993;13:73.
3Rifat UN. Kidney transplantation and tissue typing in Arabic speaking countries of the Middle East. (Letter), Brit Med J Middle East 1995; 2:16.
4Frishberg Y, Feinstein S, Drukker A. Living unrelated (Commercial) renal transplant­ation in children. J Am Soc Nephrol 1998; 9:1100-3.