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By Goodluck Musinguzi

High-quality blood transfusion and the Uganda Human Organ Donation and Transplant Bill 2021 signed into law have opened up opportunities for transplant patients that require these services. “This service will also support the JCRC Bone Marrow Transplant program that it hopes to launch by October 2023”.

Dr Diana Atwine, Permanent Secretary confirmed her support for organisations like JCRC that have shown potential in enhancing the health sector through innovative research in Uganda and Africa. Diseases such as cancer, heart, lung, liver/pancreas, kidney, eye(cornea)sickle cell, HIV and other blood cancers will soon be treated at the Joint Clinical Research Centre (JCRC) through bone marrow transplants.

The new law is going to give hope to many people but also protect them from exploitation and fraud (organ trafficking). A bone marrow transplant is a procedure that infuses healthy blood-forming stem cells into your body to replace your damaged or diseased ones. The procedure is conducted by a specialised surgeon with a team that includes transplant physicians and haematologists.

Bone marrow transplant is already happening elsewhere in the greater East African region such as in Tanzania. The Joint Clinical Research Centre (JCRC) is expanding innovations and introducing cutting-edge technology, the RS3400 System for irradiating blood products before they are given to eligible patients. Patients access the transplant services at a fee of $30,000 (about sh112.7m).

Uganda still sends patients who require bone marrow transplants abroad, mainly to India, South Africa and the USA. “There is a patient who was referred to the United States of America for a Bone Marrow Transplant and has been advised to use Tanzania and Uganda as services are available”. In an effort to make the bone marrow transplant affordable and accessible, JCRC will start treatment services in October. The cost of a bone marrow transplant in India is estimated at $50,000 (about sh187.8m) depending on the health facility.

This excludes the air ticket, meals and accommodation charges for the carer for about three months. Dr Kityo said once the bone marrow transplant is started at JCRC, the costs of the procedure would be as low as $30,000 (about sh112.7m) or even less. She said preparations were in advanced stages to have the necessary facilities in place so as to offer the services close to home.

In addition, they were currently establishing the human leukocyte antigen screening for the right donors. The human leukocyte antigen typing is used to match patients and donors for bone marrow or cord blood transplants. Jjuko said the facility would start with an autograft (autologous) bone marrow transplant.

Autologous blood transfusion is the collection of blood from a single patient and transfusion back to the same patient when required. In addition, they are also doing laboratory tests to be able to determine if cells from a matching donor could be used. According to a 2014 study by the Ministry of Health, Makerere College of Health Sciences and Cincinnati Children’s Hospital, northern Uganda has the highest prevalence of sickle cell at 18.6%.

The eastern and central regions come second with a sickle cell prevalence of 16.7%. The mid-eastern and southwestern regions have a sickle cell trait prevalence of 16.5% and 4.1% respectively. In sub-Sahara Africa, about 240,000 children are born with sickle cell disease annually and between 50-80% of these die before their 5th birthday. The clinical infrastructure set up for bone marrow transplant will be used for gene therapy.

She is optimistic that gene therapy will start by 2024. Ugandans due for bone marrow transplants will soon not need to travel abroad to access the services. Plans are underway to enable them to access transplants in Kampala at the Uganda Cancer Institute. According to the Uganda Medical Board, more than 20 Ugandans annually travel abroad to countries such as India to seek bone marrow transplants.

Most of the patients who need the treatments have either leukaemia or sickle cell anaemia. Now, there might no longer be a need to travel anymore. UCI is currently training staff and is also in the process of constructing a transplant facility so that the country can carry out its first bone marrow transplant in 2024. Dr Nixon Niyonzima, the head of the research and training directorate at the Uganda Cancer Institute says they want to start with carrying out autologous transplants (self-donating).

According to Dr Niyonzima, the government has allocated 5 billion shillings this financial year to facilitate training of staff procurement of equipment needed to start the facility. At the moment, Ugandans seeking transplants abroad need between 150 million to 200 million Shillings for the procedure and accommodation for at least one month in India during recovery.

The bone marrow is a spongy soft tissue located in the bones that helps in the formation of red and white blood cells. It also helps in the formation of blood platelets that help with blood clotting. Bone marrow or stem cell transplants are a medical procedure where healthy blood-forming stem cells are infused into the body to replace damaged or diseased bone marrow.

The transplants are a life-changing treatment for persons suffering from a number of diseases like sickle cell anaemia, immune deficiency disorders and aplastic anaemia. The transplants are also used to treat some cancers like leukaemia and lymphomas. Uganda Cancer Institute Dr Niyonzima says at UCI, the transplants will be cheaper than what Ugandans currently spend to travel abroad.

However, emphasized that all people even the poor would be able to access this treatment once the facility is set up. In addition to carrying out transplants, he says the transplant centre will also provide aftercare services for Ugandans who have travelled abroad for transplants and need to be looked after by the trained staff. The Executive Director of the Ugandan Cancer Institute, Dr Jackson Orem said that the transplant facility is one of the things that will make UCI a centre of excellence in cancer care in the region.

“We are moving towards putting in place facilities that will make us the centre of excellence. We want to be able to offer world-class cancer care to patients within the East African community but also in Africa and the World at a pocket-friendly price. We want people to enter UCI and get all the cancer treatment they need,” Dr Orem said.

The lack of the law had hindered the start of kidney or even liver transplants at Mulago National Referral Hospital despite the hospital already having facilities, equipment and even trained staff.

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