ASJ Anniversary

18 THE GLEANER | SUNDAY, MARCH 3, 2019 T HE SURGICAL technique em- ployed in kidney transplanta- tion is an example of this. In 1913, a German doctor-researcher, Dr Carel, remembered surgically for his development of the Carel suture, after many long-term fail- ures at transplanting kidneys in animals, documented the surgical technique, which has remained basically unchanged until this day. He recognised that failure was due not to the surgery, but to some other factor now recognised as the immune response. Thus, the success of modern kidney transplanta- tion is not a surgical triumph, but rather, due to the many research- ers who recognised the immune response and developed various Immunosuppressive agents to help control this. The first successful kidney trans- plant for management of end-stage renal disease (ESRD) was performed in the mid-1950s by Murray et al in Boston. No immunosuppression was required in that instance as the donor and recipient were identical twins. However, with the develop- ment of basic immunosuppression, other surgical teams began trans- planting, with the Ottawa team starting in 1966. On to that scene came a young British-trained sur- geon from Jamaica, who took a keen interest in the proceedings, taking the expertise and knowledge with him when he returned home to Jamaica in December 1969. Kidney transplantation goes hand in glove with haemodialysis, which, in those days, not only confirmed that the patient had ESRD, but allowed time for a matching kidney to be found. Enter Dr Samuel Street, a Jamaica scholar and brilliant surgeon, who, as the senior med- ical officer (SMO) of the Kingston Public Hospital (KPH), decided that technological advances should not leave the island behind and in 1966 purchased a dialysis machine for the hospital! Thus it was in January, 1970, the young surgeon from Ottawa, now consultant urologist to the Government, based at the KPH, wandering through the instrument storeroom at the hospital, came across this almost new Kolf dialysis machine. It was the identical model on which he had done his training at the Civic Hospital in Ottawa. In March of 1970, DC, aged 13- years was admitted with ESRD, and after consultation with her parents, it was decided to dialyse her. A Brachio-Cephalic arterio-venous fistula was done to provide vascu- lar access, and a month later, when it had matured, haemodialysis was started. This was done twice weekly. At first, there was quite an audi- ence to observe the new, strange treatment but soon things became mundane, and we were left on our own. After the first two or three sessions, nursing help became available. DC did well on her dialysis, and in September, a motor vehicle acci- dent left a young man seriously in- jured with no brain function. He was not only a perfect ABO blood-group match, but fitted all the criteria for organ donation. Preparations for transplantation were set in motion. The operation went off without a hitch. First, the donor was taken off the ventilator, and after the heart had stopped beating, the left kid- ney was removed, sparing the blood supply to the upper ureter. The kidney was flushed with cold normal saline until the effluent was clear then taken across to the room, where the recipient had been pre- pared by the team led by Dr Henry Shaw, and transplanted. Urine was produced almost im- mediately, which is the most joyous sight for any transplant surgeon. In the surgeons’ room, Dr Ali, Dr McHardy’s Nigerian resident, de- clared it a significant occasion and that he was honoured to have been in on the first kidney transplant in the Caribbean and possibly the ‘Third World’ (the accuracy of that has never been verified). Our longest-surviving transplant is MP, a retired nursing supervisor in Baltimore whose original transplant was done in 1971. This eventually failed about eight years ago and she had a second cadaver kidney placed by another Jamaican sur- geon working in Maryland. She continues to do well. The following were members of our transplant teams over the years without whose expertise and skills this programme would not have succeeded. Henry Uriah Shaw (my original surgical men- tor), John McHardy, Micky Roper, Dr Ali (neurosurgical resident from Nigeria), Lawson Douglas (original transplant team), Guiermo Fraser, Peter Fletcher, ‘Bangie’ Samuels, Cecil Aird, Trevor McCartney, Patrick Bhoorasingh, Hope Russell, Robert Wan, and Mark Cadogan. Apologies to any significant player whose name I have erroneously omitted. Professor Lawson Douglas Consultant Urologist Former Head of Department of Urology at the Kingston Public Hospital and University Hospital of TheWest Indies. Professor, the Hon. L. Lawson Douglas was recently named a living legend in urology by the Canadian Journal of Urology. The Genesis of Haemodialysis and Renal Transplantation ASSOCIATION OF SURGEONS IN JAMAICA 60TH ANNIV SARY FE TURE: T E SUNDAY GLEANER MAGAZINE | MARCH 3, 2019 Association of Surgeons in Jamaica OPENING HOURS Mondays to Thursdays 9:00am to 5:00pm Fridays 9:00am to 4:00pm Saturdays 10:00am - 2:00pm 72B Hope Road, Kingston 6 Tel: 618-3674, 618-3680, and 978-4242 Fax: 978-4272 Email: kingstonurology@gmail.com