Gov’t probe uncovers gaps in kidney transplants at Mediheal Hospital

A government-led investigation into Mediheal Hospital and Fertility Centre in Eldoret has unearthed serious gaps in the facility’s kidney transplant program, raising fresh concerns about possible organ trafficking involving foreign nationals.

This comes after a detailed fact-finding mission by a multidisciplinary team appointed by the Ministry of Health, following an alert from the global Transplantation Society.

The Society’s letter, dated July 20, 2023, flagged a suspicious spike in kidney transplants involving Israeli nationals in Kenya, suggesting the existence of an international syndicate bypassing local health regulations.

The team - composed of transplant specialists, ethicists, officials from the Kenya Medical Practitioners and Dentists Council (KMPDC), the Kenya Blood Transfusion and Transplant Services (KBTTS), and health ministry representatives - carried out an on-site audit from December 5 to 8, 2023.

Their mandate - according to Health Cabinet Secretary Aden Duale - was to verify the claims, assess Mediheal’s transplant practices, and provide concrete recommendations.

The team established that the hospital, a licensed level 5 private facility, had performed 372 kidney transplants over five years, mostly for patients from Kenya and the East African region, with some from countries as far as Israel, Australia, Japan, the USA, and the UK.

CS Duale noted that, while Mediheal had embraced modern techniques - conducting 99% of its surgeries laparoscopically and maintaining consent records for all sampled donors - investigators found a string of concerning issues.

One such issue was weak donor-recipient verification, whereby the hospital could not provide adequate documentation to prove biological or relational ties between donors and recipients, especially in cross-national pairings.

“All the Human Leukocyte Antigen (HLA) tests that enables distinction of ‘self’ |and ‘non self’ were done in India without the requisite approval of MOH for shipment of human samples outside the country,” stated CS Duale in a statement to newsrooms on Tuesday.

The team also found that language barriers were ignored as several donors and recipients who could not understand English were presented with untranslated documents, thereby undermining informed consent.

“There were high risk transplantations including for a patient with confirmed prostate cancer and extremes of age. Transplants were conducted despite poor donor-recipient compatibility,” added Duale.

“The facility lacked clinical morbidity and mortality reports. The hospital did not have multidisciplinary team (MDT) committee meetings.”

The investigation stopped short of confirming direct involvement in organ trafficking but found the allegations credible enough to warrant further scrutiny by law enforcement and relevant agencies.

The investigative team has called for a sweeping overhaul of Kenya’s transplant governance, including the development and rollout of national standards and clinical guidelines for transplant services.

“The Ministry of Health to develop a legislative and regulatory framework to safeguard against organ trafficking and transplant tourism. National Standards and Regulatory Frameworks in transplant services will seal legal loopholes that can be exploited to allow for clandestine unregulated transplants,” noted the Health CS.

“All donor and recipient evaluations to be presented to a multi-disciplinary committee. MDTs needs to be operationalized/ made functional and the hospital management to reconstitute the ethics committee to include interpreters who can clearly communicate with the recipients and donors, a patient advocate and experts not directly involved in the transplantation.”

Duale added: “The audit realized that there was need to strengthen the donor recruitment process and consenting by involving and documenting family member conferences. This will involve documenting a list of family/people talked to and anyone who participates in the transplant process for accountability and transparency. The due diligence and duty of care must be upheld by all health care providers as they administer their services.”

The team further recommended the establishment of a centralized registry for all transplant recipients and donors, especially foreign nationals, complete with verified documentation of their relationships.

They also want a strengthened donor consent process, with documented family involvement to ensure transparency and accountability.

In response, CS Duale said the Ministry of Health has already developed transplant service guidelines and a draft policy on the use of blood, cells, tissues, organs, and other human substances.

He said the ministry also plans to conduct a follow-up audit at Mediheal Hospital to evaluate compliance, and launch nationwide audits of all seven transplant facilities in Kenya to ensure uniform standards.