who has served as the surgical director of UCLA Health’s kidney transplant program for nearly three decades, spent most of February at The University Teaching Hospitals in Lusaka, Zambia.
This was Dr. Gritsch’s first medical mission to the southern African country, a developing nation and a young democracy, which is trying to build its health programs and improve the public’s access to quality health care. His visit had a specific purpose – to teach and train local surgeons to autonomously perform kidney transplant surgeries. It was made possible by a collaboration between the at the David Geffen School of Medicine at UCLA and the American College of Surgeons’ Health Outreach Program for Equity (HOPE).
Training is the way to self-sufficiency
During his three-week visit, Dr. Gritsch performed two kidney transplants, includ
ing the first-ever pediatric kidney transplant in that country. The other surgery involved brothers from the neighboring country of Botswana, which does not have such a surgical program.
“My goal was not to go there and do the surgeries for them, but to teach the surgeons there to do it independently,” he said. “They were ready to learn and did a good portion of the operations.”
However, like many developing nations, Zambia has its challenges, Dr. Gritsch said. The hospital system lacks well-equipped laboratories, which means their lab tests must be sent to other countries such as South Africa or India. Also, the kidney donor operations are open surgeries as opposed to the less-invasive laparoscopic or robotic procedures, which are the norm in the U.S.
“The donor operations are more challenging because there is very little room for error,” he said.
So far, only 18 kidney transplants have been performed in Zambia, with the first 14 having been done by surgeons from India. Some patients also traveled to India to have the surgeries done.
New surgical techniques
For the transplant surgery involving the brothers from Botswana, Dr. Gritsch said, his counterparts in Zambia were reluctant to do the donor surgery laparoscopically. So, being a surgeon in the United States who is experienced with the open procedure, Dr. Gritsch assisted the Lusaka team.
“It’s interesting that the skills needed for doing an open donor surgery have been lost in the U.S. because laparoscopic procedures are the norm, and for good reason, because they are better and safer,” he said.
For the second patient, the first child kidney transplant patient in Zambia, Dr. Gritsch helped perform the first laparoscopic donor surgery ever done in that country on the child’s father, using borrowed instruments and equipment from another hospital.
“They were happy to see it could be done,” he said. “My goal was to help them get to the point where they would be comfortable doing it on their own.”
Dr. Gritsch hopes to make another trip there in the next year or so to continue training the surgeons, which he believes is a critical step for Zambia to progress in this field. He said with dwindling funds, the way of the future is for countries such as Zambia to become self-sufficient and gain the ability to handle their health care needs independently, without relying on outside assistance.
Transplants result in better health outcomes
Helping the 14-year-old boy get a kidney transplant was the most satisfying part of the trip for Dr. Gritsch.
“I cannot imagine being 14 and on dialysis,” he said, adding that the boy had a disease called Alport syndrome that causes hearing impairment. “I was grateful to be able to help a father help his son have a better life. I feel grateful to do the same for patients here at UCLA as well. We have children and adults who are able to have a better life as a result of kidney transplant surgeries.”
Organ transplantation is also the superior solution from a financial perspective, Dr. Gritsch said.
“The expense of the actual operation and the medications is not prohibitive if we can do it in an economical way,” he said. “It’s a much better solution for those with renal failure than being on dialysis. We wanted to present the argument to the government and media in Zambia that this form of treatment should be promoted because, in the long run, it is cheaper than putting people on dialysis. They can lead healthier lives.”
Passing sound legislation also helps make transplant programs safe and equitable, Dr. Gritsch said. For example, the passage of the National Organ Transplant Act (NOTA) in 1984 established a framework for the U.S. organ transplant system outlawing the sale of human organs and creating the Organ Procurement and Transplantation Network (OPTN) to manage organ allocation and ensure fair access to transplantation. Also, kidney transplants benefited more people in the U.S. after the federal government granted medical coverage to those with end-stage renal disease, he said.
“Without the law and funding, we would have even more disparities in access to dialysis and renal transplants.”
UCLA Health’s significant role
UCLA Health also has a robust fellowship program to help train young surgeons, Dr. Gritsch said, adding that he has helped train many who are now running transplant programs across the country.
“It takes a lot to run a transplant center – operations, doctors managing medications, infectious diseases experts, imaging including radiation and ultrasound,” he said. “I believe that such highly complex procedures should be done in regional centers and not small community hospitals. But, we should absolutely reach out to them to make sure they have access to these programs.”
Dr. Gritsch said he would like to see the relationship between UCLA Health and the American College of Surgeons grow and thrive so other surgeons could help impart their skills and help train more doctors. He said, especially in surgery, learning in person is extremely valuable – even irreplaceable.
The Global Health Program at UCLA also helps create long-term collaborations where students, trainees, faculty and staff work alongside colleagues around the world on multidisciplinary education programs, clinical training, patient care and public health initiatives.
Such collaborations are crucial when it comes to sharing knowledge and skills related to transplant surgery, which cannot be replicated by textbooks or how-to manuals, Dr. Gritsch said.
“There’s a lot that’s not in the chapters of a book or presented in any website. It’s a lot more complicated than that.”
