Introduction

This paper relates to our transplant experiences in Third World countries. Over the years, I have started kidney transplant programs in Aden, Yemen and Abuja, Nigeria and restarted the transplant program in Khartoum, Sudan.

First 5 Kidney Transplants Performed in Aden, Yemen (2003)
I was invited by Professor Hussain Al Kaff to visit Aden, Yemen and attend the first International Yemeni Conference on Nephro-Urology (March 29 to 31, 2003). I accepted despite the war in Iraq. During my short stay, I was asked whether I would perform a living related kidney transplant.

All of the patients were between the ages of 20 and 40 years. I was very impressed by the quality of the preoperative assessments. I informed the director of the hospital that I would be ready to start the transplant procedure the next morning of my arrival and received his agreement.

At the last minute the next morning, I received a message saying that all of the surgeries were cancelled and that the Minister of Health would not allow any of the transplants to take place as this was not going to take place in the Capital Sanaa and that the hospital was not well equipped. This was a very big blow to all of us, not to mention very disappointing to the patients.

I met that same afternoon with the Governor of Aden and pleaded with him to support the transplants. I called the Minister of Health and the Prime Minister, who then agreed to allow us to do the transplants.

I reached the hospital at noon and started the surgery at 1 pm. All 12 patients were fasting as they were still hoping that we would do the surgery. The first donor nephrectomy was started at 1 pm and by 9 pm I had performed 3 donor nephrectomies and 3 kidney transplants. All procedures went well. The group was excited by the success, and we decided to perform the remainder of the transplants on Sunday. Indeed, at 8 am, we performed the fourth followed by the fifth. We were ready to perform the sixth; however, the donor of the sixth patient had a difficult intubation and we decided to abandon the transplant. I did not want to push my luck and decided to accept that performing 5 transplants in less than 24 hours was good enough.

A press conference took place on Monday, March 31, 2003, attended by all 5 donors who were operated on just 24 hours earlier. It was a triumph. I still cannot believe that we were able to perform 10 surgeries in less than 24 hours.

I was assisted by Professor Hussain Al Kaff and Dr. Abdulla Karama. Nephrologic support was offered by Dr. Abdulla Khader and Dr. Faisal Shaheen from Saudi Arabia.

First 8 Cases of Living Related Kidney Transplants in Abuja, Nigeria (2013)
In 2013, 8 living related renal transplant procedures were performed at Garki Hospital, a public private partnership facility in Abuja, Nigeria, over 5 days. The patients were 6 males and 2 females in both the recipient and donor groups, and all were adults. The mean ages were 43.2 years (range, 19-61 y) for the kidney recipients and 27.9 years (range, 23-50 y) for the donors. The average hospital stays were 17 days (range, 14-26 d) for the recipients and 5 days for the donors. All donor nephrectomies were done using the finger-assisted technique, which I had developed. Complications in the recipients were reported as hematoma collection in 2 patients and a kidney stone causing obstruction in another patient. The total number of transplants performed so far is 17. Recipients are reported to be well with functioning grafts.

Report of 6 Living Related Renal Transplants in Khartoum, Sudan in 72 Hours (2014)
The first living related renal transplant in Sudan was performed in Khartoum at its Teaching Hospital in 1974. Until 2014, the number of transplants dramatically receded. In April 2014, our group performed 6 living related renal transplants at the Ibn Sina Renal Centre for Renal Disease and Transplantation Unit.

Six living related donor-recipient groups were selected. Two procedures were performed daily over 3 consecutive days. The patients had been investigated preoperatively and had been reviewed by a multidisciplinary team at the Renal Centre.

Conclusions

Successful renal transplant improves the well-being of patients with end-stage renal disease. In developing countries with inadequate facilities for dialysis, transplant appears to offer a better option for those afflicted with this disease. We actively encourage centers to start kidney transplant procedures in Third World countries to avoid having patients seek transplant services outside their country at exorbitant costs with equal if not less favorable results.