Dr. Niroshan Seneviratne, Consultant Urologist and Transplant Surgeon at Sri Jayewardenepura General Hospital recently delivered the prestigious SAARC oration at the College of Surgeons. He has been at the forefront of advancing kidney transplantation in the country.

Dr. Seneviratne’s pioneering work includes introducing laparoscopic donor nephrectomy and robotic-assisted surgeries to Sri Lanka. As a co-founder of the Organ Donation and Transplant Foundation, he has been instrumental in raising awareness about organ donation and establishing the National Organ Donor Card program.

His leadership extends beyond national borders, serving as the President of the International Community for Belt & Road Cooperation Alliance on Organ Donation & Transplantation. Dr. Seneviratne’s dedication to advancing transplant surgery and urology in Sri Lanka has not only saved countless lives but also positioned the country as an emerging leader in organ transplantation in the region.

Revolutionizing Kidney Donation and Transplantation: Dr. Niroshan Seneviratne and the transplant team of Sri Jayewardenepura General Hospital lead the Way.

In the realm of organ transplantation, Sri Lanka has made remarkable strides, particularly in kidney transplantation. At the forefront of this medical revolution is the dedicated transplant team at Sri Jayewardenepura General Hospital (SJGH), led by Dr. Niroshan Seneviratne. Their groundbreaking work has become a beacon of hope for those suffering from end-stage renal disease. Today, we delve into the life-changing advancements being made at SJGH, focusing on their pioneering laparoscopic donor nephrectomy program. Successful organ transplantation relies on a dedicated team working with passion, trust, and compassion, united in their mission to save lives.

How serious is the kidney disease problem in Sri Lanka?

Chronic kidney disease (CKD) has become a silent epidemic in Sri Lanka, affecting nearly 150,000 people. Imagine a city the size of Galle, with every resident battling this life-threatening condition. Even more alarming, about 20,000 suffer from a mysterious type called CKD of unknown etiology (CKDu). Each year, approximately 3,000 families lose a loved one to CKD-related complications. These staggering numbers underscore the urgent need for effective treatment options, with kidney transplantation offering the best hope for many.

What options are available for patients with end-stage kidney disease in Sri Lanka?

Patients with end-stage renal disease in Sri Lanka have two main options for renal replacement therapy: dialysis (either hemodialysis or peritoneal dialysis) and kidney transplantation. While both options are available, kidney transplantation is generally considered the best option for long-term survival and quality of life. However, the availability of transplantation is limited by factors such as donor availability and healthcare resources

How has kidney transplantation progressed in Sri Lanka?

Kidney transplantation in Sri Lanka has shown significant progress since its inception. The first kidney transplant was performed in 1985, and by 2022, the country was performing over 200 transplants annually. Sri Jayawardenapura General Hospital has emerged as a leading centre for transplantation, performing both living donor and deceased donor transplants. The country has also adopted advanced techniques such as laparoscopic donor nephrectomy, which has largely replaced open surgery for kidney removal from living donors

What makes Sri Jayewardenepura General Hospital unique in its approach to kidney transplantation?

Our team at SJGH has emerged as a pioneer in kidney transplantation, particularly in the field of laparoscopic donor nephrectomy. This minimally invasive surgical technique for kidney removal from living donors has revolutionized the transplantation process. We are currently the only centre in Sri Lanka routinely performing this advanced procedure, making it a beacon of hope for patients and donors alike.

Can you explain what laparoscopic donor nephrectomy is and why it’s significant?

Imagine being able to give the gift of life with minimal impact on your own. That’s what laparoscopic donor nephrectomy offers. Unlike traditional open surgery, which requires a large incision, this procedure is performed through several small incisions using specialized instruments and a camera. For donors, this means less pain, quicker recovery, and better cosmetic results. It’s a game-changer that’s making more people consider becoming living donors.

Why is it important to emphasize that the donor is not a patient?

A donor is not just a patient; they become an ambassador to society after the surgery, conveying the message: “I feel good about kidney donation; it’s your chance to save lives.”

The donor does not benefit from the surgical incision; the incision is made for the surgeons to remove the kidney. The larger the patient, the larger the incision required. This is why, in laparoscopic surgery, the incision is smaller. Additionally, the availability of 3D technology enhances the precision of the surgery, minimizing tissue damage to the donor.

It’s crucial to remember that kidney donors are everyday heroes making a selfless decision to save someone else’s life. They’re not sick; they’re choosing to give a part of themselves to help another. By using laparoscopic techniques, we ensure that these generous individuals experience minimal disruption to their lives. The reduced recovery time and decreased pain allow donors to return to their normal activities much sooner, making their act of kindness easier on them and their families.

Dr. Niroshan Seneviratne, Consultant Urologist and Transplant Surgeon at Sri Jayewardenepura General Hospital recently delivered the prestigious SAARC oration at the College of Surgeons. He has been at the forefront of advancing kidney transplantation in the country.

What are some challenges facing organ transplantation in Sri Lanka?

Despite progress, organ transplantation in Sri Lanka faces several challenges. These include limited resources for dialysis (with only 107 dialysis centers and 785 dialysis machines nationwide), a shortage of specialized medical professionals (for example, there are only 36 adult nephrologists in the country), low political commitment and funding for organ donation and transplantation programs, and limited public awareness coupled with cultural resistance to organ donation. These factors collectively hinder the expansion of transplantation services and the increase in donor availability

Why is promoting deceased organ donation particularly important for Sri Lanka’s healthcare?

Sri Lanka, like many low and middle-income countries, is heavily dependent on living donors for organ transplantation. However, this creates ethical dilemmas. Deceased donation offers a way to expand the donor pool without these concerns. By focusing on promoting deceased organ donation, Sri Lanka can address its kidney disease crisis more effectively, reduce healthcare costs, improve patient outcomes, and build a more self-sufficient and ethical organ transplantation system.

How is Sri Lanka trying to increase the number of kidney donors?

We are taking several innovative steps to increase kidney donation. These include expanding the living donor pool by carefully evaluating and accepting medically and surgically complex donors, promoting deceased organ donation through public awareness campaigns, and organizing events like National Organ Donor Day to encourage donor registration. In collaboration with the Ministry of Health, we’ve launched a National Organ Donor Card and created a database of registered donors. A website (www.odtfsrilanka.com) has been developed to share inspiring organ donation stories, aiming to educate and inspire potential donors.

What are the future goals for the transplantation program in Sri Lanka?

The futuristic goals in organ donation include the establishment of a simultaneous pancreas-kidney transplant program, which involves transplanting both a kidney and a pancreas together. This approach benefits kidney transplant patients with long-standing diabetes by helping to ensure their new kidney functions for a much longer time. Additionally, there is a goal to commence multi-organ donation, allowing for the possibility of saving eight lives through the donation of the heart, lungs, liver, pancreas, intestines, and kidneys. It is important to recognize that every citizen has the civic right to become an organ donor. The advancement of robotic transplantation is also a key objective, as it promises to enhance the precision and effectiveness of transplant procedures.

Looking ahead, Sri Lanka should aim to further expand its laparoscopic donor nephrectomy program and increase public awareness about both living and deceased kidney donation. The country will need to enhance collaboration among hospitals to share expertise and resources. Advocating for increased government support and funding for transplantation services will be another key objective. Sri Lanka should continue investing in advanced technologies to improve surgical outcomes. Additionally, the country will need to train more surgeons in laparoscopic techniques, which will increase the availability of this minimally invasive procedure.

The story of laparoscopic donor nephrectomy at Sri Jayewardenepura General Hospital by Dr. Niroshan Seneviratne is one of hope, innovation, and dedication. It represents a significant step forward in Sri Lanka’s fight against chronic kidney disease, offering a lifeline to thousands of patients while respecting the well-being of donors. As SJGH continues to lead the way in this field, it not only transforms individual lives but also sets a new standard for kidney transplantation in Sri Lanka and beyond.