As time passes Natia Tkabladze starts to forget the faded colors on the walls in the hospitals, the unpleasant smell of the cafeterias, and the large kidney dialysis machines.
She is 17 now. She received a transplanted kidney from her mother two years ago. This year she is finishing school and she wants to enter the State Medical Institute in Tbilisi. "If I'm lucky I am going to pass the exams," she says. "I want to become a nephrologist (kidney specialist) with all my heart, so I have a chance to cure others in need."
Tkabladze, who lives in one of the villages of Tskaltubo in western Georgia, first noticed dark spots of blood bruises on her body when she was 12 years old. She felt weak and couldn't spend as much time playing as before. Her parents brought her to Tbilisi Children's Second Hospital. Nephrologists Guram Chitaia and Medea Tsanava identified chronic renal failure.
"This is an intensively progressive disease of the kidney that may occur after infection in the renal system," says Chitaia. "Chronic Renal Failure cannot be completely treated and eventually it causes kidney failure. It is a serious disease that leads patients to death. The only full recovery from kidney failure can be with transplantation." (Transplantation is a surgical procedure by which a tissue or organ is removed and replaced by a corresponding part, either from another part of the body or from another individual.)
The first period was especially hard for Tkabladze: "I became a patient. My life changed in a second. I had to move to Tbilisi to get the right treatment, and I didn't want to leave Tskaltubo, my home, my school, my friends. The doctors and the hospital itself sounded so scary to me."
After four years of treatment, in April 2003, the doctors identified kidney failure and Tkabladze needed to be put on dialysis. Dialysis is the process of cleansing the blood by passing it through a special machine. It is needed by patients whose kidneys are incapable of filtering the blood. The machine takes over the function of the kidneys and removes waste, such as urea, from the blood. Three times a week Tkabladze had dialysis.
"Dialysis still has its drawbacks," says Archil Chkotua, the kidney transplant program director. "First of all, patients cannot fully recover with just dialysis. It only helps the patients stay alive. Over time there may be damage to healthy organs as well, such as the heart and circulation system. Every year the number of these patients who come to hospitals increases by 50; in fact, there are far more than 50. The only way out, especially for children and young patients, is the transplantation surgery.'
"I was tired from all the medicines and dialysis," Tkabladze said. "After the dialysis, I couldn't do anything. I just laid and slept, while I knew my friends were going to school and having fun together. No one ever told me that the only chance to survive was the operation, but I knew my illness was very serious. So I was not surprised when one day my doctor Medea Tsanava told me I had to have the operation on the 18th of December, 2003." The operation was performed at the National Urology Center by surgeon Archil Chkotua.
"It was hard for all of us," says Natia's mother, Mzia Tsertsvadze. "But Natia always remained calm; she never complained. The doctors were so surprised! Everyone loved her for her calmness."
"I remember that morning vaguely," says Natia. "Before the doctors took my mother to the other room to prepare both of us for the surgery, she came to see me. She said only that we will be fine, and then she left. I looked out of the window and saw the church of 'Sameba,' which was still being built then, and suddenly I knew I was going to be fine. Later, when I saw my mom after the operation, she told me she was also watching 'Sameba' before the doctors took her to the operating-room. That was our last hope."
Kidney transplantation surgery began 30 years ago. But it was first performed in Georgia by French surgeons in 1999. Now 10 kidney transplant surgeries are financed by the government every year. Each operation costs up to 13,000 lari (about $7,225). According to the president of the Georgian Association of Transplantologists, Gia Tomadze, presently there are 38 patients with a transplanted kidney in Georgia. But there are 467 patients on dialysis throughout Georgia. Dialysis is expensive; each procedure costs up to 200 lari (about $111) and it is scheduled three times a week, so the monthly treatment adds up to about $450. The treatment for all 467 patients on dialysis is financed by the government. All patients who are on dialysis theoretically need kidney transplants, but they need donors and financial support from the government.
Every step of the transplant surgery, starting with the donor selection, is regulated by Georgian legislation. Presently only two hospitals have permission to perform this surgery: the National Urology Center and Surgery Institute in Tbilisi. (For the past two years, the operations cannot be performed in the Surgery Institute because of reconstruction works.) The law only allows blood relatives to donate organs. For example, a mother-in-law or brother-in-law cannot donate their organs to the patient.
"Donors and finances are our main problem," says Chkotua. "In Georgia, we have only living donors. Because people have two kidneys, a living donor is possible. But in Georgia it is impossible to transplant a heart or liver or other important single organs, because we don't have the practice of getting donated organs from cadavers. Donors could be patients whose brain is already dead, but the heart beats and breathing is kept going by a machine. Usually these are cases when someone had an accident or got shot, and the organs for transplantation are not damaged. One cadaver donor could donate several organs and save several lives.
" But this is the problem of our mentality. How can I let the doctors take my child off the breathing machine when the heart is still beating? This is usually how a patient's parents or relatives are thinking. They don't understand that when the brain has died, this person no longer exists. It is only the heart beating; there is no chance after such brain death that the person will recover. This has never happened. It is useless to try, when you can save other lives and very often lives of children and young people.
"Imagine, diabetic disease is treatable on the second day after transplanting a pancreatic organ. The next day, the patient has no diabetes (Diabetes mellitus is a group of metabolic diseases characterized by high blood sugar levels, which result from defects in insulin secretion, or action, or both.) Some heart diseases and liver cirrhosis, (a chronic progressive disease of the liver characterized by the replacement of healthy cells with scar tissue) can be treated only by transplantation surgery. But we are not ready for such decisions and we waste so many lives that could be saved."
There are number of factors that determine the long-term success of the operation. According to Chkotua, the first is selecting the right donor for the patient. The donor must not have any heart or circulation problems, cancer or infectious diseases. Donor and recipient blood groups must be identical; their HLA-antigens (a complex family of genetically inherited proteins which are found on the surface of cells throughout the body) must comply to minimize the chance of causing organ rejection by the patients. This happens when the recipient's system refuses to accept an "unknown body" and defends itself by attacking the new organ. Before the operation, and after until the end of their lives, patients who have transplanted organs have to take special immunosuppressive drugs that help them stop any rejection of the new organ.
According to Raul Managadze, director of the National Urology Center in Tbilisi, in Europe there is an alliance called 'Euro-transplantation' which includes almost all European countries. They have common computerized data in the Netherlands where all patients who need transplant organs are registered. If there is a donor in Portugal and a recipient in Greece whose blood groups and HLA-antigens match, they can do a transplant.
Natia Tkabladze was one of the children who visited a sports camp in 2005, with the support of Gia Tomadze. Since the project began in 2002, five winter camps have been held in Anzere, Switzerland, and hundreds of children from 23 countries who have had transplants have participated. At the camp children try new sports such as skiing, snowboarding and scuba diving, and have the opportunity to meet peers who have shared the same experience and can now have fun together. Natia Tkabladze became a champion in skiing and won a cup. 'I was so happy," she said. "And I was so proud I was the first. I have really enjoyed it. I like sports very much."
Tkabladze has been taking immunosuppressive drugs and is grateful to the Kartu insurance company for their financial support. She had no insurance, but the company decided to pay. "These drugs are too expensive, and I could never buy them by myself," she said.
Now she feels fine and tries to study hard to enter the Medical Institute in Tbilisi. "I was a much better pupil before the illness," she admits, "but I try my best." My doctors inspired me to decide to become a doctor, and a good one. I dream my patients will love me the way I loved all of doctors who have ever supported me."