The Beginning of Our Journey: 2012
In 2012, 60 years after the first successful kidney transplant internationally, a transplant operation had never been performed in Gaza. We were determined that our team’s would be the first. However, there were a myriad of obstacles to be overcome before any of the 500 patients who were on dialysis in Gaza could benefit from the lifesaving operation. First and foremost, facilities taken for granted in British hospitals were lacking. This difficulty was coupled by the lack of trained transplant surgeons in Gaza. The third major obstacle was the stringent transport restrictions. Nevertheless our team decided to press ahead and focused on Al-Shifa’a Hospital as the location for their pilot scheme.
Our first trip to Gaza in April 2012 was focused purely on working out logistics and determining the feasibility of proposed plan. We met with The Ministry of Health and examined the suitability of possible patients. We settled on two middle-aged patients as likely successful candidates.
After this trip, an arduous process of laying the groundwork for the transplants was undertaken. Because the law in Gaza did not permit cadaver transplant donations, our team decided to undertake live donor transplants. Given the lack of facilities in Gaza, even blood samples taken from patients had to be sent to the UK for analysis. Difficulties in this process meant that this had to be done three times before a satisfactory result was obtained. Finally, after eight months of prep, both the team and our prospective patients were ready.
Gaza's First Ever Transplant and Beyond: 2013
On the 23rd January 2013, our team successfully conducted the Gaza’s first ever transplant. The patient, Zaid Ma’atouk, received a kidney from his wife, ending four painful years of dialysis. Over the following week we conducted another live donor transplant. Around six months later, in June 2013, we would make return trips to Gaza, this time prepping for and conducting a further three successful transplants. This time the beneficiaries were two young children suffering from kidney failure, Fatma Othman, and Abdelmotalib Rihan, both aged 9 as well as a 47-year-old mother of eight. Over the next year, we would return to Gaza and conduct a further three successful transplants.
Where we are now: 2022
87 transplants later, a self-sufficient transplant unit in Gaza is well on the way to being set up!
Systems and processes
We have managed to secure agreement with the Ministry of Health in Gaza and the Legislative Council for the establishment of two committees: The higher committee for organ donation and transplantation which will have wide representation from MoH, legislative council, leaders of the local community, university, and the medical association. The main aim of this committee is to oversee and drive organ donation and transplantation. The second committee is operational within the Ministry of Health, to implement policies, and follow up decisions, especially in between visits. IT processes are also key to good patient care. We have succeeded in building an IT system for managing transplant patients at Al-Shifa Hopsital, which now has a go-live date set this year.
Physical capacity
A kidney transplant unit is planned in the new surgical building which is currently under construction. With an eight bed capacity, the equipment will be funded by the Qatari Red Cross. Alongside a tissue typing lab, the equipment includes theatre equipment, scans and monitors.
Staff Training
Further to the training course that was undertaken by 11 doctors, nurses and technicians here in Liverpool, our training of Al-Shifa staff has continued through workshops delivered in Gaza, on IT as well as medical workshops. A surgeon from Al-Shifa is due to participate in further training at The Royal Liverpool and Broadgreen University Hospital in June 2015. The main focus of our Gaza project moving forward will be on extensive training for Al Shifa's staff as well as maintaining our current momentum in terms of transplant operations.
Poster on the Gaza project presented at the ISN World Congress of Nephrology 2015:
Building a Legal Framework: Cadaver Donations
When our team first went to Gaza, cadaver donation was illegal. Through meetings with the relevant authorities within Gaza's legislative council, our team successfully lobbied for the establishment of a legal framework allowing cadaver donations, as well as the creation of an apolitical, independent transplant authority to regulate and monitor transplant activity in Gaza and promote organ donation.
Coupled with our high level advocacy approach, our team have also consistently utilised our expert knowledge to encourage organ donation and public acceptance of cadaver transplantation, through appearances on popular Palestinian news outlets, such as Al-Aqsa and Al-Jazeera Arabic. We believe that institutionalising a system of cadaver donations will contribute greatly to the development of transplant care in Gaza.
Capacity Building: Strengthening Systems and Human Resources
The first part of institutionalising Gaza’s organ transplant system involved building an IT system to aid in the implementation of an organised transplant system. Our team were not only able to source IT software for Al-Shifa, our IT specialist was also able to deliver important training sessions at Al-Shifa hospital for key members of staff. These lectures formed part of a structured teaching program, delivered by our medical team during our visits to Gaza.
The next step in our capacity building efforts involved bringing surgeons from Gaza to train at The Royal Liverpool University Hospital in different disciplines related to kidney transplant. It was with this in mind that our team applied for, and achieved, ISN/TTS twinning between the two hospitals. Following this, we selected staff for this program and raised the requisite funds in partnership with Palmed. The newly arrived team of staff from Al-Shifa hospital completed their two month training with us in early 2014, and returned hoping to implement their new expertise in Al-Shifa hospital.
Promoting a Culture of Clinical Excellence
The impact of our work is perhaps greatest in terms of the culture of clinical excellence that we are attempting to bring to Gaza. Aside from technical skills and know-how, a key part of the training we have provided in Gaza focused on patient-doctor interaction and on achieving high quality participatory care. In terms of improving standards of clinical care, it is important to note that the British team we assembled consisted not only of surgeons or medics, as is the case in Gaza. By bringing a clinical scientist as a key part of our team we were able to convey practical emphasis to our teaching at Al-Shifa Hospital regarding the importance of having a multi-specialist team for enhanced patient care.
In 2012, 60 years after the first successful kidney transplant internationally, a transplant operation had never been performed in Gaza. We were determined that our team’s would be the first. However, there were a myriad of obstacles to be overcome before any of the 500 patients who were on dialysis in Gaza could benefit from the lifesaving operation. First and foremost, facilities taken for granted in British hospitals were lacking. This difficulty was coupled by the lack of trained transplant surgeons in Gaza. The third major obstacle was the stringent transport restrictions. Nevertheless our team decided to press ahead and focused on Al-Shifa’a Hospital as the location for their pilot scheme.
Our first trip to Gaza in April 2012 was focused purely on working out logistics and determining the feasibility of proposed plan. We met with The Ministry of Health and examined the suitability of possible patients. We settled on two middle-aged patients as likely successful candidates.
After this trip, an arduous process of laying the groundwork for the transplants was undertaken. Because the law in Gaza did not permit cadaver transplant donations, our team decided to undertake live donor transplants. Given the lack of facilities in Gaza, even blood samples taken from patients had to be sent to the UK for analysis. Difficulties in this process meant that this had to be done three times before a satisfactory result was obtained. Finally, after eight months of prep, both the team and our prospective patients were ready.
Gaza's First Ever Transplant and Beyond: 2013
On the 23rd January 2013, our team successfully conducted the Gaza’s first ever transplant. The patient, Zaid Ma’atouk, received a kidney from his wife, ending four painful years of dialysis. Over the following week we conducted another live donor transplant. Around six months later, in June 2013, we would make return trips to Gaza, this time prepping for and conducting a further three successful transplants. This time the beneficiaries were two young children suffering from kidney failure, Fatma Othman, and Abdelmotalib Rihan, both aged 9 as well as a 47-year-old mother of eight. Over the next year, we would return to Gaza and conduct a further three successful transplants.
Where we are now: 2022
87 transplants later, a self-sufficient transplant unit in Gaza is well on the way to being set up!
Systems and processes
We have managed to secure agreement with the Ministry of Health in Gaza and the Legislative Council for the establishment of two committees: The higher committee for organ donation and transplantation which will have wide representation from MoH, legislative council, leaders of the local community, university, and the medical association. The main aim of this committee is to oversee and drive organ donation and transplantation. The second committee is operational within the Ministry of Health, to implement policies, and follow up decisions, especially in between visits. IT processes are also key to good patient care. We have succeeded in building an IT system for managing transplant patients at Al-Shifa Hopsital, which now has a go-live date set this year.
Physical capacity
A kidney transplant unit is planned in the new surgical building which is currently under construction. With an eight bed capacity, the equipment will be funded by the Qatari Red Cross. Alongside a tissue typing lab, the equipment includes theatre equipment, scans and monitors.
Staff Training
Further to the training course that was undertaken by 11 doctors, nurses and technicians here in Liverpool, our training of Al-Shifa staff has continued through workshops delivered in Gaza, on IT as well as medical workshops. A surgeon from Al-Shifa is due to participate in further training at The Royal Liverpool and Broadgreen University Hospital in June 2015. The main focus of our Gaza project moving forward will be on extensive training for Al Shifa's staff as well as maintaining our current momentum in terms of transplant operations.
Poster on the Gaza project presented at the ISN World Congress of Nephrology 2015:
Building a Legal Framework: Cadaver Donations
When our team first went to Gaza, cadaver donation was illegal. Through meetings with the relevant authorities within Gaza's legislative council, our team successfully lobbied for the establishment of a legal framework allowing cadaver donations, as well as the creation of an apolitical, independent transplant authority to regulate and monitor transplant activity in Gaza and promote organ donation.
Coupled with our high level advocacy approach, our team have also consistently utilised our expert knowledge to encourage organ donation and public acceptance of cadaver transplantation, through appearances on popular Palestinian news outlets, such as Al-Aqsa and Al-Jazeera Arabic. We believe that institutionalising a system of cadaver donations will contribute greatly to the development of transplant care in Gaza.
Capacity Building: Strengthening Systems and Human Resources
The first part of institutionalising Gaza’s organ transplant system involved building an IT system to aid in the implementation of an organised transplant system. Our team were not only able to source IT software for Al-Shifa, our IT specialist was also able to deliver important training sessions at Al-Shifa hospital for key members of staff. These lectures formed part of a structured teaching program, delivered by our medical team during our visits to Gaza.
The next step in our capacity building efforts involved bringing surgeons from Gaza to train at The Royal Liverpool University Hospital in different disciplines related to kidney transplant. It was with this in mind that our team applied for, and achieved, ISN/TTS twinning between the two hospitals. Following this, we selected staff for this program and raised the requisite funds in partnership with Palmed. The newly arrived team of staff from Al-Shifa hospital completed their two month training with us in early 2014, and returned hoping to implement their new expertise in Al-Shifa hospital.
Promoting a Culture of Clinical Excellence
The impact of our work is perhaps greatest in terms of the culture of clinical excellence that we are attempting to bring to Gaza. Aside from technical skills and know-how, a key part of the training we have provided in Gaza focused on patient-doctor interaction and on achieving high quality participatory care. In terms of improving standards of clinical care, it is important to note that the British team we assembled consisted not only of surgeons or medics, as is the case in Gaza. By bringing a clinical scientist as a key part of our team we were able to convey practical emphasis to our teaching at Al-Shifa Hospital regarding the importance of having a multi-specialist team for enhanced patient care.
photographs copyright of Craig Stennett