Tuesday 2 July 2013

Fewer kidney transplants despite donor rule changes

179 transplants took place from 2010 to 2012, down from 225 previously
By Melissa Pang, The Straits Times, 1 Jul 2013

IN THE three years since the Government allowed the use of organs from deceased donors above 60 years of age, the number of kidney transplants here has actually gone down.

This is also despite the green light being given in 2009 to paired donations, in which a donor, whose kidney is not a match for a relative, gives it to someone else who also has a relative willing to give up a kidney.

There were 225 kidney transplants from living and deceased donors in the 2007 to 2009 period. This dropped to 179 in the period from 2010 to last year. In the last three-year period, the waiting list for a kidney grew by 45 people, bringing the total to the current 457.

Worldwide, Singapore has the second-highest incidence of kidney failure due to diabetes, increasing the need for donor organs here.

This was why the Government relaxed the Human Organ Transplant Act in 2009 and lifted the age cap for cadaveric donors.

At the time, the Health Ministry estimated that the change could lead to about 10 to 12 additional organ donors each year.

Instead, the amendment has resulted in just 12 more donors since 2009.

With the number of kidney patients expected to grow and the shrinking number of donors, hospitals have had to use other potential deceased donor pools.

Increasingly, doctors are turning to expanded criteria donors. These include those aged 50 to 60 who had hypertension or abnormal renal function at the time of death, or died of stroke.

Doctors at Singapore General Hospital (SGH) and National University Hospital (NUH) say that without such sources, the number of transplants would be between 25 per cent and 40 per cent lower.

An expanded criteria donor kidney "is a healthy kidney in the strictest sense of the word", said SGH's renal transplantation programme director Terence Kee. "It does not carry disease, infection, or cancer."

But organs from these donors may have some damage, thus a biopsy has to be done at the time of kidney removal to check if it is suitable for use, said Professor A. Vathsala, head and senior consultant of the nephrology division at NUH. If there is severe damage, the organ would be rejected.

The biopsy would also help to determine if both the donor's kidneys should be given to two recipients, or if the two kidneys should be transplanted into a single patient.

Previous evidence has suggested the use of such organs is less effective. But current research suggests that any sort of transplant - be it from a healthy, unwell or older donor - offers a higher chance of survival than dialysis.

Local data is not available as the use of organs from expanded criteria donors is a relatively new development here.

In the United States, the five- year survival rate from using such organs is 49 per cent, compared to 65 per cent for organs from standard healthy donors, normally accident victims under 60.

Transplants involving organs from expanded criteria donors are also associated with longer stays in hospital.

Despite these drawbacks, any available organ is good news for kidney patients, who wait an average of nine years for a deceased donor kidney transplant, said Prof Vathsala.

Incompatible blood type kidney transplants set to rise
By Melissa PangThe Straits Times, 1 Jul 2013

FIVE years ago, he spent his days lying on the living room couch, too ill and weak to move.

Looking at him today, it is hard to believe that the 51-year-old, who wanted to be known only as Mr K.I., once suffered from end-stage kidney failure and, at his worst stage, was given just 18 months to live.

Life for Mr K.I. became "perfect" after an incompatible blood type transplant at Mount Elizabeth Hospital in 2008.

The father of three, who has O+ blood, received a kidney from his wife, Madam Radiyah Mohd Som, 48, whose blood type is A+.

Normally, both donor and recipient must have a common blood group, or the kidney will be rejected automatically by the recipient's body. But the use of immunosuppressive drugs and other procedures now allow for incompatible blood type transplants for some patients.

Hospitals predict the number of such transplants will rise due to the limited pool of kidney donors and the growing waiting list.

National University Hospital (NUH) has done five such transplants since 2009, while Mount Elizabeth Hospital has handled more than 10 cases since 2008.

Singapore General Hospital (SGH), which started its ABO blood group incompatible kidney transplant programme in 2009, currently has about two to three patients undergoing this procedure annually. Its renal transplantation programme director, Dr Terence Kee, believes the numbers will go up. About 30 per cent of SGH's current referrals for living kidney donor transplants are for ABO blood group incompatible kidney transplants.

But due to the use of stronger immunosuppressive drugs, weaker patients may not be medically fit for such transplants.

Still, living kidney donations are the best treatment for kidney failure. The five-year survival is 95 per cent, compared to 84 per cent if the kidney comes from a deceased donor, said Professor A. Vathsala, co-director of NUH's National University Centre for Organ Transplantation.

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