Procedure lets father give son new lease of life: ABO-incompatible transplant

It allows people to donate organs to those with incompatible blood groups
By Kash Cheong, The Straits Times, 29 Nov 2014

POLYTECHNIC student Mohamed Zarif Maarof was 18 when he found out he had kidney disease. That was in 2012.

"I was shocked, I used to run and play soccer so I thought I was healthy," he said.

The teenager had to give up evening outings with friends so he could be home by 8pm for his daily dialysis sessions.

His sleep was often disrupted because he had to attach a tube to his stomach to allow for water dialysis throughout the night.

His father, Mr Mohamed Maarof Ghani, a supermarket branch manager, said: "It was no way for a teenager to live. He still has a bright future."

The 49-year-old decided to donate a kidney to Zarif but their blood groups are incompatible.

However, thanks to a procedure called an ABO-incompatible transplant, Mr Maarof was able to donate a kidney to save his son in April.

Zarif was 19 when the transplant was carried out at the National University Hospital (NUH), making him the youngest person in Singapore to have gone through this procedure. He is now 20.

A week before the transplant, Zarif had to be hooked up to a machine which got rid of certain anti-bodies in his blood.

This helped reduce the risk of the new kidney being rejected, said Professor A. Vathsala, co-director of the National University Centre for Organ Transplantation at NUH.

"Zarif was our youngest patient, so we were concerned that the rejection... could be particularly strong as younger patients usually have better immune systems," said Prof Vathsala.

The transplant went well but Zarif still had to be treated to suppress his immune system after the procedure to prevent rejection.

NUH has done seven such transplants since 2009, including that for Zarif.

The Singapore General Hospital (SGH) has carried out 11 of these transplants in five years, including one for a 62-year-old patient, its oldest to go through the procedure. Mount Elizabeth Hospital has done at least 10 of these transplants and Gleneagles about five of them.

Most ABO-incompatible transplants done locally have been successful.

"Some patients have returned to their usual jobs and one is even trying for a baby," said Dr Terence Kee, director of SGH's renal transplant programme.

Doctors hope more patients can have ABO-incompatible transplants for a better quality of life.

There are more than 400 kidney disease patients waiting for a new organ, although not all of them may be suitable for ABO-incompatible transplants, doctors say. Also, some do not want to attempt such transplants, fearing the higher risk of rejection.

The chance of a patient rejecting organs from an ABO-incompatible transplant is 10 per cent, while it is 5 per cent for a normal transplant, said Dr Vathsala. "But if we pick up signs of rejection early, we can treat them," she added.

Patients might also have to be on life-long medication to suppress their immune systems, which may make them more susceptible to infections. But doctors try to prescribe drugs to counter this.

Also, patients may be put off by the higher costs. An ABO-incompatible transplant may cost $50,000 more than a normal one, Dr Vathsala said.

For instance, Mr Maarof's bill came to more than $100,000. But with insurance, he paid only $11,000 from his Medisave and $6,000 out-of-pocket expenses.

It was money well spent for Mr Maarof, who said: "My son can go back to having a life, and that is priceless."

Come forward and be a kidney donor

I WAS heartened to read last Saturday's article ("Procedure lets father give son new lease of life") about a father donating his kidney to his son, and am glad that the son no longer faces restrictions in his daily activities from having to undergo dialysis daily.

A transplant provides kidney failure patients with the best chance of long-term survival and quality of life. It is the optimal solution to kidney failure.

The transplanted kidney can take on almost all the functions of the failed kidneys, and it usually begins to function right away, allowing the patient to lead a normal life.

The National Kidney Foundation (NKF) has been promoting kidney transplantation. Unfortunately, there is still a shortage of donors. Last year, there were 424 people on the waiting list for a transplant, but only 34 cadaveric and 34 live donor kidney transplants were carried out. Many patients have waited beyond the average waiting time of nine years.

Cadaveric donations alone will not have a significant impact on the long waiting list. We hope more family members and relatives will come forward to give their loved ones with kidney failure a new lease of life, through living donations. This is the closest to a cure, and our loved ones can have a better quality of life and less restriction in terms of diet and time.

In this regard, the NKF launched the Kidney Live Donor Support Programme in 2009, where financial assistance is given to needy live donors.

The funding covers the costs of annual health screenings and medical follow-ups; one-time reimbursement for loss of income; reimbursement of hospitalisation and surgical insurance premiums; and insurance coverage for the Group Living Policy, for which we have doubled the sum insured to $200,000.

We will constantly look at ways to enhance coverage so patients can be assured that costs will not be an obstacle for the donor's long-term medical follow-up.

While kidney failure cannot be reversed, the main causes such as diabetes and hypertension are preventable.

We want to raise awareness of kidney disease and prevention in the community. Let us work together so that many more Singaporeans will take charge of their health through simple efforts such as having a healthy diet of less sugar and less salt, and a more active lifestyle with a good dose of exercise and regular health checks to keep diseases at bay.

For more information, visit our website (www.nkfs.org) or call 6299-0200.

Edmund Kwok
Chief Executive Officer
National Kidney Foundation
ST Forum, 3 Dec 2014

Rare double transplant gives man new lease of life
Father of four children gets new pancreas and kidney at one go
By Salma Khalik, Senior Health Correspondent, The Straits Times, 11 Dec 2014

MR SEOW Hock Lin, 43, who has been plagued by kidney failure for two years and diabetes for more than 20, is enjoying a new lease of life after receiving not just one but two new organs in October.

The father of four children aged two to 17 is only the second person in Singapore to have undergone a combined pancreas and kidney transplant.

Mr Shawn Huang had the first such transplant in 2012, and is doing well.

The Ministry of Health (MOH) had set up a five-year joint National University Hospital (NUH)- Singapore General Hospital (SGH) programme in 2011 to support such transplants.

Mr Seow did not have to pay for the surgery as he is fully covered by Medifund, the Govern-ment's safety net for the poor.

While there is funding from the MOH and expertise in doing these transplants here, it is a challenge getting two suitable organs.

For one thing, the Human Organ Transplant Act - under which organs can be taken from people who die in hospital, unless they have opted out of the scheme - does not cover the pancreas.

More importantly, it is better for the pancreas to be from someone under 30, as a transplanted pancreas loses half its viability in 15 to 20 years and another half in the next 15 to 20 years.

This was why it took two years before the second such transplant was done on Mr Seow, who received the organs after the family of a teenager who died unexpectedly of a stroke donated them.

Both he and Mr Huang suffer from Type 1, or childhood diabetes, a condition by which the body cannot produce any insulin at all as the pancreas does not work properly.

Unlike patients who have the more common Type 2 diabetes, where insulin is still produced but not used by the body properly, those with Type 1 often suffer from wild fluctuations of blood sugar levels that land them in hospital several times a year.

A significant proportion of diabetic patients develop kidney failure. For Type 1 patients, once their kidneys fail, they are at constant risk of hypoglycaemia or very low blood sugar levels that could lead to seizures, brain damage or even death.

"For them, there is always the fear that when they go to sleep at night, they might not wake up the next morning," said Professor K. Madhavan of the National University Health System (NUHS).

He and Dr Tiong Ho Yee, also of NUHS, did a retrospective search and found that from 2001 to 2011, a total of 95 people here with Type 1 diabetes had renal failure.

Of them, only 35 are still alive at the end of that 10-year period.

For Type 1 patients, a kidney transplant alone is not good enough as their inability to produce insulin would destroy the new kidney in 10 to 15 years.

Dr Victor Lee of SGH, who with Prof Madhavan are directors of the programme, said transplanting both organs makes sense, as the patient would already be on drugs to prevent rejection of the kidney. Having a new pancreas would cure them of their diabetes.

Currently, two Type 1 diabetics with renal failure are on the waiting list for the combined transplants.

As for Mr Seow, who quit his production supervisor job after his kidney failed two years ago, he hopes to find a new job in a few months.

Mr Seow was diagnosed with Type 1 diabetes in his late teens when he was still a polytechnic student. Shortly after he turned 40 in 2012, his kidneys failed and he needed to go on dialysis.

"I was very sick and had no energy," he recalled. He did not even have the energy to take an interest in his children, something he hopes to make up for now.

Now, more than a month after the transplant, Mr Seow said: "I am very grateful to them for giving me a new life."