First paired kidney exchange transplant in Singapore

Mum donates kidney to patient on wait list so daughter can get matching organ from stranger
By Linette Lai, The Straits Times, 1 Mar 2016

When doctors said her daughter needed a new kidney, Madam Noor Rafidah Nasir immediately volunteered one of her own.

But then came the bad news - Madam Rafidah and her daughter, Ms Siti Rasyidah Lokman Hadan, were not a match.

"I was heartbroken," recalled the 47-year-old housewife. "I cried."

Twenty-three-year-old Siti Rasyidah binte Lokman Hadan was given a new lease of life following Singapore’s first living...
Posted by National University Hospital on Tuesday, March 1, 2016

Then doctors approached her in August 2014 with a novel proposal known as a paired kidney exchange transplant.

Someone had come forward wanting to donate a kidney to a stranger, and was found to be a match for Ms Siti. In exchange, her mother would have to give one of her kidneys to a person on the national waiting list.

Ms Siti, 23, became Singapore's first recipient of such a transplant in April last year, at the National University Hospital (NUH).

The procedure has been approved since 2009, but has never been carried out until last year because of a lack of pairs who were both willing and medically fit.

"Between 2009 and 2014, nobody entered the pair exchange registry... and there was a lack of enthusiasm from patients," said Professor A. Vathsala, co-director of the National University Centre for Organ Transplantation at NUH.

For example, some feared that they would donate a kidney only to find that the one received by their loved one did not work.

Currently, there are 450 patients on the waiting list for a new kidney. The average waiting time is around eight or nine years.

Each year, two to three people offer to donate their healthy kidneys to strangers - as in Ms Siti's case - but in general, only one is found suitable in the end.

Ms Siti has systemic lupus erythematosus - a condition in which the immune system mistakenly attacks the body - and was born with abnormal kidneys.

By 15, she was having regular dialysis. At 22, her condition had deteriorated so much that her doctors were on the brink of carrying out the mismatched transplant despite its many risks.

"We would have gone ahead; we had already prepared all the forms," said Professor Yap Hui Kim, head of the paediatric nephrology division at NUH.

The recipient of such an incompatible transplant would typically have to take medication to prevent her immune system from attacking the foreign organ.

However, Ms Siti's medical condition meant that doing so would further weaken her and leave her susceptible to various infections.

Ms Siti used a wheelchair for four years but can now walk. "Being able to walk was a big thing for me," said the oldest of four children. She plans to take her A-level examination this year and hopes to become a teacher.

She does not know who donated the kidney to her. Nor does her mother know who her kidney went to. The identities of donors and recipients in a paired kidney exchange transplant are kept secret to avoid feelings of mutual obligation, or pressuring anyone to donate out of pity, Prof Vathsala said.

But mother and daughter are glad for the chance to pay it forward. Said Ms Siti: "It's only natural that after I get something, we give something in return."

More living donations can cut waiting time for kidney

The National Kidney Foundation (NKF) shares the double joy in Tuesday's report ("First paired kidney exchange here") and applauds donors such as Madam Noor Rafidah Nasir for their gifts to humanity.

We are heartened to learn that both Madam Noor and her daughter, Ms Siti Rasyidah Lokman Hadan, can now lead normal lives after their transplants and no longer face limitations in their day-to-day activities, such as having to undergo routine dialysis treatment.

A transplant provides kidney patients with the best chance of long-term survival and quality of life.

It is the optimal solution to kidney failure, as it is the closest to a cure and will enable young kidney patients such as Ms Siti to grow up like any other normal person and be able to fulfil their dreams and aspirations.

The NKF continues to promote kidney transplant. Together with the National University Hospital, the Shaw-NKF Children's Kidney Centre seeks to help young patients on dialysis, through a wide range of programmes to give them hope that they will one day be given a new lease of life through kidney transplantation.

The numbers have been modest so far, with many patients waiting beyond the average waiting time of nine years for a good match.

Cadaveric donations alone are not enough to have an impact on the long waiting list.

We hope that more people will come forward to give others with kidney failure, especially loved ones, a better quality of life, through living donations, just like what Madam Noor did.

To encourage this, the NKF has in place a Kidney Live Donor Support Programme, where financial assistance is given to needy living donors.

The funding covers the costs of annual health screenings and medical follow-ups; one-time 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 continue to look at ways to enhance coverage so patients can be assured that costs will not be an obstacle in the donor's long-term medical follow-up.

NKF remains committed to raising awareness of kidney disease and prevention in the community.

We encourage people to take charge of their health by simply following a healthy diet, a more active lifestyle, with a good dose of exercise, and regular health checks when appropriate.

Edmund Kwok
Chief Executive
National Kidney Foundation

ST Forum, 4 Mar 2016