Organ donations remain low despite changes to law

Average wait for kidney transplant still 9 to 10 years, and 1 to 2 years for liver or heart
By Janice Tai, The Straits Times, 23 May 2016

Singaporeans are still not donating their organs despite several legislative changes made over the years to enlarge the donor pool.

"The numbers of deceased organ transplantation for kidney, heart and liver (have) remained low for the past 10 years," said a Ministry of Health (MOH) spokesman.

There were 58 such organ transplants last year, compared with 69 in 2006, the latest figures from the National Organ Transplant Unit show. These numbers are a far cry from those in other developed countries such as Spain and Norway, which have eight times the number of cadaveric kidneys for every million people.

Donations from living donors - which are much better for recipients than cadaveric organ donations - have seen only modest growth. Last year, 58 people donated their kidneys and livers, up from 34 in 2006.

Despite legislative changes, such as including Muslims as donors, the average wait for a kidney is still nine to 10 years and one to two years for a liver or heart. Many people with heart and liver failure here die each year, and thousands with kidney failure are on dialysis.

The availability of organs for transplantation is influenced by factors such as public awareness, and societal views and religious beliefs, said the MOH spokesman.

"Even with legislation aimed at improving deceased organ donations, there is a need to continuously engage the public to raise awareness about the issues around organ donation and transplantation, including the benefits of transplantation," she added.

Last year, 334 people were on the waiting list for kidney transplants, with 54 people waiting for a liver and 23 for a heart.

While the number of people waiting for liver and heart transplants has risen, the figure for those waiting for a kidney has plunged by about 70 per cent over the last 10 years. People are usually taken off the waiting list because they could not get the organs in time and had either died, or become too old or sick for a transplant.

The National Kidney Foundation (NKF) said eight in 10 of its patients are above 51 years old.

"We hope that more people will come forward to donate because there is still a long way to go, with the kidney failure population continuing to increase at an alarming rate," said the NKF spokesman.

On average, about five people here lose the use of their kidneys each day. Singapore has one of the highest kidney failure rates in the world, as a result of more people getting diabetes and hypertension, the main causes of kidney failure.

Low transplant rates here are partly due to worries about surgical risk, poor health after donation and the cost. Surgeons say the lack of "buy-in" by other doctors to harvest organs upon death is also a factor, as organs have to be retrieved during a certain time period.

Donating an organ does not only save lives. Many studies have shown that it is cheaper for the country and better for a kidney patient to get a transplant than to stay on dialysis.

"Organ donation is an emotive and sensitive issue, especially for the next of kin who are coping with the loss of their loved ones," said the MOH spokesman.

"With greater social awareness, acknowledgement and acceptance about the realities of (the) sufferings of patients with organ failure and the life-saving acts of organ donations, we are hopeful that the organ donation rates in Singapore will improve in the coming years."

Man's gift of love to girlfriend - a kidney
She was on transplant waiting list for 10 years; procedure is rare between people who are not family members
By Janice Tai, The Straits Times, 23 May 2016

Mr Ng Chai Lai dated his girlfriend for six years before popping the question in 2013. But instead of a marriage proposal, he offered her the gift of life - one of his kidneys.

Back then, Ms Chua Bee Leng had been on the waiting list for a kidney transplant for 10 years after an autoimmune disease caused her kidneys to fail in 2004.

"I thought he was joking. I had already given up hope of receiving a kidney as my family members were unsuitable. Who would have thought a boyfriend would do that?" said Ms Chua, 47.

The transplant was done in December 2013. Such transplants, between people who are not family members, are few and far between.

 

The transplant was nothing less than a miracle due to three factors, said Mr Ng, 47, a taxi driver.

First, the doctor told them that should they have wanted a transplant a few years earlier, it would not have been possible. Both had different blood types and it was only recent medical advancements that enabled the transplant to proceed.

Second, Mr Ng was a former drug abuser who had been behind bars for close to 20 years. He first met Ms Chua while undergoing rehabilitation at a halfway house, as she was visiting her brother, who was then also a drug addict.

Due to Mr Ng's history of drug abuse, he had to get the nod from the authorities and a transplant ethics committee, as well as go through a battery of tests, before the transplant was approved.

Third, doctors found that one of Ms Chua's coronary arteries was blocked and she needed heart bypass surgery before the transplant.

But the couple were willing to go through the obstacles as Ms Chua had been in great pain while on dialysis. Several operations had to be done to create a fistula in her arms, legs, neck and thigh for blood to enter and leave her body during dialysis.

Serious infections kept setting in and she had to be hospitalised almost weekly. Mr Ng recalled that her screams of pain were so loud that everyone in the ward could hear them. After her thrice-weekly dialysis sessions, she would be so weak that she could not walk home.

"The doctor said she did not have much time left and I made up my mind to give my kidney to her.

"I figured that even if my health fails after that, better to have two of us around for that short span of time than me having two kidneys yet end up losing her," said Mr Ng.

Ms Chua's quality of life improved greatly after the transplant.

She is now able to work as a part-time cashier. In her downtime, she jogs slowly or does brisk walking. Mr Ng also recovered quickly. He said being a donor has not affected his health at all.

Both of them have since applied for a flat in Bukit Batok and intend to marry in the next two years.

Said Ms Chua: "He made a noble sacrifice and I am forever indebted and grateful. Life is no longer the same now."

Efforts to spur organ donation
The Straits Times, 23 May 2016

In 2004 and 2008, the Human Organ Transplant Act was extended to include as donors, people who die from non-accidental causes and Muslims respectively.

The list of organs was also expanded beyond kidneys to include livers, hearts and corneas.

In 2009, the age cap of 60 for dead donors was lifted. In 2011, the law was amended to allow living organ donors to be reimbursed for medical expenses and loss of income.

The Ministry of Health (MOH) said it has, with charities such as the National Kidney Foundation (NKF), regularly engaged with the public and organ failure patients and families to increase awareness of organ donation. This year, it will again embark on an awareness campaign.

Likewise, the NKF has started a campaign this year, featuring radio interviews with its patients and donors to dispel fears about kidney transplants. Almost every other day, NKF staff go to schools, offices and community and religious organisations to conduct educational roadshows on live kidney donation.

These campaigns are important because would-be donors often have concerns about their health should they go ahead with the donation, said the NKF. People can live on easily with one kidney, and the risk to the donor is low, it added.

In response to cost concerns, the NKF launched a scheme in 2009 to provide financial aid for needy live donors to assure them that many post-transplant charges will be taken care of. It also enhanced its insurance coverage for donors in 2013.