Kidney failure: A Singapore journey

20161210070000, Hema K
Kidney failures and organ donors: Singapore
Kidney failures and organ donors: Singapore
Singapore has one of the highest rates of kidney failure across the world, due to an increasing number of patients being afflicted with diabetes and hypertension. However, while the waiting list for kidney transplants has decreased from 436 in 2011 to 310, the number of living donors has also decreased from 31 to 16 in the same period. Deceased donor organ transplants have also decreased from 36 to 19 in this period. The low transplant rate of organs was attributed to surgical risks and poorer health after donation of organ. Today, surgical risks are few and far in between for kidney transplant, but this was the result of years of studies and experiments.

A study from the Duke-NUS Medical School and Singapore General Hospital (SGH) has found that people are not at a higher risk of kidney failure or dying if they donated one kidney, and the donor’s kidney function returned to 75% of pre-donation levels after five years for 40% of the donors. The researchers hoped that their findings can encourage more people to become living donors, as kidneys from living donors are much better for those who have end-stage kidney failure. 

Renal transplant first carried out on animals

The first renal transplant was carried out in animals and was experimental in nature. Researchers at the Vienna Medical School in Austria attempted successful transplantation of the kidney in animals in 1902. Although around seven years later, French doctors attempted an animal to human kidney transplant in a little girl using a rabbit’s kidney. She died in a matter of two weeks.

It was only in 1933 that the first human to human renal transplant was attempted. It proved to be a failure as the doctors did not know that the donor’s blood type did not match the recipient’s. Suffice it to say that the transplanted kidney did not function. 1954 became the year when the first successful renal transplant took place. Doctors in Boston attempted the surgery on identical twins, which proved to have a resounding positive result for the global medical community. A difficult bridge had finally been crossed.

29-year old woman the first successful renal transplant in Singapore

At 29 years of age, Doreen Tan became the first Singaporean to undergo a successful kidney or renal transplant. The donor was 20-year-old Yee Kwok Chong who had passed away hours before from a brain tumour. His mother sanctioned the donation of his kidney to Doreen Tan.

The operation lasted for three hours. The housewife from Singapore who received her new kidney at SGH made history in the island nation. According to the Singapore Medical Association’s newsletter, the surgeons who operated on Doreen Tan had to experiment on dogs in 1969, the previous year. With the S$75, 000 donation from an American foundation, the doctors in Singapore could attempt the animal experimentation before moving on to actual operations on human patients.

Carried on with life normally after surgery

The patient eventually recovered, and after her surgery on July 8, she was discharged from SGH two months later. Doreen Tan, who had been in a coma for a time in 1969, was able to carry on with her life, notwithstanding some complications post-surgery. She developed arthritis a year later due to medication, and she later suffered a slip disc.

She would, however, emphasise that these were nothing compared to the kidneys which had failed her before. “After kidney failure, you don’t complain about a slipped disc; it’s minor by comparison,” she said. She would later attend a commemorative reunion recognising 20 years of kidney transplantation which was held at SGH. Doreen Tan passed away in 1992, 22 years after her history-making transplant.

Back to the present

Under the Human Organ Transplant Act, Singaporeans have to opt-out if they do not wish to donate their organs upon death. Despite this, organ donations remained low as few doctors will take their deceased patients’ organs without consent of the family members. Recently, an NTU student passed away in Slovakia after a tragic accident. His family honoured his wish to donate his organs upon death, and four patients in Slovakia have received his organs. Perhaps one day his story will be the norm rather than the exception for Singaporeans, and more people will be able to receive the organs they need for a better life. MIMS

Read more:
Kidney failure risk upped 40% with red meat consumption – Singapore Chinese Health Study
Why patients receiving organs from deceased donors have higher risk of cancer
How can the shortage of organs for transplants be addressed?

Sources:
http://www.straitstimes.com/singapore/health/living-donor-not-at-higher-risk-of-kidney-failure-study?login=true
http://www.straitstimes.com/singapore/organ-donations-remain-low-despite-changes-to-law
http://www.straitstimes.com/singapore/efforts-to-spur-organ-donation
http://www.straitstimes.com/singapore/four-slovakian-patients-receive-organs-of-ntu-student-who-died-in-slovakia
http://www.straitstimes.com/forum/letters-in-print/make-organ-donation-a-mandated-choice