The main function of the kidneys is to remove waste products and excess fluid from the blood which are then excreted from the body through the urine. This complex process is necessary to keep the rest of the body in balance.
Chronic kidney disease is the gradual loss of the function of the kidneys which leads to damage to the kidneys and build-up of excess fluid and waste in the body to dangerous levels.
The cause of chronic kidney disease may be the result of family history or prolonged medical conditions like diabetes, hypertension, blockages in the urinary tract and kidneys. Early signs of chronic kidney disease may be subtle.
It can take many years before it deteriorates to kidney failure. Some people with chronic kidney disease may not reach the stage of kidney failure. Others end up with kidney failure and they need to be on dialysis or undergo kidney transplant to keep them alive.
Being on dialysis requires the patient to follow a strict treatment schedule, take medications regularly with drastic adjustments in diet. Complications from dialysis include high or low blood pressure, anaemia, fluid overload, heart disease, infection and depression. While dialysis prolongs the life of the patient, his life expectancy is much less than that for the general population.
“Don’t wait for dialysis”
Dr. Roger Tan from Gleneagles Hospital is a nephrologist – a doctor specialising in kidney diseases. Addressing the media at a gathering organised by ParkwayHealth in Singapore in February, he said: “Less than 10% of dialysis patients are transplanted. However, I always tell my patients that if their kidney function is not so good, don’t wait for dialysis, go for transplant. It is pre-emptive.”
Commenting on donors, he said that anyone who can donate a kidney will just as long as a normal person, which is an assurance to any potential donor. “It’s keyhole surgery for the donor; they will be moving around by the second day. The scar is smaller than the kidney since we rotate it before taking it out. For the recipient, the scar is the size of the kidney.”
Dr. Tan noted that in the past, rejection rates were very high, especially in the ’60s and ’70s, and the survival rate was 50%. However, he says that now it is very easy to bring the rejection rate down to zero. “If a centre says they have no rejection rate, I would say don’t go. You come back prone to infections, because too much immune suppression leads to low immunity.”
The average cost for an uncomplicated transplant is in the range of Singaporean Dollars 80,000 to 85,000. If it is a complex transplant, the cost rises to around Singaporean Dollars 100,000 to 110,000.
“The main reason for the popularity of dialysis is the lack of a donor. Provided your heart is healthy, you can do a transplant. Out of habit, surgeons take the left kidney and put in on the right. It is a die-hard habit. We don’t take out the native kidney. The surgery to transplant the kidney is very superficial so there is no need to touch the native kidney and complicate surgery. Furthermore, doing a biopsy in case any issues are afterwards is simple since the kidney is transplanted only one cm below,” he added.
Living donor kidney transplant
Kidney transplant is a surgical procedure to transplant a healthy kidney to a person whose kidneys are no longer functioning properly. Most times, it is the best treatment for kidney failure. “Only one kidney is needed to replace the two damaged kidneys, which makes Living Donor Kidney Transplant (LDKT) an option for people suffering from end-stage kidney failure,” said Dr. Tan.
Dr. Tan explained that LDKT transforms the lives of people with kidney failure, freeing them from dialysis, and enabling them to live an active life. It is something to be considered even before starting on dialysis with its accompanying potential complications.
- Advantages of a transplant are:
- Freedom from dialysis
- No fluid restriction
- Normal, healthy diet
- Gainful employment
- Better health
- Restores fertility
Dr. Tan said: “With all the advantages, transplant is the best treatment option for people suffering from end-stage kidney failure. In fact, we recommend pre-emptive transplant – even before the kidneys fail totally and before commencement of dialysis. This is because pre-emptive transplants have a higher chance of success.”
The transplant procedure
If you and your donor are foreigners, back in your home country, both of you will undergo physical examination by your local doctor, screening for hepatitis B and C, and HIV, chest x-ray, heart examination (if needed) and CT scan for donor to determine the number of kidney arteries and veins.
On arrival in Singapore, you and your donor will be examined by a nephrologists and surgeon to confirm your suitability to undergo a kidney transplant surgery. The donor may be a family member or someone who has no blood ties but is “emotionally related”. This refers to a non-relative who is related to you “emotionally” such as a friend, colleague or your employer.
Dr. Tan says that the aim of the extensive medical evaluation of the donor is to ensure that the donor is in good mental and physical health to donate his or her kidney – to minimise any risk to the donor and recipient.
Upon determining the suitability of the donor and recipient, they will need to be further evaluated by a transplant coordinator. The information gathered will then be presented to the Transplant Ethics Committee, which is governed under the Ministry of Health in Singapore. “This strict protocol is to protect the interests of the donor and the recipient,” said Dr. Tan.
The entire process from the time of arrival in Singapore to getting the approval from the TEC takes about two weeks. After this, there will be a one week ‘cooling off’ period, during which the two of them are given the time to think it through again before the transplant takes place.
The transplant surgery
The transplant surgeon will remove the donor’s kidney via keyhole surgery. This minimally invasive surgery means reduced risk and the recovery time is shorter. The scar from the surgery is about 10cm (four inches) long.
This kidney will then be transplanted into the recipient’s lower right or left side of the abdomen, one centimetre below the skin. Placing the kidney in this location allows it to be easily connected to the bladder and nearby blood vessels. Unless the recipient’s kidneys are causing complications, they will not be removed. The donor will be discharged after three to five days. For the recipient, he will need to stay in hospital for about 10 days.
Unlike many countries, Singapore allows donation of kidney from another person who is not of blood tie but is “emotionally related.” The stringent protocol imposed by the Singapore Government ensures that the transplant is legal and above-board to minimise any legal implications that may arise from it, as well as for the well-being of the donor and the recipient.
Dr Tan says that the multi-disciplinary transplant team at Gleneagles Hospital, including the surgeons, doctors and nurses, are specially trained to care for transplant patients. For example, the transplant surgeon is gazetted by the Ministry of Health. He needs to be certified annually after meeting the required number of continuing medical education points to maintain and develop his skills.
With the advances in medications and quality care, the transplant team in Gleneagles Hospital is able to handle complicated transplant cases where the blood group of the recipient and donor are not compatible, or in cases where the recipients have had previous transplants or multiple blood transfusions, making it difficult for them to receive a transplant as their bodies are likely to reject the transplanted kidney.
There is no age limit to undergo a transplant but the recipient must be medically fit to undergo the surgery.
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