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Kidney Transplant (2)


How is a person assessed as a donor for living related transplant?

The potential donor has to undergo very thorough and vigorous investigations to make sure that both his kidneys are healthy. If there is even the slightest doubt about his kidney it will not be taken from him. He must be in good health and have no history of kidney disease, hypertension, diabetes mellitus, cancer or any other disease. He will be assessed psychologically and mentally to ensure that he fully comprehends the nature of the donation, that there are no social pressures on him to donate and that he is donating voluntarily out of love and consideration for the patient. He will undergo a thorough physical examination. The urine and blood tests performed on him must be normal. There must be no protein or blood in the urine. One of the tests involves the collection of a 24-hour urine sample.

The ABO blood group between the donor and the recipient must be compatible. The HLA tissue typing must have at least a 50% match ( one haplotype match ).

If the above tests are satisfactory the prospective donor will have to undergo a special X-ray examination to find out if there is any abnormality in the kidneys. This test is called a renal arteriogram. If it is satisfactory, then the donor is considered suitable for a kidney donation and a date for the transplant operation will be scheduled.

Who are the potential cadaver kidney donors?

Donors should not be patients suffering from cancer as cancer may invade the kidney and be carried over to the recipient. The donor should not suffer from any infection as it can be transmitted to the recipient. The cadaver donor should also be not more than 60 years of age. Most donors were patients who had sustained head injuries from road traffic or other accidents. Sometimes a bleed in the brain from various causes can also result in brain death, qualifying the person as a suitable cadaver donor.

The potential donor is therefore someone who has had an accident or damage to the brain with no possibility of recovery and has to be maintained on a respirator. It is important that the potential donor be placed on a respirator as it pumps oxygen into the donor's lungs and keep the heart beating and blood flowing to the kidneys for normal functioning even though his brain is already dead ( brain death ).

What is meant by brain death?

When a person dies, it means that his brain has ceased to function. The medical term for this is brain death. The beating of the heart and respiration can be taken over by machines but it does not mean that the dead person is still alive. If the machines are turned off, the heart and respiration will stop because the dead brain is incapable of supporting these functions.

By testing certain functions of the brain and noting their absence, a doctor can pronounce that a person is dead.

The heart can still be beating as the heart muscles can continue to beat for some time after brain death. For the purpose of kidney transplant, it is important that the cadaver donor's heart is still beating for blood to continue circulating into the kidneys to keep them functioning and producing urine. If the heart stops beating for more than an hour, the kidneys, deprived of blood, would be irreparably damaged and be of no use at all in a kidney transplant. This explains why kidneys for transplant must be removed during the time when the person is brain dead rather than wait till the heart stops beating.

What is the Opting Out Law?

In most countries most of the transplanted kidneys are from cadaver donors but in Singapore most of our transplanted kidneys come from living related donors. There is sadly a lack of cadaver donors because relatives have refused to give consent for kidney donation for various cultural and other reasons. These kidneys which are buried or cremated actually go to waste because they could be used to save the lives of a hundred people a year who die needlessly because they are unable to get cadaver kidney transplants. It is a tragedy as the majority are young, aged between 30 and 40. Many are married and are fathers or mothers of very young children. Many are also sole bread winners at the peak of their lives. Most are too poor to be able to seek private dialysis. In many overseas countries they go on to the state-supported dialysis programme and within weeks, receive a cadaver transplant which accounts for 90% of the total transplants done there. In Singapore there are 3 state-supported dialysis centres with about 160 places but since these people cannot undergo transplants because of lack of cadaver kidneys there is no turnover of dialysis places. There are no vacancies in these centres for patients and because of their very small family income they cannot afford to seek private dialysis. As a result most die and only about 20 to 30% of the 200 new patients with end-stage renal failure are saved each year. Most of those who are saved were fortunate to have living related transplants from a parent or sibling. The majority die due to a lack of cadaver kidneys.

The government has studied this problem and has come out with a solution. In 1986, 128 people died from road traffic accidents. To save 100 patients with kidney failure only 50 brain dead cadavers are required because each cadaver has 2 kidneys and a patient with kidney failure needs only one kidney to survive. A law called the Human Organ Transplant Act was passed on 16th July 1987 and implemented in January 1988. The Act allows for the removal of kidneys from Singaporeans and Permanent Residents who die from accidents for the purpose of transplant to kidney failure patients, unless they have specifically objected to this in their lifetime. In some countries like France, Austria, Israel and Belgium where this Act is practised, many patients who suffer from kidney failure have been saved. Next >>>


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