Worrying lack of transplants

Experts: More kidney failure patients turning to dialysis instead

KUALA LUMPUR: It is cheaper and proven to boost the quality of life of kidney failure patients compared to dialysis.

However, kidney transplants still severely trail behind dialysis rates in Malaysia.

The latest statistics show that dialysis patients outnumber those who have undergone transplants by over twenty-fold.

About 40,000 Malaysians are on dialysis today – a prevalence rate of 1,286 per one million population (pmp).

But this number is 21.8 times more than patients who had transplants (59 pmp).

This is based on data from the 2016 Malaysian Dialysis and Transplant Registry and National Renal Registry made available to The Star.

The low prevalence of Malaysians who had transplants (59 pmp) also pales in comparison with countries such as Japan (64 pmp), Thailand (114 pmp), New Zealand (369 pmp), Australia (444 pmp) and Britain (482 pmp).

There were 82 new kidney transplants in 2016, but it was a drop in an ocean compared to the 7,663 new patients put on dialysis that year.

And as the number of dialysis patients rises yearly, the number of new kidney transplants continues to dwindle.

Some 141 transplants were done in 2009. But last year, only 81 transplants were performed, according to the Health Ministry.

“This brings the rate of new kidney transplants in Malaysia to a miserable level of only three transplants per one million population,” said National Renal Registry chairman Datuk Dr Ghazali Ahmad in an interview.

Aside from the lack of organ pledges, getting consent from family members of a deceased person is also a hurdle.

“Medical staff can only approach family members if the patient is confirmed to be brain-dead.

“The challenge arises because there are few patients in intensive care units (ICUs) who meet the criteria as an organ donor.

“From this small pool, some families will refuse to donate the patients’ organs.

“This may happen even though the deceased had signed up as an organ donor previously,” said Dr Ghazali, who is also Malaysian Society of Transplantation president.

It does not help that there is no clear policy or written guidelines on such contradictions to date.

Dr Ghazali said kidney trans- plants should be made the officially preferred and prioritised form of renal replacement therapy instead of dialysis.

“With transplants, patients will enjoy longer life expectancy, productivity and quality of life compared to dialysis patients,” he said, adding that kidney transplants also save more in healthcare costs.

For every successful transplant, over RM10,000 can be saved every year per patient from the second year onwards, compared to maintaining a patient on dialysis.

Meanwhile, two experts on transplantation from the University of Sydney, Australia, recently shared best practices with doctors at Hospital Kuala Lumpur.

Professor of medicine Steve Chadban proposed to have a few people in key hospitals whose specific role is to look for potential organ donors.

“If this demonstrates success, it can be applied elsewhere,” he said.

Richard Allen, a professor of transplantation surgery, said a simple way to increase donors was to do a daily audit on deaths in ICUs of designated hospitals.

This brings the rate of new kidney transplants in Malaysia to a miserable level of only three transplants per one million population.

Datuk Dr Ghazali Ahmad