| Opinion |
SEPTEMBER , 2022 | THE HEALTH
Kidney transplant the viable option
While dialysis is indeed a life-saving treatment , a kidney transplant is a better choice for a vastly improved quality of life
WHEN it comes to end-stage kidney disease ( ESKD ), the viable treatment is a kidney transplant . It offers an effective cure for the condition , thus vastly improving the patient ’ s chances of survival and quality of life and helping to cut down on their medical expenses in the long term .
In ESKD , both the patient ’ s kidneys have essentially failed to remove waste products and excess fluid from the body . Dialysis , whether haemodialysis or peritoneal dialysis , is prescribed to perform this duty artificially instead .
While dialysis is indeed a life-saving treatment , it cannot fully substitute for even one functional kidney . This leaves patients vulnerable to health complications arising from ESKD and the dialysis itself .
These include fatigue , muscle cramps , anaemia , renal bone disease , and heart disease . In fact , only 52 per cent of Malaysian patients on dialysis are still alive five years after they start the treatment . In contrast , the five-year survival rate for those who undergo a kidney transplant is 90 per cent .
There is also a vastly improved quality of life for patients who go from being on dialysis to receiving a donated kidney to replace their non-functioning ones . The most obvious advantage is that the patient ( and their families ) no longer needs to plan their lives around the patient ’ s dialysis schedule .
This would involve spending around four hours at a haemodialysis centre three times a week for those on haemodialysis . Those on continuous ambulatory peritoneal dialysis would have to undergo the dialysis process four times a day for a period of 30 to 40 minutes each time . And
BY DR WONG HIN SENG even for those on automated peritoneal dialysis , which probably offers the most flexibility among the dialysis options , the patient must undergo the procedure for 8 to 10 hours daily , usually asleep at night .
Cost of a kidney transplant
Kidney transplantation removes the need for this huge time commitment . Instead , those who have received a donated kidney mainly need to take immunosuppressant medications for the rest of their lives to ensure that their body does not reject the donated kidney – and of course , live an overall healthy lifestyle .
Dialysis is a lifelong treatment , and the expenses can certainly accumulate to a large amount over time . According to a study by Surendra et al ., the annual cost for a haemodialysis patient is RM39,790 , while the cost for a patient on continuous ambulatory peritoneal dialysis is RM37,576 .
While just over two-thirds ( 67.1 per cent ) of dialysis patients are sponsored by the Malaysian government , 14.9 per cent are self-funded , with the rest paid for by charities ( 13.2 per cent ), employers ( 1.3 per cent ), insurance ( 0.5 per cent ) and other sources .
In contrast , the transplant services provided by Ministry of Health ( MoH ) hospitals – namely , Hospital Kuala Lumpur and Hospital Selayang , Selangor – are heavily subsidised . Transplant recipients pay only RM1,000 for the entire procedure and are also provided with expensive , lifelong immunosuppressant medications for free .
Kidney donors do not have to pay for the transplant surgery and will receive free medical care at MoH hospitals for the rest of their lives . Meanwhile , transplant services and medications in Ministry of Education hospitals , e . g . University
Malaya Medical Centre in Kuala Lumpur , are only partially subsidised . The hospital bill for the transplant is expected to be around RM50,000 to RM60,000 while those who opt to do their transplant at a private hospital can expect to pay between RM70,000 and RM100,000 for the recipient ’ s surgery and another RM40,000 to RM60,000 for the donor .
Finding donors a challenge
Organ donation in Malaysia is strictly voluntary and cannot be done in exchange for any reward or compensation ( cash , property , career advancement , etc ). While the majority of organs can only be harvested from a deceased donor , kidneys are one of the two organs that can be donated by a living donor ( with the other being part of the liver ).
This is very important for ESKD patients as deceased donors are very rare in Malaysia . Based on the MyKAS ( Malaysia Kidney Allocation System ) database , there are currently 10,278 ESKD patients awaiting a kidney transplant . However , only 20-40 kidney transplants involving deceased donors are performed annually , accounting for approximately one per million population ( pmp ).
However , a living donor can only give a kidney to their spouse , first-or seconddegree relative . A first-degree relative is one ’ s parent , child or full sibling . A seconddegree relative is one ’ s grandparent , grandchild , aunt , uncle , nephew , niece or half-sibling . It is also possible for a living donor to donate to a more distant relative , or even a non-family member . But permission must be obtained from the MoH ’ s Unrelated Transplant Approval Committee ( UTAC ) before this can occur .
Overall , it is also better for the patient to receive an organ from a living donor who would have been evaluated for their suitability and health before the procedure . This is as kidneys from brain-dead donors are harvested and preserved in ice ( usually for several hours ) before the kidney is transplanted into the recipient .
Furthermore , the deceased donor would likely have developed acute kidney injury before organ procurement . Hence , kidneys from deceased donors generally have poorer graft survival , i . e . the transplanted kidney does not last as long as a kidney from a living donor .
The annual rate of graft loss , where the patient has to be put back on dialysis because their graft has failed , is four per cent . These are still excellent odds compared to the ESKD patient remaining on dialysis and not undergoing a kidney transplant at all .
At the end of the day , an ESKD patient who has received a donated kidney will have a better chance of living longer and better than someone who remains on dialysis . Such a patient would also be able to resume their career , with no restrictions as to their occupation , if they are of working age .
Younger patients would also be able to start a family if they wish , which would be very hard to do while on dialysis . Therefore , if there is a chance for an eligible ESKD patient to receive a donated kidney , whether , from a deceased donor or a living one , we strongly advise and encourage them to do so . – The Health
Dr Wong Hin Seng is Senior Consultant Nephrologist , Head of the Renal Transplant Unit , Head of the Department of Nephrology and Head of the Clinical Research Centre at Hospital Selayang , Selangor .