Fixing the kidney deficit, fast

Oct 6, 2008
Fixing the kidney deficit, fast
Regulating organ trade is best option, owing to extent of problem here
By Salma Khalik , HEALTH CORRESPONDENT - SINGAPORE

IN JUNE, Health Minister Khaw Boon Wan said that there was no possibility of legalising organ trading any time soon.

In July, he raised the idea of a third party making the payment, to put some distance between buyer and seller.

In August, he told Parliament that he would visit kidney sellers in the Philippines, to see the aftermath of their decisions.

Last month, he not only floated the idea of reimbursing those who donate a kidney to someone they do not know, but also asked his officials to calculate a reasonable compensation.

Even for a minister known for getting things done quickly, this rapid change in Government position has surprised many.

But given the information that has surfaced in recent months about the true extent of kidney failure here, such a shift is in keeping with the country's quick reaction to problems.

Real figures and some hard facts on dialysis have emerged, showing that the problem is far greater than many people thought it was.

There were 563 patients waiting for a transplant at the end of last year. What this figure does not reflect is the actual number of people whose kidneys have failed and who could benefit from a transplant.

That figure is in the thousands.

The official number looks somewhat manageable because people are taken off the list once they turn 60. Many of these patients could expect to live for many more years, especially with a transplant.

Others - like retail magnate Tang Wee Sung, who was caught trying to buy a kidney for transplant here - are not on the transplant waiting list simply because they have other medical problems.

In other words, they are off the list, not because they would not benefit from a transplant, but because decision makers have excluded them in order to give healthier patients a better chance of getting the very limited number of cadaveric kidneys available each year.

Given that 1,000 people a year lose the use of their kidneys in Singapore, the number of those here who need a kidney is not small. And the figure is set to go up, due to the ageing population and the high incidence of diabetes - the major cause of kidney failure in Singapore.

What about dialysis?

Many family members of patients, and even patients themselves, wrongly assume that dialysis works as well as does a kidney. They assume the only difference is that the procedure is more troublesome, as patients have to undergo it several times a day or week, depending on the type of dialysis they choose.

Sadly, they are mistaken.

The scary truth is that about a third of patients who go on dialysis die within a few months.

Dialysis survival figures worldwide, Singapore included, do not reflect this high mortality rate. Instead, they use survival figures for 'established dialysis patients' - which only includes patients after they survive the first 90 days.

But if all kidney failure patients are included from the day their kidneys fail, then the numbers look very different. Within the first year, 38 per cent of people on dialysis die, compared to just 7 per cent of people who had transplants.

The opt-out system here for getting cadaveric kidneys, which supposedly yields more organs for donation, has benefited only a few, that too after a wait of up to 10 years. Forty-six got a cadaveric kidney last year, 56 in 2006 and 43 in 2005.

There are even fewer live kidney donations from relatives or friends - 31 last year, 29 in 2006 and 23 in 2005.

Faced with a situation in which hundreds of people are dying early, and needlessly, the minister correctly concluded that doing nothing is not a valid option.

His first actions, including amendments to the Human Organ Transplant Act, have been aimed at increasing the number of cadaveric organs available for donation and at trying to cut the number of kidney failures due to diabetes. But these changes alone will not be enough.

This is especially so when it is no secret that illegal transactions are taking place. The ministry is quite open about the 20 to 30 people who ask to be taken off the waiting list for kidneys each year, because they have had a transplant overseas.

It is true that the authorities do not know for a fact that such overseas transplants are illegal. They do not question these patients on their return, but simply help them with subsidised medicine to prevent their bodies from rejecting their new organs.

The actual number of Singaporeans who get transplants abroad is likely to be much higher. But the ministry would not be informed as these people are not on the waiting list - either because they are too old or have other illnesses.

It is obvious that a black market for organs exist, and that Singaporeans are among those who make it happen.

With all this coming to light, it is no longer feasible to simply ignore the situation. Doing so means passively endorsing the exploitation of poor sellers.

There is also a move worldwide towards finding some equitable way of compensating 'altruistic donors'.

Even the Declaration of Istanbul, in which 150 doctors, ethicists and government representatives condemned the sale of organs earlier this year, stated that there was nothing wrong with thanking a donor by ensuring he does not suffer from the life-giving gift he has made.

Given the great need for donated organs, the likelihood that the problem will get worse over the years, plus international acceptance that some compensation is due the donor, it should not be surprising that Mr Khaw's attitude has changed.

Once it is accepted that doing nothing about the situation is morally wrong, as it condones exploitation, it follows that the faster regulations are in place, the better for all.

For objectors, Mr Khaw might be moving too fast. For patients who are likely to die as the debate continues, it cannot be fast enough.

salma@sph.com.sg

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