Outspoken doctor wants to make organ donation a way of life in S’pore

NOTHING thrills kidney transplant veteran A. Vathsala quite like a healthy stream of pee.
 
That first gush after a patient receives a new organ is a sign that the donated kidney has come to life, and has begun to expel the poisons in the body that his own kidneys could no longer cope with.

“The first thing I do after the operation is to look for the urine,” said Professor Vathsala, who heads the Adult Renal Transplantation Programme at the National University Hospital (NUH).

“It’s watching a miracle happen.”
 
In a career spanning over two decades, the 53-year-old senior consultant has taken hundreds of kidney failure patients under her wing.

“Things we all take for granted, going to school, taking care of our children, and even the inconvenience of going to the toilet, they struggle to do.”

“After the transplant, life is virtually back to normal. What keeps me going is seeing my patients living a long, productive life,” she said, pointing out a few highs.

There was the single mother who invited Prof Vathsala to her daughter’s university graduation – she started treating the woman when her daughter was 12; a new mother who sent flowers – she could not have had children without a transplant; and two patients who gave her medals they had won at the “Transplant Olympics”, an international sporting event for transplant recipients.

About 85 people get a kidney transplant each year. Last year, 38 were done at NUH.

Among the most challenging cases last year was that of housewife Daisy Goh whose kidneys were failing. Her husband stepped up to offer his kidney but the blood type was not a match. To make things worse, Madam Goh had a hyperactive immune system which would attack and destroy donor tissue.

Prof Vathsala and her team, including surgeons and other specialists, worked for months to plan the transplant – the first of its kind in Singapore and one of only 40 done worldwide. The procedure included removing Madam Goh’s antibodies by running her blood through a special machine, and dampening her hyperactive immune system with immunosuppression drugs.

“The week before, we were in hospital virtually from morning till night.”

Despite all the challenges, Madam Goh’s kidneys began working almost immediately, and the 36-year-old housewife is now doing very well, she added.

But there are many others who die waiting.

In Singapore each year, more than 1,000 people – about half of them diabetics – lose the use of their kidneys.

When this happens, the best option is a transplant from a living donor. Another option is a kidney from a dead donor, but the average waiting time for this in Singapore is nine years. Nine in 10 transplant patients live for five years or more after their operation.

Dialysis is a poor alternative: Nearly a third of dialysis patients may die within the first year.

There are currently about 460 people waiting for a kidney here.

The outspoken doctor has, together with other doctors, lobbied for years to expand the donor pool, fighting for over a decade, for example, to remove age restrictions on dead donors so that more organs would become available.

Things really began to take shape when she became a consultant on transplantation matters to the Health Ministry in 2004, to look at how to increase awareness on organ donation and make recommendations on how to make more organs available.

“I’m not afraid of being vocal and when I set my mind to something I stick to it like a leech,” she said.

She was gratified by the changes to the Human Organ Transplant Act (Hota) last year.

The age limit for cadaveric donors at 60 years was removed, potentially adding another 10 to 12 donors each year.

Another key change: Living donors could be reimbursed for expenses related to the transplant, allowing them to claim for such things as the cost of health checks, laboratory tests, surgery, hospitalisation and follow-ups, as well as lost income.

Under the National Kidney Foundation’s $10 million Kidney Live Donor Support Fund, needy donors can be covered for medical and insurance expenses, and be paid up to $5,000 for the loss of income due to the procedure.

Prof Vathsala is now in talks with insurance companies to expand coverage to all kidney donors – something which is not available anywhere in the world at present, she explained.

“If we can do this, Singapore will be an example to the world, and we’ll have taken the Istanbul Declaration to the forefront,” she said, referring to the pledge by the international transplant community to work towards prohibiting and fighting against organ trafficking.

She is a steering committee member and the only Singaporean on the team which drafted the declaration.

Firmly against payment for organ donation, she said that the ends of saving lives never justify the means of commercialising transplantation.

“The poor man’s organs cannot end up as body parts for the rich.

“Payment takes away from this act of altruism, but I do believe we should not penalise the donor,” she added.

The way forward for Singapore is to make organ donation a way of life, she said.

“We’re far from it. If people here had a choice, two in three would say no to organ donation.”

“In Norway, for example, the whole family shows up offering to donate to a patient with kidney failure. Grandmothers, husbands, children, everyone donates!

“In Singapore, on the other hand, we often have parents reluctant to donate a kidney to their children.”

With all the pressures and time spent at work, it helps to have a close-knit family, she added.

“We take two solid weeks of vacation together every year,” said the mother of three. Her older son, 28, is doing his PhD in genetics, while her other son, 24, is a science undergraduate and her daughter, 18, is waiting for a place in university.

“It helps to have the best husband in the world,” she added. She is married to Professor V. Anantharaman, senior consultant at Singapore General Hospital’s Department of Emergency Medicine.

Her free time is spent cooking and crocheting.

Her children swear by her pizza, which combines Indian influences with standard pizza ingredients such as tandoori paste with pineapple, said the vegetarian.

And working on her crochet bedspread – a 25-year project so far, that is about a fifth of the way complete – is another way of relaxing.

“Like me, it’s a work in progress,” she says with a laugh.