New lease of life
With Singapore's ageing population, more needs to be done to persuade potential donors to give patients on the organ transplant waitlist a second chance at life
Heart transplant recipient Lim Gek Chan is so thankful to be alive he is paying it forward - by donating his own heart valves.
Mr Lim, 50, who is unemployed, had a heart transplant in February.
He said in Mandarin: "I'm grateful for my new heart. Without the donor prior consent, I would not be alive."
Mr Lim has donated his own heart valves to the National Cardiovascular Homograft Bank. (NCHB). Deemed healthy by his doctors, they were recovered for donation during his heart transplant operation.
He said: "My heart valves can help others, so I might as well donate them."
Such a mindset is what the people behind the Human Organ Transplant Act (Hota) and other organ transplant
Professor London Lucien Ooi, chairman of the division of surgery at Singapore General Hospital (SGH), said:
"Organs do not go on working forever. They fail for a variety of reasons, namely ageing, over-use and disease.
"In kidney failure cases, dialysis is not an ideal long-term solution as the patient is tied to a machine. With a transplant, you replace what is lost."
A spokesman for the Ministry of Health said organ donation is important because same 500 patients in Singapore
are currently awaiting the chance for a new lease of life through organ transplant.
As of last month, the waitlist reads: 468 for a kidney transplant; six for a new heart; 25 for a liver; and 31 for a
The average waiting time for a cornea, liver or heart is a few months. The avernge waiting time for a kidney is between five and seven years.
Currently, the organs and tissues which are donated and transplanted in Singapore include the heart, lung, liver,
kidney, cornea, skin, heart valves, bone, bone marrow and cord-blood stem cells.
Of these organs and tissues, Hota covers four - kidney, liver, heart and cornea.
Under Hota, the kidney, liver, heart and cornea used for organ transplants must come from Singaporeans or permanent residents who had died from any cause.
Hota also provides for the regulation of living donor organ transplantation where a living person donates a kidney
or part of a liver to another person. Organs and tissues which can be obtained from living donors include the
kidney, liver, bone marrow and cord blood.
Age is no barrier
The Straits Times reported last Thursday that 75-year-old Madam Chee Leng Yin was the oldest living donor in Singapore. She had donated a kidney to her daughter, 46-year-old Shirley Lau in July.
When asked if organs or tissues from older donors are less healthy than those from younger donors, Prof Ooi said: "It is not the donor's chronological age that is important.
"An 80-year-old can have the body of a 60-year-old."
There are several transplant programmes in Singapore covering various organs, with the newest being the NCHB.
Set up in February last year, it creates a safe, reliable and affordable supply of heart valves, trachea tissues and iliac vessels (one of the blood vessels of the heart) in Singapore.
Since its inception, the bank has recovered 40 heart tissues from 15 donors. Between 40 and 50 per cent of the recipients of these tissues are children, most of whom suffer from debilitating heart conditions.
Many have Misconceptions
While Singaporeans are now more open to donating their organs after death, - medical professionals Mind Your Body spoke to said more needs to be done to persuade and encourage potential donors.
Ms Tracy Seck, a clinical coordinator at NCHB, which is part of the National Heart Centre Singapore, said a
challenge she faces is convincing deceased patients' next-of-kin to agree to donate the deceased's organs and tissues.
She said, that some families may decline donation as they do not want their dead kin to be cut up.
In cases when families do agree to donate, she said: "There's always a timing issue. Families usually want to
claim the patient's body quickly.
'Upon consent, I have to activate the surgical team as quickly as!possible." As the NCHB deals with heart vaives,
trachea tissues and iliac vessels, which are not covered under Hota, families can decline to donate these tissues
belonging to their dead kin.
Families cannot decide to donate organs such as kidneys, livers, hearts and corneas, which come under Hota if
their dead kin had not opted out of the scheme. However, they can impose a time limit within which the organ
recovery operation must be performed.
Besides the pressing need to deal with funeral matters, the deceased's family may resist or decline organ donation due to misconception of transplant procedures.
Associate Professor Heog Wee Jin, the head of cornea and refractive surgery at NHG Eye Institute at Tan Tock Seng Hospital, said of cornea harvesting: "A big rnisconception among the public is that the deceased's entire eyeball is removed.
"We remove only the cornea which is the transparent layer covering the front of the eye, leaving the rest of the eye intact."
He added that it takes just 10 to 15 minutes to harvest one cornea.
The deceased's body is treated with respect and handled gently. Prof Heng said: "After removing the corneas, we replace them with artificial plastic coverings so the shape of the eye remains unchanged.
"Then we close the deceased patient's eyelids."
Once a potential donor is identified, the Ministry of Health and the National Organ Transplant Unit (Notu) are notified. Notu officials go through their waiting lists and match the donor organs to the most suitable individual
whose case is the most urgent.
While transplantation is no magic cure-all, Prof Ooi said that if there are no issues with rejection and the recipient takes good care of his health, transplanted organs can last to 20 years or even more.
Liver, heart, lung and kidney transplants are often the best treatment for patients suffering end-stage failure of such organs.
Prof Ooi said: "Donating your organs is a gift of life."
When asked why organ donation is necessary to the health-care system, Professor Donald Tan, the medical director of Singapore National Eye Centre and Singapore Eye Bank, said "Many patients today need comeas, kidneys, hearts, livers and so on live or recover a full and active life.
"As many of these conditions occur mainly in the elderly, especially corneal diseases, this becomes even more
important as Singapore's ageing population continues to rise."
When someone who has already agreed to donale his organs or tissues dies or when the family consents to organ or tissue donation, harvesting of the organs or tissues is done in a single operation.
Only healthy and disease-free organs or tissue are recovered.
Doctors first remove the heart and lung, followed by the liver and kidney. Recovery of other tissues like skin or corneas comes after.
The heart and lungs have to be transplanted within four hours of the donor's death while the liver and kidney need to be transplanted within 12 and 24 hours respectively. This is because they cannot survive out of the human body for long.
Upon removal, the organs are kept in a chemical solution and cooled in ice to preserve them and keep them viable for transplantation.
Other tissues can be kept for longer. For example, heart valves are stored in liquid nitrogen at minus 180 deg C for up to five years.
Associate Professor Heng Wee Jin, the head of cornea and refractive surgery at NHG Eye Instiitute at Tan Tock Seng Hospital. explained: "The heart, lungs, kidney and liver are vascular tissues as they undergo cellular death without blood circulation."