Launch of National Transplant Awareness Campaign and Donor Appreciation Ceremony

12 Nov 2005

By Dr Balaji Sadasivan, Senior Minister of State for Information, Communications and the Arts and Health

Venue: 29 Heng Mui Keng Terrace, The Auditorium

Dr Gordon Ku, Chairman, Kidney Dialysis Foundation,

Dr Pary Sivaraman, Medical Director of People's Dialysis Centre, representing the Khoo Foundation,

Dr A Vathsala, Chairman, Organising Committee,

It gives me great pleasure to be here today at the launch of the National Transplant Awareness Campaign and the Donor Appreciation Ceremony.

The transplantation of organs and tissues is a miracle of modern science. Transplantation of kidneys, heart, lung or liver gives a new lease of life to patients with organ failure. Bone marrow transplantation can cure many diseases of the blood, while cornea, bone and skin transplantation can help restore sight, help a crippled man to walk or heal the skin in burn patients. This year's theme to promote National Transplant Awareness is focused on Live Donor Kidney Transplantation and is appropriately named "Share A Life".

Singapore has a high rate of kidney failure. On the average, every year, 750 new kidney failure patients are started on dialysis. The majority of these kidney failure patients are treated with maintenance dialysis rather than with kidney transplant as only 60 to 70 kidney transplants are performed for Singaporeans every year and the number of patients on dialysis is increasing annually.

Kidney transplant patients live longer than their dialysis counterparts and spend fewer days hospitalized. Transplant patients lead richer and fuller lives, partly because they are healthier, spend less time undergoing the dialysis procedure and have higher employment rates. In fact, female transplant patients can even undergo successful pregnancies, an event which occurs rarely in dialysis patients.

There are of course two possible sources of kidney transplants, live donors and cadaveric donors. Cadaveric donors are those who have died. My Ministry has been working hard to increase the number of cadaveric kidney transplants in Singapore. In 1987, the Human Organ Transplant Act was passed to allow kidneys to be removed from Singaporeans and Permanent Residents who had died of accidents, provided they had not objected during their lifetime. In July 2004, this Act was extended to cover non-accidental causes of death and to include the heart, liver and corneas. The cadaveric kidney transplant rate for Singapore in 2004 is 9.2 per million population, the highest in Asia.

Notwithstanding its success, cadaveric kidney transplants are not enough to meet the needs of the large and growing numbers of patients with kidney failure in Singapore. At present, about 620 dialysis patients are on the waiting list for a kidney transplant from a cadaveric donor. These patients generally wait about 7 years for a cadaveric kidney transplant in Singapore. Many dialysis patients die or become medically unfit to receive a kidney transplant while on this waiting list.

For these reasons, it is important to promote live donor kidney transplants. Live donor kidney transplant recipients live longer, have better kidney function and fewer complications than their cadaveric kidney transplant counterparts. Whereas the average live donor kidney transplant will still be functioning 32 years from now, the survival for a cadaveric kidney transplant may be only 21 years. This is because, kidneys for live donor kidney transplants tend to come from very healthy donors. The greatest advantage is that live donor kidney transplants can be performed even before the kidney failure patient starts dialysis, completely avoiding the risks and costs of dialysis. Thus live donor kidney transplant saves more lives than any other treatment for kidney failure and is the best treatment for kidney failure.

Sadly however, our live donor kidney transplant rate for Singaporeans is low at only 7.5 per million population. Norway and USA have among the best live donor kidney transplant rates in the world at 20.8 per million population and 22.5 per million population respectively.

Therefore, there is a lot that can be done in Singapore to enhance live donor kidney transplantation and promote it as first choice therapy for the treatment of kidney failure. Early in 2005, the Ministry of Health facilitated the establishment of a multi-sectoral group, including kidney specialists, transplant coordinators and medical social workers from various hospitals, Voluntary Welfare Organisations and the Society of Transplantation (Singapore) to identify obstacles to live donor kidney transplant and to plan a cohesive and holistic approach to overcoming these obstacles.

The workgroup has identified inadequate patient education as a key obstacle to live donor kidney transplant. Kidney failure patients and their family members mistakenly believe that dialysis is as good as transplantation. Indeed this is not true; live donor kidney transplant is a much better treatment for kidney failure than any other and should be first choice treatment. Families of patients with kidney failure often do not come forward to donate a kidney for transplant, even to someone they care for, out of fear that donating a kidney may be dangerous. I can understand this fear. Donors in our public hospitals have developed complications and have died. I understand that in Norway there has been no mortality among donors despite more than 4000 renal transplantation surgery procedures. We need to learn from countries like Norway. We must never be afraid to learn from others. We must constantly review all our procedures to ensure that the highest standards are always maintained. Then, I am sure more people will come forward and donate their kidney.

Today marks the launch of the National Transplant Awareness Campaign which we hope will be held annually to increase the awareness on transplantation in Singapore. Today also marks the launch of many of the initiatives that the workgroup has put together to improve the live donor kidney transplant rate in Singapore.

At today's Donor Appreciation Ceremony, over 100 kidney donors, who have donated kidneys previously to their loved ones are being honoured for their act of courage. These people have undergone an operation, not to help or heal themselves, but to help someone else be healed. They must be truly commended and they are the heroes of our times, giving selflessly of themselves. It is indeed my privilege to award them their Badge of Courage today. We hope that many of these donors, by sharing their stories with others, will have demonstrated the safety of donating a kidney; we hope that these donors serve as a shining example for others to follow their path of altruism.

There will also be a patient education seminar on various aspects of kidney transplantation. It is hoped that patients who are on the waiting list and their families will see the benefit of live donor kidney transplant and opt for this instead of waiting for a cadaveric kidney transplant. So as to increase patient awareness about live donor kidney transplant, the workgroup has also prepared a video on live donor kidney transplantation. This video was commissioned by the Khoo Foundation and supported by the Kidney Dialysis Foundation and had the participation of our public sector hospitals. Again, I am pleased to see all these organisations working together to provide education on live donor kidney transplant to kidney failure patients. Hospitals and clinics will likely use this video to encourage kidney failure patients and their families to consider live donor kidney transplant as the first option for their treatment.

Later this week, professionals will share information on the advances in live donor kidney transplant at the Society of Transplantation's Annual Scientific Meeting. Pre-emptive kidney transplantation or transplantation just before the need for dialysis will be an initiative that will be discussed at this meeting and I urge all kidney specialists and kidney coordinators to keep up with these advances.

The Singapore Transplant Games, organized by the Society of Transplantation, is yet another event promoting National Transplant Awareness, which will be held at the end of this week. The Games will be yet another testament to the success of kidney transplantation, and will showcase the abilities of transplant patients in sports.

Promoting live donor kidney transplantation in Singapore will allow more kidney failure patients to benefit from kidney transplantation and reduce the numbers of dialysis patients waiting for a cadaveric transplant and their waiting times. Giving a kidney for donation is more than an act of giving; it is an act of sharing a life.

I am now pleased to launch the National Transplant Awareness Campaign. 

Thank you.