Opening Ceremony Of Transplant Asia 2004

01 Dec 2004

By Dr Balaji Sadasivan, Senior Minister Of State For Information, Communications And The Arts and Health

Venue: Singapore International Convention And Exhibition Centre

Speech By Dr Balaji Sadasivan, Senior Minister Of State, Ministry Of Information, Communications & The Arts And Ministry Of Health, At The Opening Ceremony Of Transplant Asia 2004 On Wednesday, 1st December 2004 At 7.15 Pm At The Singapore International Convention And Exhibition Centre

Sir Roy Calne, Professor of Surgery Emeritus, Cambridge University

Dr Mohamed Sayegh, Chairman, Transplant Medicine, Harvard Medical School & Director, Transplantation Research Centre, Brigham & Women's Hospital and Children's Hospital Boston

Dr Donald E Hricik, Director, Division of Nephrology, University Hospitals of Cleveland & Case Western Reserve University of Medicine

Dr C Sivathasan, President, Society of Transplantation Singapore & Director, Heart/Lung Transplantation Programme, National Heart Centre, Singapore

Mr Richard Yong, Chairman of NKF

Mr TT Durai, CEO and Honorary Secretary of NKF Singapore

Distinguished Guests,

Ladies and Gentlemen

Introduction

It is a pleasure to be here this evening at the opening ceremony of Transplant Asia 2004. This event has brought together over 500 international delegates from around 40 countries to discuss the latest developments and share best practices in the field of organ transplantation. Among us tonight are many leading members of the transplant community. I am sure this meeting will be most stimulating and insightful.

The demand for organ transplantation

Organ transplantation - the ability to replace a diseased organ with a healthy one from another person - is one of the greatest achievements in the history of medicine. However, it is a relatively recent development. The first successes of organ transplantation were reported in the 1950s, but it was only in the 1980s with the development of powerful immunosuppressant drugs that organ transplantation came of age. Presently, it is not uncommon to get a first year kidney graft survival of over 90%. These remarkable achievements in such a short period of time are a testament to the dedication and commitment of the transplant community in helping patients with organ failure.

Today, one of the greatest challenges facing organ transplantation is the shortage of organs. Throughout the world, the demand for organs for transplantation continues to increase. The situation is no different in Singapore. The number of patients waiting for a kidney transplant has increased by more than 3 times from slightly over 200 patients in 1988 to almost 700 patients today. The average waiting time for a cadaveric kidney has correspondingly increased by 3 times from 2 years in 1992 to 7 years in 2003.

Human Organ Transplant Act

The first cadaveric kidney transplant was carried out in Singapore more than 30 years ago in 1970. Between 1970 and 1987, there were only about 100 cadaveric kidney transplants carried out in Singapore. To allow more Singaporeans to benefit from organ transplantation, the Human Organ Transplant Act or HOTA was passed by Parliament in 1987. HOTA was based on the concept of presumed consent and it made possible for the removal of kidneys for transplantation from those who died as a result of accidents, unless they had earlier opted out.

Although more kidneys had been made available for transplant under HOTA, the cadaveric organ donation rate in Singapore had remained low - between 1990 and 2003, the average cadaveric donor rate in Singapore was only about 6.2 per million population (pmp). This was because the scope of the original HOTA had deliberately been kept narrow as Singaporeans were new to the concept of organ transplantation then. With the increasing incidence of patients with organ failure and the growing need for organs for transplant, there was a need to revise HOTA.

In 2003, the Ministry of Health embarked on a series of public consultations and in early 2004, amended HOTA so that even more Singaporeans could benefit from organ transplantation. There were 3 main amendments to HOTA. First, HOTA was extended beyond deaths due to accidents to include all causes of death. Second, HOTA was extended beyond kidneys to also include liver, heart and cornea. And third, HOTA was extended beyond cadaveric organ donation to also regulate live donor organ transplant.

The revised HOTA was implemented on 1 July 2004 and has helped more Singaporeans through the gift of life. In the first 4 months since the implementation of the revised HOTA, there have been 6 HOTA donors. Of these 6 HOTA donors, 5 donors died from non-accidental causes of death and therefore came under the extended clause provided for by the revised HOTA. The organs from these 6 donors benefited a total of 23 patients with organ failure. The revised HOTA will help to save lives and reduce suffering, but it will not solve the problem of organ shortage.

Role of the transplantation unity and community organisations in promoting organ transplantation

I will next like to turn to how the transplant community and community organisations such as the National Kidney Foundation, the Kidney Dialysis Foundation and the Khoo Foundation can help to promote organ transplantation. The community organisations have been extremely successful in developing excellent kidney dialysis programmes and I commend them on this.

Nonetheless, renal dialysis is costly and the patient is dependent on dialysis for the rest of his life. International literature has clearly demonstrated that kidney transplantation is more cost-effective and provides a better quality of life compared to renal dialysis. In Singapore, when we analyse the cost to the healthcare system, the average annual cost of dialysis has been estimated to be twice that of kidney transplantation.

Organ transplantation remains the best treatment option for patients with organ failure. However, we are very much limited by the availability of organs. More recently, living donor organ transplantation has become an important alternative to cadaveric organ donation. The kidney living donor rate in Singapore is low compared to other developed countries. Singapore's kidney living donor rate is 4.4 pmp (per million population). In comparison, the kidney living donor rate is 20.2 pmp (per million population) in the United States and 19.1 pmp (per million population) in Norway. This indicates that there is a large potential for us to enhance our living related donor transplant programme.

My Ministry strongly supports living related donor organ transplantation. Part of the recent HOTA amendments involved putting in place ethical and legal safeguards to protect donors. However, we must go beyond that. I would like to suggest 3 ways in which the transplant community and community organisations can further promote living related donor transplantation.

First, there is a need for more public education. On one hand, there is a need to inform potential donors of the small but nonetheless significant risk of complications. On the other hand, there is also a need to address misperceptions such as organ donation leading to general poor health or the inability to return to their usual occupation. There is also a need to remove the social stigma that is currently associated with live donation. Though live donation should be lauded as an act of courage, often, donors hide the fact from their employers for fear of discrimination at work, or from their relatives for fear of causing unnecessary worry to their relatives. In this regard, the dialysis providers have a huge capacity to reach out through their patients and to the community-at-large to correct these misperceptions.

Second, the community organisations should not just look at the provision of dialysis service as an end-point, but to take it as their mission to reduce the burden of end-stage organ failure. They should do this through the pooling of their resources and investing more resources to support organ donation through social and financial programmes.

Third, the transplant community should continue to focus on research to improve the science of organ transplantation and to collaborate closely to enhance the organ transplantation process. My Ministry set up the National Organ Transplant Unit (OTU) in 2000 to oversee and coordinate all organ transplant activities in Singapore. Beyond this, there remains much opportunity for the transplant community to come together to share their experience and further develop organ transplantation.

Conculsion

There are many other ways which we can all help organ failure patients through organ transplantation. I have but highlighted a few. I am sure many more ideas and approaches would be raised and discussed over the new few days.

In conclusion, I would like to wish all our visiting delegates an enjoyable stay in Singapore. To all delegates, I wish you a most stimulating meeting. It gives me great pleasure to declare Transplant Asia 2004 open.

Thank you.