Fewer people on waiting list for kidney transplant

Dialysis patient Mohd Masri Sapawi, 69, feels it would be a waste to get a kidney transplant at his age, but an MOH spokesman said a transplant "has been shown to provide better quality of life and survival outcomes".
Dialysis patient Mohd Masri Sapawi, 69, feels it would be a waste to get a kidney transplant at his age, but an MOH spokesman said a transplant "has been shown to provide better quality of life and survival outcomes".ST PHOTO: ONG WEE JIN

Reasons for sharp fall in numbers include patients being too old or ill for procedure

The number of people on the waiting list for a kidney transplant has fallen, in part due to many patients being too old or ill to undergo the procedure.

There were 563 people on the waiting list for a cadaveric kidney in 2007, but this has fallen sharply to just 253 as at June 30 last year.

A cadaveric kidney refers to one taken from a deceased person; a kidney can also be transplanted from a living donor.

Yet the number of transplants has actually fallen, from 82 in 2007 to 72 in 2016.

Dr Terence Kee, medical director of the Kidney Transplant Programme at Singapore General Hospital (SGH), said one reason for the drop in patients waiting for a transplant could be that more are experiencing kidney failure later in life.

In 1999, the average age of new dialysis patients was 50.4 years. By 2015, it had gone up to 61.8 years.

Dr Kee said that many of these elderly patients who start dialysis have other medical problems that rule out a kidney transplant.

And many of those who are eligible do not want a transplant because "they perceive themselves as being too old to benefit", he added.

This is totally not true, said Dr Kee, since older patients fare much better with a transplant than if they were to stay on dialysis.

One study showed that 90 per cent of patients aged 60 and older who had a transplant were still alive five years later, compared with only 30 per cent of those who stayed on dialysis.

But while the transplant list has shortened, the wait for a cadaveric transplant remains about nine years, said a Ministry of Health (MOH) spokesman.

She said this is because of the small number of kidneys available "as not all donors are clinically suitable to proceed with donation".

Over the past 10 years, the number of cadaveric kidneys for transplant has ranged from 17 to 46 a year.

Meanwhile, every year, about 175 people are taken off the waiting list for various reasons, including patients opting out.

Dr Kee would like to see more living donor kidney transplants. Among patients who received a kidney from a living person, 96.4 per cent lived longer than five years, compared with 90.9 per cent of those who received a cadaveric kidney.

The National University Hospital noted that "after donating a kidney, the remaining kidney compensates well and functions just as well". Donors are also less likely to suffer from kidney failure.

 

The oldest living kidney donor at SGH was 75 years old, and the oldest recipient was 73 years old, so it is a myth when people say they are too old for a transplant, Dr Kee said.

Mr Mohd Masri Sapawi, 69, is one such patient. He suffered from kidney failure at the age of 61, but refused to go on the waiting list for a kidney because he felt it would be a waste at his age. He has been on dialysis since 2008.

"I see many younger people with kidney failure. Better for them to get the kidney. If I get a transplant and die after two years, it would be such a waste. They have many more years, let them enjoy their lives," he said.

One of his sons had offered him a kidney, but he turned it down.

The MOH spokesman said that transplant is preferred over dialysis as "it has been shown to provide better quality of life and survival outcomes".

There were 6,700 people on dialysis as at the end of 2016.

The number of people suffering from kidney failure has been increasing, from 679 in 1999 to 1,671 in 2014. Two out of three cases were caused by uncontrolled diabetes - which means that every day, three diabetics lose the use of their kidneys.

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A version of this article appeared in the print edition of The Straits Times on January 03, 2018, with the headline 'Fewer people on waiting list for kidney transplant'. Print Edition | Subscribe