Organ transplant in Malaysia: Large number of potential donors but inadequate surgeons

KUALA LUMPUR (THE STAR/ASIA NEWS NETWORK) - Malaysians spend years on the organ transplant waiting list in public hospitals not because of a lack of organ donors, but because hospitals cannot handle the sheer number of requests.

An average of 60 organ transplants are done in government hospitals a year but there are 18,000 Malaysians on the waiting list.

The problem is there are only a dozen dedicated transplant surgeons in government hospitals, said Health Ministry deputy director-general Datuk Dr Jeyaindran Sinnadurai.

Malaysia has a large pool of potential donors - over 300,000 citizens have pledged their organs for use after their death. This does not include the living, related donors and other forms of organ donation methods.

"However, most transplants are done by general surgeons and the process is slow because they also have to juggle their daily duties," Dr Jeyaindran said.

This means even if a patient is ready to undergo surgery in three months, he or she has to wait years.

To remedy the situation, Hospital Kuala Lumpur (HKL) has linked up with the renowned Royal Prince Alfred Hospital (RPAH) in Sydney to exchange ideas on improving transplant services in government hospitals.

RPAH's kidney transplantation director Prof Steve Chadban, who is coordinating the programme, said there was a long waiting list and a shortage of donors in most countries.

"In Malaysia, however, there is a long waiting list coupled with an equally substantial list of potential donors.

"But the roadblock is the mechanism to transplant the organs, which is an unusual situation anywhere in the world."

With a waiting list of 200 people and an average 80 transplants a year, RPAH is a model for general hospitals here.

Like most other public hospitals in Australia, RPAH relies on a dedicated transplant team of doctors, nurses and healthcare workers on the ground to help the organ retrieval process.

HKL nephrology department head and senior consultant Datuk Dr Ghazali Ahmad said government hospitals here should first streamline their different departments to fast-track transplant procedures.

"For a transplant surgery, we need, among other things, an assured operating theatre and an experienced anaesthetist to handle situations that may go beyond the transplant surgeon's capacity.

"We also need services from departments like radiology and nuclear medicine, but they have their own waiting list, so there is no systematic way of prioritising procedures."

Ironically, Malaysian government hospitals conducted a lot more organ transplants in the 1980s and 1990s.

Dr Ghazali remembers a time when HKL alone did about 50 surgeries a year. Today, it conducts only about 30 such transplants a year.

"At the time, our doctors and nurses were sent to prestigious international institutions, including RPAH, for formal training on transplantation," he said.

"In those days, alternative treatment like dialysis was not easily available, so the fastest and best treatment was organ transplantation," said Dr Jeyaindran.

"Nowadays, dialysis is widely available, so people are more likely to choose dialysis over surgery."

However, the experts believe organ transplantation provides a better quality of life after the procedure.

Prof Chadban said patients who undergo organ transplant pay the same amount as one undergoing initial dialysis treatment at a hospital. The subsequent treatment, however, costs only a quarter of that amount.

"Also, a patient can rejoin the workforce about six months after the surgery," he said.

Asked what Malaysia would benefit from its collaboration, Dr Ghazali said HKL too wanted its own dedicated transplant team.

"Apart from getting formal training for our healthcare workers, this twinning programme will ensure we get used to our partner hospital's way of fast tracking transplant procedures," he said.