Even after someone has agreed to donate a kidney, it can take another 15 months or more before a transplant goes ahead. Both the organ donor and recipient have to go through a series of tests to evaluate, among other things, their health, fitness and suitability.

Kidney failure patients typically make multiple visits to the hospital to take different tests or see different specialists. Many find it difficult to take time off from work, and some find the evaluation process too tedious. But a long evaluation time increases a patient’s risks. Starting dialysis in the meantime adds to his chances of developing and dying from cardiovascular disease and complications.

So a team from Singapore General Hospital’s (SGH) Department of Renal Medicine decided to look at how evaluation time can be reduced. “By identifying bottlenecks and streamlining the evaluation process, we managed to reduce the evaluation time by 60 per cent,” said Dr Terence Kee, Senior Consultant, Department of Renal Medicine, and Programme Director, Renal Transplantation, Singapore General Hospital.

This much shorter evaluation time is possible because some tasks are now done at the same time, instead of one after another. “For example, the screening for both recipients and donors is now done concurrently, and we carry out multiple screenings if there is more than one potential donor,” said Ms Tee Ping Sing, Senior Transplant Coordinator, SGH. “In the past, recipients were screened first, before donors, and this takes up to seven months if the donor isn’t rejected for health reasons. The screening process now takes about half the time as before.”

Some investigations and consultations with other clinical specialists are arranged ahead of time, instead of after patients have seen their nephrologists. For instance, patients over the age of 50 now see a cardiologist on the same day as their nephrologist.

Some standard tests that patients have to undergo are pre-ordered as part of standard procedure, saving them a visit to the clinic. They now just make one visit to a specialist to review their test results, instead of two (to have the test done, and the results reviewed).

Transplant coordinators have also been given the authority to order simple blood and urine tests as the initial step in the evaluation process for certain cases without first getting approval from Dr Kee. When he is away, it can mean several days’ delay.

The shorter evaluation period doesn’t guarantee that patients will go through a living donor renal transplant, but it does help SGH assess more patients for the procedure more quickly, said Ms Tee. A shorter evaluation process, she added, is also less tedious for patients.

More patients have undergone transplants as a result of the team’s streamlined processes. In 2013, 20 living donor renal transplants were performed at SGH, compared to an average of nine a year between 2010 and 2012.

SGH ’s Kidney Transplant Programme currently cares for 825 transplant recipients and 170 living kidney donors. The hospital has performed more than 1,200 kidney transplants. Some 750 new cases of end-stage kidney failure are diagnosed every year in Singapore. Waiting for a kidney from a deceased donor takes many years.

Dialysis or transplant when kidneys fail

When a patient’s kidneys can no longer clean his body of waste products and excess fluids, dialysis or a kidney transplant is needed. Dialysis, be it haemodialysis or peritoneal dialysis, cannot remove all the toxins, putting patients at risk of developing further complications such as cardiovascular disease.

In haemodialysis, blood is drawn from the patient and circulated in a machine with a special membrane to filter waste substances. The cleaned blood is returned to the patient. In peritoneal dialysis, a special sterile fluid circulates through the abdomen to draw impurities from surrounding blood vessels in the peritoneum, which is then drained from the body.

End-stage kidney failure patients who opt for a transplant either join the long national queue for an organ from a deceased donor or receive a kidney from a living donor (usually a family member). A patient’s condition can deteriorate and complications can set in during the long wait. Studies have also shown that a kidney transplant from a living donor gives the best result of all treatment options.

Ref: Q15