At the SingHealth Duke-NUS Transplant Centre, giving happens in many forms, whether it is a parent donating a liver to save the life of the child; a grieving family donating the heart of their deceased loved one; or an individual making a gift in support of the Transplant Centre’s lifesaving work.
Dr Tan Ek Khoon, Consultant, Department of Hepatopancreatobiliary & Transplant Surgery, Singapore General Hospital, shares how research opens up new avenues and possibilities for organ donation, and how philanthropy allows more patients to benefit from this gift of hope.
Q: What is the landscape of organ donation in Singapore?
A: Every year, more than 500 persons are on a waitlist for a life-saving organ transplant in Singapore. Despite the opt-out Human Organ Transplant Act (HOTA) and opt-in Medical (Therapy, Education and Research) Act (MTERA), the organ donation rate of Singapore is amongst the lowest in the world at 4.48 deceased donors per million population1.
As a result, most patients who require urgent transplantation due to severe organ failure will unfortunately succumb to their disease. For patients with end stage kidney disease, the waiting time for a deceased donor kidney transplant can be up to 10 years, which in turn, translates to 10 years of haemodialysis or other renal replacement therapy, unless a living donor kidney transplant can be performed promptly.
Q: How can research alleviate the shortage?
A: Living donor transplantation has helped to partially alleviate the shortage of organs to meet the demand of patients with end-stage organ disease or malignancies. There is, however, one major limitation: even with a willing healthy living donor whose organ was found to be suitable, the donor could be of a different blood group from the intended recipient. If the blood groups are incompatible, there is an increased risk of graft failure from antibody-mediated rejection.
Advances in the understanding of immunology have now made transplantation across blood groups a reality. This is known as ABO-incompatible or ABO-i transplantation. It involves using medication to pre-condition the recipient, close monitoring for development of rejection, and the use of immunomodulating agents to treat rejection should it occur. However, the threat of antibody-mediated rejection has not been completely eradicated and more needs to be done to understand and improve the management of ABO-i transplantation.
We believe that advances in research toward ABO-I transplantation will help to mitigate the overwhelming demand for deceased donor organs, reduce patient mortality and improve patients’ post-transplant survival rates. In Singapore, it will deepen and strengthen our transplant programmes and expertise as patient volume increases.
Q: What needs to be done so that ABO-i transplantation can be a safe and viable alternative to all patients in need of an organ transplant?
A: Through extensive bio-profiling of donors and recipients, we can determine genomic signatures that can predict the risk of antibody mediated rejection, detect subtle biochemical changes that indicate early rejection so that prompt intervention can be performed, and provide precise immunosuppression to reduce the risk of complications from these medications. Unfortunately, these tests are expensive due to the specialist manpower, equipment and logistical support that are required. Philanthropic partnerships go a long way by fuelling constructive and novel research to understand the science and develop new treatment methods to make organ transplantation safer.
Q: How does the TRUEFund help patients?
A: The “TRUE” in TRUEFund presents Transplant Research, Unique care and Education. Established in 2010, the fund is set up for the benefit of needy transplant patients, public education campaigns for organ/tissue donation and transplantation, and transplantation research initiatives.
For many patients, the transplant journey is an exceedingly long and arduous one. A number of patients who are preparing for or have undergone transplants are unable to hold down full-time or regular employment. It can be difficult to even manage the financial cost of transportation to medical reviews and appointments, or to afford items like a blood pressure machine which, albeit a one-off expense, is not covered by Medifund. TRUEfund helps to bridge that gap for those assessed by medical social workers to have significant financial need. The assistance rendered by the TRUEFund gives these patients some peace of mind so they can focus on the recovery process and obtain the best outcome of their transplant procedure and their new gift of life.
ABO-i transplantation is one of the many life-saving transplant research projects that are taking place under the auspices of the SingHealth Duke-NUS Transplant Centre. Over the years, the Centre has taken immense strides to bring the gift of hope and the gift of life to many patients and their families. To read more about the Transplant Centre’s transformative journey over the last 10 years, click here.
To do your part to make a difference and give hope to transplant patients and their families, contact the SingHealth Duke-NUS Transplant Centre at firstname.lastname@example.org or +65 6326 5194 or make a gift online to the Centre’s TRUEFund by clicking here.
1 Source: Global observatory on donation and transplant (http://www.transplant-observatory.org/summary/)