​Mr Tony Chua, diagnosed in 1998 with chronic obstructive pulmonary disease, received a donor lung in 2008 and now enjoys a normal life. -- PHOTO: JOSEPH NAIR FOR THE STRAITS TIMES

Hota and the Medical Therapy Education and Research Act give patients a new lease of life, reports Lydia Vasko

DEATH came knocking for accountant Tony Chua a few years ago.

A pack-a-day smoker since his national service days, the 60-year-old was diagnosed in 1998 with chronic obstructive pulmonary disease, which makes it difficult to breathe. He was bedridden, too weak to walk and unable to breathe without an oxygen mask.

Although he gave up smoking after that 1998 diagnosis, 30 years of puffing meant it was too late: The condition was irreversible. He was rushed to hospital five times, where medics revived him using electrocardiogram paddles to shock his oxygen-deprived heart back to life.

After 10 years of that sort of life - two of them breathing through a mask - he started to despair.

The only hope was a lung transplant but that was a very risky option even if doctors could find a donor.

SingHealth Transplant, a programme at Singapore General Hospital, offers eight different transplant programmes, from corneas to kidneys, skin to lungs. But while the transplant resources are available, the organs are often not.

Nearly 500 people are now waiting for vital organ transplants - heart, kidneys, liver and lungs - here. On average, 15 to 20 people each year die waiting for an organ transplant.

Since 2009, all Singaporeans and permanent residents over 21 have been covered under the Human Organ Transplant Act (Hota) unless they opt out. It allows their kidneys, liver, heart and corneas to be recovered for transplant upon their death.

About 3 per cent of people here have opted out of Hota so far, according to the Health Ministry, which means they have lower priority on the donor list should they need an organ in the future.

Despite these provisions, finding a suitable organ is difficult. Although there is no cut-off age for organ donors, there are strict suitability criteria, such as previous medical history.

How the donor died plays a big role as well. In a cardiac death when the heart stops functioning and vital functions of the body cease, other organs quickly deteriorate and become unusable.

Vital organs can be harvested only in the case of brain injury when the brain no longer functions, usually due to a stroke or car accident.

But even when a healthy donor organ is found, the organ size, condition, blood type and tissue type have to fit. How long a patient waits varies by organ. It takes about a year for a heart transplant but eight to nine years for a kidney.

The wait for transplant patients like Mr Chua who need organs not covered under Hota is unpredictable.

A donor or his next-of-kin must opt in to the Medical Therapy Education and Research Act, in place since 1972, if they want to donate an organ not covered by Hota. So far, only around 50,000 people here have opted into this Act, which allows people over 18 or the family of the dead person to donate any organ or body part for transplant, education or research upon their death.

Donors can choose to donate all of their organs or specify which organs and tissues, such as lungs, skin and marrow, they would like to donate.

But the scarcity of lung donors meant Mr Chua's prospects were grim. Since the Lung Transplant Programme was set up by the National Heart Centre Singapore in 1998, there have been only nine lung transplants. This is partly because only 20 per cent of brain-death donors worldwide are suitable lung donors and the global shortage means lungs cannot be imported from overseas.

What is more, the mortality rate in transplant patients is very high. The survival rate in the first five years is only 50 to 60 per cent, and 10 per cent after 10 years. So Mr Chua was more scared than jubilant when he received word that a donor lung was available in 2008, after two years of waiting. Still, the father of three, including a five-year-old daughter from his second marriage, went through with the surgery and has regained the life he lost.

Apart from regular check-ups, life for Mr Chua is now mostly back to normal. He is back to working, travelling and taking his daughter cycling in East Coast Park. He lives, he says, for his family and is thankful to the doctors and the unknown donor who saved his life.

Hoping to increase the numbers of local organ donors, SingHealth is organising a roadshow at Suntec City Mall tomorrow and on Sunday. It will feature interactive exhibits, patient-doctor sharing sessions and a runway show featuring transplant patients and professionals.

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