When we talk about organ transplant, most people think of kidney and liver transplantation.
Professor London Lucien Ooi, Chairman of the Division of Surgery in Singapore General Hospital (SGH), pointed out that few people would think of other organ transplants such as skin, heart and haemapoietic stem cell, because kidney and liver transplant are more commonly known. Thus, there is a need to create awareness on other organ transplant programmes through public education.
Professor Ooi said, "Many people are reluctant to donate their organs probably because of religious reasons, traditional Chinese belief that 'the whole body must be complete’, and lack of correct knowledge of the culture which results in superstition, and thus do not want to donate organs. If they donate their organs, the story of their life can be continued. The number of organs a person can donate after death, if distributed to different beneficiaries, can benefit at least 10 people and he can continue to spread the gift of life. "
According to SGH last year, there were a total of 15 living donor kidney transplants, which was twice the number from the previous year. However, there were 24, 23, and 26 deceased donor kidney transplants for the past three years respectively. These numbers show that people still have reservations about the donation of an organ after death.
According to the information provided by Singapore Health Services Pte Ltd, there is an annual average of 15-20 patients who die while waiting for an organ transplant.
Professor Ooi, Interim Director of SingHealth Transplant and well-known tumour specialist said that the most urgent need is local kidney donation as there are a lot of people waiting for a kidney transplant. SGH also partners with the Ministry of Health to advocate organ transplantation and actively promote such activities.
Inclusion of all who become 21 years of age to plans for organ donation
At present, most of the organ donation cases are accounted under deceased donor donation. There are two laws governing organ transplant in Singapore. Firstly, the Human Organ Transplant Act (HOTA) covers 4 organs; kidney, liver, heart and cornea. Singapore citizens and permanent residents who are 21 and above, and who have not opted out of the programme, would be included in the act. In the event that the patient is certified brain dead, the organs will be retrieved by the hospital for transplant into other patients who are on the waiting list. Many young people are not aware that when they turn 21 years old, they will automatically be added to the organ donation program unless they had opt out.
The other act that governs organ and tissue donation in Singapore is the Medical (Therapy, Education and Research) Act (MTERA). Under this act, all organs and tissues such as lung, skin, cornea, haemapoietic stem cells can be donated. However, the deceased (during his/her lifetime) or the next of kin must give their consent for donation. At any point in time, they can also retract their consent.
Professor Ooi said that SingHealth hopes that people donate their organs not only because of the Act that governs mandatory organ donation, but to give it (donated organs) as a gift, so that more patients can continue to live. This way, it will be more meaningful. He said, “In some countries such as Europe, USA and Australia, people donate their organs to those who need it, or their whole bodies to hospitals for medical research. The eastern societies are more conservative."
Comprehensive Transplant Service Centre to provide more comprehensive care
The SGH Campus, situated in the Outram Park area where several speciality centres including the National Heart Centre, National Cancer Center, National Neuroscience Institute, Singapore National Eye Centre and the National Dental Centre are, will be the local centre for transplant. From this centre, patients can benefit from kidney, liver, heart and lung, cornea, skin, cardiovascular homograft, haemapoietic stem cell and umbilical cord blood transplants.
Professor Ooi pointed out that SingHealth plans to consolidate all the eight transplant programmes under the same roof, so that the transplant specialists and medical staff can share resources and experiences to provide a more professional and comprehensive care for transplant patients.
In the United States, there are more individual organ transplant centres, and fewer comprehensive transplant centres. SingHealth is progressing towards the establishment of a comprehensive transplant service centre. Professor Ooi mentioned that post-operative transplant patients’ immunity resistance is greatly weakened, and when transplant patients move around to go to different specialist clinics for follow-up treatment, they would be exposed to increased risk of infection. This new set-up will change the model of how transplant patients are currently seen - by bringing different specialists to the patient instead. This integration scheme has since started out in phases. This year, SGH will have a solid organ transplant specialist outpatient clinic to provide specialized care for kidney, liver, heart and lung transplant patients. SGH will also have two more clinics, one for corneal transplant patients and another for the haemapoietic stem cell transplant patients. By 2015, SGH will set up a dedicated ward for solid organ transplant patients. After surgery, transplant patients requiring hospitalization, be it for transplant-related or non-related illnesses, can be admitted to the ward for medical treatment.
Professor Ooi pointed out that SGH is currently working with National University Hospital to start providing pancreas transplants.
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