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14. ORGAN DONATION & KIDNEY TRANSPLANTATION

14.1. Organ donation



  • Organ donation is the greatest act of love, compassion and charity when one pledges his or her organs to save the lives of others. Through surgical procedures, donated organs and tissues can be removed and then transplanted into other individuals who are in need of a transplant.

    People of all ages may become organ or tissue donors. “Organ and tissue transplantation has provided the gift of life and enhanced the health of thousands of health impaired and terminally ill people. Unfortunately, the waiting list for organ donation grows longer and longer each day.” (Tan Sri Lee Lam Thye, adapted from The Star, 8/12/2011)

    Every organ donation pledge helps and is one of the most compassionate ways of helping patients that anyone can imagine.

  • 14.1. What are the organs and tissues that can be donated?


  • Organs that are common for transplant are:
    • kidneys
    • heart
    • liver
    • lungs
    • pancreas (currently pancreas transplant has yet to be carried out in Malaysia);

    The transplantable tissues are:
    • corneas
    • arteries or veins
    • intestines
    • tendons
    • ligament
    • bones
    • skin
    • heart valves

  • 14.1.2. How are organs and tissues obtained?


  • The two sources are:

    (a) From living donors

    Donation of an organ or part of an organ by a living person is referred to as, living donation. According to the National Transplant Resource Centre, living donation is usually limited to close family members (living-related or genetically-related) such as parents and siblings whose genetic make-up are more compatible to the recipient of the transplant. The patient may also receive an organ donation from his or her spouse, with whom he or she has an emotional relationship.

    Un-related living donation is forbidden in the local practice, less the patient who is suffering from a fatal organ failure and does not have any family members, cadaveric donors or other alternative treatments available to save his or her life.

    (b) From cadaveric donors

    Cadaveric donors are also known as deceased donors – organs donated by those who have just died recently. Cadaveric donation may come from accident casualties whose organs are still in good condition and suitable for transplant purposes.

    Organs from cadaveric donors are allocated to the best tissue matched patients on the transplant waiting list. Potential cadaveric donors with a history of cancer or transmissible viruses such as Hepatitis B, Hepatitis C and HIV are not considered for organ donation.


    There are 2 types of cadaveric donors:

    • Beating - Heart Donors
    Beating - heart donors may have suffered severe trauma to the brain. In order to be enlisted as organ donors, these patients must be ventilated in an intensive care unit and medically certified as “brain” dead, meaning that all functions of the brain have ceased and no recovery is possible. In other words, life cannot be sustained. Heart beat and lung functions are artificially maintained by a respirator. As such, deaths in hospitals occurring under these circumstances are very rare.

    • Non Beating - Heart Donors
    Donors who died from cardiac arrest (in simpler words, heart attack) in the hospital can donate all their organs; whilst donors who died at other places instead of a hospital can only donate their corneas.

  • 14.1.3 How life changes for a life donor recipient?


  • 1. Time spent on dialysis is reduced. This is a crucial improvement particularly for diabetics and also young children.

    2. Generally, the recipient requires less immunosuppressive drugs; therefore, fewer side effects.

    3. Improved survival rates for donor recipients - many of them live many years after transplantation.

  • 14.1.4 Who can be a living donor?


  • A close blood relative, i.e. a brother, sister, parent or child may be a suitable donor. Due to inherited genes, siblings have higher compatibility in their blood and tissue type; whilst parents and children have at least half of the compatibility. It is essential that the donor and the recipient to have compatible blood and tissue type for transplant surgery to be carried out. However, genders are not taken into account.

    The prospective donor must be an adult (over 18 years of age), in good health and free from high-risk lifestyles. Individuals below the age limit will require parental or guardian consent to be a donor.

  • 14.1.5. Can I select which organs and tissues I want to donate?


  • Yes, you may indicate your decision to donate all organs and tissues, or only specific organs and tissues when you pledge to be a donor.

  • 14.1.6. Can I choose who should receive my organs and tissues?


  • Local health policy only allows living-related donations, in which the recipient is a close family member to the donor - parents, siblings or spouse. For cadaveric donors however, donated organs and tissues are given to individual recipients based on their need, blood types, genetic matches and such.

    This is to prevent any organ trading between the donor and the recipient. Note: Buying and selling organs or tissues are illegal in Malaysia.

  • 14.17. If I am an organ donor, will the doctors save me should I be in a life - threatening condition?


  • Yes. The first and foremost concern for doctors caring for critically ill patients is to save lives using any possible treatments. The possibility of donation will only be considered when all life-saving efforts have failed and “brain death” is declared and certified.

  • 14.1.8. What happens after the organs and tissues are removed (cadaveric or deceased donors)?


  • The body is released to the family or funeral home in a clean condition. The surgical procedures are scheduled so as to not affect funeral arrangements.

  • 14.1.9. Can I change my mind in becoming a Donor?


  • Yes, you may change your mind anytime, and retract your decision. However, it is highly encouraged to discuss your decisions with your family members.

  • 14.1.10. Are there any religious objections with regards to organ donation?


  • No. All the major religions of the world – Islam, Christianity, Hinduism, Buddhism and Sikhism endorse organ and tissue donation.

    “Whosoever saves the life of one person it would be as if he saved the life of all mankind.”
    -Holy Qur’an, chapter 5:32

    “…freely you have received, freely give”
    -Matthew, chapter 10:8

    Buddha said to the other monks that,
    “Whoever would care for me, let him care for those who are sick.”
    -Mahavagga VIII.26.1-8
    Kucchivikara-vatthu
    The Monk with Dysentery

    “…it is said that the soul is invisible…knowing this you should not grieve for the body.”
    -Bhagavad Gita, chapter 2:25

    “The dead sustain their bond with the living through virtuous need.”
    -Guru Nanak, Guru Granth Sahib, pg 143.





  • KIDNEY TRANSPLANT

    14.2.1. Kidney transplant operation


  • A transplant operation takes about 3 to 4 hours and is handled by healthcare professionals. The transplanted kidney is placed in the right or left side of the lower belly. The new kidney's artery and vein are joined to an artery and vein in the pelvic area. The urine tube (ureter) from the kidney is attached to the bladder.

    Many patients will be surprised to learn that their failed kidneys are not removed but left to continue whatever small amount of function they may still have. However, if the failed kidneys must be removed, a separate operation is necessary prior to transplantation. This is only rarely required - in the case of chronic infection or very large size of the kidney.

  • 14.2.2. Who is eligible for kidney transplant?


  • Most people who suffered from irreversible kidney failure and are on dialysis can be considered for kidney transplant. Aside from kidney failure, these people must be in relatively good health and willing to undergo the procedures involved. Currently, there are about 13,000 patients on the kidney-transplant waiting list in Malaysia. (Adapted from the National Transplant Resource Centre 2011)

    For those with other major medical problems, such as severe heart and vascular disease – may face problems for transplantation. Hence, dialysis may be a better treatment option. Some patients are contented with their dialysis treatments and do not wish to undergo transplantation.

    Each patient should always discuss his or her own medical suitability with their doctors or kidney specialists (nephrologists).

  • 14.2.3. Donor and family concerns


  • One’s decision to donate a kidney must be a voluntary decision, free from being “pressured” or “coerced.” It is crucial to talk the decision over with family members – particularly the patient/ recipient. It is also essential for the prospective donor to discuss feelings, emotions and concerns with the kidney doctor, social worker or even psychiatrist in a confidential manner.

    After discussions and considering the facts, the prospective donor has every right to retract his or her decision and against the donation.

  • 14.2.4. Can I donate one of my kidneys to someone?


  • You cannot just decide to donate your kidney – living non-related organ donation is prohibited in Malaysia. However, if the occasion should arise that a family member is in need of a kidney transplant, you may be asked to submit to a complete blood test to determine whether you are a match for him or her. Only in rare situations do physicians consider anyone than other family or cadavers as organ donors.

    The most appropriate action you can take is to be a registered organ donor. Be sure to discuss your choice with your family members and friends so that they are aware of your decision. You may also contact National Kidney Foundation of Malaysia (NKF) should you need more information on organ donation or if you decide to pledge your organs for a good cause.

  • 14.2.5. Transplant success rate


  • The updated statistics from year 2000 to 2009 showed that the success rate at one year interval after live donor transplant is 93%, while cadaveric donor transplant is 78%. For a 9 years interval, the success rate for live donor transplant is 76% while for cadaveric donors is 47%. (Adapted from 6th National Transplant Registry Report 2009, Malaysia)

    Usually, if the transplant works well for the first year, the chances are good that the transplanted kidney will function for many years to come. However, if the transplant fails, a second transplant is possible and can be entirely successful. Constant medical breakthrough and the development of immunosuppressive medications continuously improves the success rate of kidney transplantation.

  • 14.2.6. Kidney transplant and Rejection


  • Rejection of a transplanted kidney is due to the same immune response our body produces to help protect us against colds and other viruses. The immune system in the body regards the new kidney as a foreign element and tries to destroy it.

    To prevent rejection of the new kidney, immunosuppressive medications (also known as anti-rejection drugs) are used to suppress the body’s immune system. However, lower immune defences also mean that the patient is facing higher infection and cancer risks.

    Before the transplant surgery, tests can be carried out to indicate (in a general way) how likely the rejection will be. Unfortunately, there is no way to be entirely sure about it.

  • 14.2.7. Living with a new kidney

    14.2.7. Living with a new kidney


  • A kidney transplant can offer a “new lease of life” but patients and their families have to make many adjustments during the first year of the transplant, particularly in learning to live with disruption to one’s life and the “uncertainty” about how long the new kidney will function. In addition to regular follow-ups with doctors or kidney specialists after the transplantation, the patients should always take their medication as per directed.

    Most people are able to get back to their normal activities and work within 3 to 6 months after the transplantation. Exercise (gentle at first) is also an important part of toning muscles and maintaining good health. The patients can also consult their doctor or dieticians for proper dietary intake.

    For many patients, sexual functions improve after kidney transplantation. Sexual activities will not harm the transplanted kidney nor increase the risk of infection. However, as it is the case for any major surgery, it is advisable to wait about four weeks before having sexual intercourse.

    Having a baby after receiving a kidney transplant is possible but not usually advised until at least 1 – 2 years of good kidney function. There are considerably increased risks of pregnancy complications, such as premature births and high blood pressure in women who have kidney transplants and careful monitoring of the pregnancy is needed. Couples considering pregnancy should seek advice from their doctor, as x-rays and other tests might be necessary and preferably done before the pregnancy. Women should go for annual Pap smears and mammograms.

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