Organ Donation & Kidney Transplantation

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.

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.

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.

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.

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.

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 Quran, 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.

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.

Ones 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.

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.

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.