The Courage To Pledge — Dr Mohamad Zaimi Abdul Wahab

Organ donation is an altruistic act of the highest order that goes a long, long way.

The first successful kidney transplant in the world was performed in 1954. With medical advancements in the prevention and treatment of rejection, more successful transplants have taken place since, and the demands are increasing as the years go by.

Malaysia has an estimated number of 48,000 patients on dialysis and awaiting kidney transplant. Each patient has an average waiting period of 13 years before having the opportunity to get a transplant done, due to the low donation rate.

A scoring system is put in place because of this, and with it, only about 10,000 patients are eligible to receive a kidney from a deceased donor.

This revelation is alarming.

Have you pledged to donate your organ or even considered making one? It takes courage to pledge oneself as an organ donor, and while organ donation can be done alive or deceased, the number of pledges to support organ recipients await a better response.

The call for kidney donation has been a request made for many years from medical professionals, government, and non-governmental organisations, as their plea for support to the public.

End stage renal failure cases are increasing in numbers and complexity. Decades ago, many kidney failure patients had no hope of survival or recovery, but with recent medical innovations and discoveries, there is light at the end of the tunnel for them, and to them, a healthy donor is their light.

Awareness And Action

We don’t often hear stories from patients suffering with kidney disease, unless it is depicted in a movie or a story from a loved one who is suffering from it.

It is not a common act to want to be aware of these things either, unless it is relatable to our own journey. But the matter is as real as it can be, and many are struggling with kidney disease and kidney failure. 

The current numbers involving organ donation and organ transplant have risen compared to the years before, but could be even better if more stepped forward to support this cause. 

Although a 2 per cent rise has been seen since 2020, with 77 transplants conducted from 16 deceased donors this year, the numbers could certainly be better.

Though there are constant reminders in the media, ore should be done to highlight this critical need, despite the continuing efforts by the National Transplant Resource Centre (NTRC) through social media platforms. 

The ongoing efforts of the NTRC in increasing organ donations are seen in several significant efforts since the last four years. The prioritisation to expedite the work for living kidney donors and recipients which started in 2019 by the Ministry of Health (MOH) has led to the increased numbers of living kidney transplants at HKL and Hospital Selayang.

In addition, the restructuring of the Transplant Organ Procurement (TOP) team into Unit Perolehan Organ Hospital (UPOH) has strengthened deceased organ donation since 2018. With education being the key to such awareness, the initiative to educate health professionals who are involved in organ donation through programmes such as Organ Donation Initiatives in South-East Asia (ODiSSEA), a collaboration between the Donation and Transplantation Institute, Barcelona, University of Malaya Medical Centre (UMMC), and Universiti Teknologi MARA (UiTM).

With UiTM and UMMC working closely to make many understand the underlying needs and approach to address this critical matter in Malaysia, this effort has gone a long way as a call for more to come forward and pledge. 

The Malaysian government plays a significant role in addressing kidney transplant issues and the welfare of kidney patients. It is currently working on getting a new law on transplantation to be passed mainly to regulate the activity and to avoid organ trafficking, which is seen as a threat globally.

The Malaysian Society of Transplantation was also given a RM150,000 grant in 2019 by the MOH to help with patients’ needs. However, the need for more financial support has increased with each passing year. Given the severity of this matter, possible support through a dedicated budget for transplantations from the MOH is another possibility. 

The latest initiative made by the MOH in introducing pledger registration through the MySejahtera app has made a significant impact in raising the number of donors. To date, an average of 1,000 pledges per day are made on the app, and this would help families to offer deceased donations as well.

While there is no data on which age category has pledged the most for kidney donors, it is known that most living donors have pledged to donate their kidneys, compared to liver and other organs, and this is certainly good news for many kidney disease patients. 

Addressing Mindsets And Myths

The permissibility of organ transplant has been a cause for concern and a challenge in changing mindsets. While most religions in Malaysia encourage organ donation, some beliefs like Jehovah’s Witnesses and Shinto do not permit organ donations.

Based on NTRC statistics, bodily mutilation and the lack of knowledge as to what the deceased would have wanted are two of the most common reasons why families refused to give consent for deceased organ donations when the UPOH team approached these families. 

Mutilation of the deceased body is a misconception, because in order to successfully conduct a transplant, the deceased would also have to undergo a surgery similar to that of the living. The organ needs to be in a good condition for transplant.

The NTRC and UPOH team have given their assurance that this procedure is done meticulously to preserve the anatomy of the deceased, so that no obvious disfigurement is seen after the retrieval process. 

The Benefits of Being a Donor

Often donors ask what their health benefits are. According to the NTRC, the health benefits of organ donations for living donors are none, other than the satisfaction one gets in stepping forward to do an altruistic act through this pledge either for their loved ones, or any recipient in need.

However, another benefit is the discovery of one’s own predisposition to the disease, or discovery of any undiagnosed diseases during the process of being a potential donor. Donors have the benefit of getting diagnosis and management earlier, depending on individual cases, if they are found to have something concerning. 

For deceased donations, it constitutes a new lease of life for patients with organ failure. Unlike kidney disease, where dialysis is an option for its patient’s survival, heart, lung, and liver patients will not survive if they do not get their transplants.

It is a known fact that transplant is the cheaper alternative in the long run with better survival rates as well as quality of life compared to dialysis. Hence, the more donors are made available, the better it will be for the country if these patients receive transplants.

So, have you asked yourself if you have the courage to pledge your kidney for the support of another and to give a new lease of life to a patient with kidney failure? If you have done so, kudos to you, but if you have not, ask yourself what is stopping you, and address those doubts scientifically.

These are facts that need to come to the attention of the public, and by knowing this we can all do our part in making a difference for another person. It is an altruistic act of the highest order that goes a long, long way.

Have the courage to make a pledge to be an organ donor now via your MySejahtera app.

Dr Mohamad Zaimi Abdul Wahab is a transplant nephrologist at Hospital Kuala Lumpur and vice president of the Malaysian Society of Transplantation.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.

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