Courage To Pledge

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By Dr Mohamad Zaimi Abdul Wahab

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 information 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 the 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 a light at the end of the tunnel for them and to them, a healthy donor is their light.

Awareness & Action

We don’t often hear the stories from patients suffering with kidney disease unless it is a movie on the tele, or a story from a dear 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. 
According to Dr Mohamad Zaimi Abdul Wahab, Transplant Nephrologist at Hospital Kuala Lumpur (HKL), and Vice- President of the Malaysian Society of Transplantation, the current statistics of organ donation and organ transplant although rose compared to the years before, could be even better if many stepped forward to help advocate this cause.  Although a two per cent rise was seen since 2020 with seventy-seven transplants conducted from sixteen deceased donors this year, the numbers could certainly get better, says Dr Zaimi. Though there are constant reminders through the media, not enough is being highlighted in the mainstream media regarding this critical need despite the continuous efforts by the National Transplant Resource Centre (NTRC) through social media platforms. 
The ongoing efforts of NTRC in increasing organ donations are seen in several significant efforts since the last four years. The prioritization to expedite the work for living kidney donors and recipients which started in 2019 by the Ministry of Health led to the increased numbers of living kidney transplants in HKL and Hospital Selayang. In addition to that effort, the restructuring of the Transplant Organ Procurement (TOP) team into “Unit Perolehan Organ Hospital” or UPOH, 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 programs such as Organ Donation Initiatives in South East Asia (ODiSSEA), which is a collaboration between the Donation and Transplantation Institute, Barcelona, University Malaya Medical Centre (UMMC), and UiTM also coincides with the increase of deceased organ donations. With UiTM and UMMC working closely to make many understand the underlying needs and approach to address this critical matter in Malaysia, this effort goes a long way to the public 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 and continuously supports NTRC’s efforts. 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 Ministry of Health to help with patient’s need for their transplant, however, the need for more financial support increases alongside hope in each passing year, given the severity of this matter, with a possible support through dedicated budget from the ministry for transplantations to ensure it thrives within Malaysia. 
The latest initiative made by the Ministry of Health, spearheaded by YBMK Khairy Jamaluddin in introducing pledger registration through MySejahtera made a significant impact in raising the number of donors. To date, an average of one thousand pledges per day and these pledges made on the application would help families to show as proof for deceased donations as well. While there is no data on which age category is pledging the most for kidney donors, it is known that most living donors pledge to donate their kidneys compared to liver and other organs, and this is hope 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 Witness and Shinto do not permit organ donation. Based on NTRC’s statistics, bodily mutilation and the lack of knowledge as to what the deceased would have wanted were 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/UPOH team assures this procedure is done in the very best of manner to preserve the anatomy of the deceased so that no obvious disfigurement is seen after the retrieval process, Dr Zaimi said,

The Benefits of Being a Donor

Often donors ask what their health benefits be and according to NTRC the health benefits of organ donations for living donors till date are none, other than the self-satisfaction one can get in stepping forward to do an altruistic act through this pledge either for their loved ones, or any recipient in need. 
Another benefit however, 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 their case if they are found to have something concerning. 
For deceased donation, it is a new lease of life for patients with organ failure. Unlike kidneys where dialysis is an option for its patient’s survival, heart, lung and liver patients will not survive if they do not get their transplant and it is a known fact that transplant is the cheaper alternative in the long run with better survival rate 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 a transplant, says Dr. Zaimi.
So have you asked yourself if you have the courage to pledge your kidney for the support of another and to give a fuller 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 the attention of the public and by knowing this we can all do our part in making a difference for another person and their families. 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.

About the author: Dr Mohamad Zaimi Abdul Wahab is the Transplant Nephrologist Hospital Kuala Lumpur and the Vice President, Malaysia Society of Transplantation. This is an opinion column. The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of this publication.

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