A person suffering from kidney failure might be able to live with dialysis treatment several times per week – be it through haemodialysis or peritoneal dialysis. However, it is not an ideal replacement for a functioning kidney. Dialysis patients may still present with chronic complications with time, including anaemia, renal bone disease, or heart disease and stroke.
Most importantly, in terms of survival, only about half of dialysis patients are still alive five years after they start dialysis treatment.
Associate Professor Dr. Lim Soo Kun, Consultant nephrologist and Head of the Renal Division, Department of Medicine, University of Malaya, said those undergoing dialysis face strict limitations to their work and leisure timetable. He explained the taxing requisites: how haemodialysis patients need to go to a haemodialysis centre at least three times a week for a period of around four hours each time; while those on peritoneal dialysis need to perform the procedure four times a day for 30 to 40 minutes each time with continuous ambulatory peritoneal dialysis, or once a day (usually during bedtime) for a period of 8 to 10 hours with automated peritoneal dialysis.
On the other hand, kidney failure patients who receive a donated kidney have a much better chance of survival and experience better quality of life. At the same time, the risk of chronic health complications from dialysis and the absence of functioning kidneys will be removed.
In a kidney transplant, there are two types of donors: living and deceased. In Malaysia, living donors must offer their kidney voluntarily (i.e., with no inducement or compensation like money), as well as be related to the recipient as they would share a certain amount of genetic material (thus, decreasing the chances of the donated kidney being rejected by the recipient’s body). The donated kidneys also tend to be healthier and function well for longer.
Meanwhile, deceased donors are usually registered organ donors who – typically in Malaysia – are casualties of motor vehicle accidents. They would have sustained severe enough head injuries to be considered braindead, but with still-functioning kidneys. When a kidney from a deceased donor becomes available, there is a “golden” period of 24 hours in which all necessary preparations are made for the transplant. A deceased donor kidney transplant recipient would still have better long-term survival as compared to those who continue with long term dialysis, despite needing a higher dosage of immunosuppressant medications to prevent organ rejection or infection from a lack of shared genes.
Statistics show a kidney transplant is superior to dialysis for the ultimate health and survival of a kidney failure patient, but the number of such procedures is still very small in comparison to the need. In 2020, 151 kidney transplants were performed – most with living donor organs. As of now, only seven hospitals perform kidney transplants in Malaysia: Hospital Kuala Lumpur, University Malaya Medical Centre, and Prince Court Medical Centre, Kuala Lumpur; Hospital UiTM, Hospital Selayang, and Sunway Medical Centre, Selangor; and Mahkota Medical Centre, Melaka.
Currently, there are about 25,000 kidney failure patients awaiting a kidney from a deceased donor – about half the number of people on dialysis in the country. With only about 50 cadaveric organ donations or so per year, the usual wait for a kidney is more than a decade.
According to Dr. Lim, a patient whose kidney is failing should consider a pre-emptive kidney transplant foremost before they even begin dialysis. At University Malaya Medical Centre, patients are given this option by stage 4 of chronic kidney disease – when the kidney function is less than 30%. This is because the longer the patient is on dialysis, the more complications they will develop, leading to a lowering in benefits from a kidney transplant. Having said that, a transplant still has far better results than dialysis, even though it is performed a few years after a patient has started on dialysis.
Dr. Lim additionally encourages healthy Malaysians to sign up as organ donors as they would be able to offer a gift of life not only to kidney failure patients, but also those in need of other organs.