With the increased incidence of chronic disease leading to organ failure, there is a gap between organ demand and supply of donor organs.
As of 2020, more than 330 people are on the kidney transplant waiting list. The average wait time for a suitable organ donor can be as long as nine years.
Living kidney donation is key in easing the ever-present problem of organ shortage. Compared to deceased donor kidney transplantation, living kidney transplantation has significantly better graft and patient survival in the long term. Other than improved viability of the donated organ, recipients can undergo the operation earlier in a better state of health.
The success rate for living donor kidney transplant is over 99% after the first year of surgery, although after around 20 years, some kidney transplants may be lost to rejection or other causes.
Living donation is a sacrifice and anyone can be a potential organ donor. It is the noblest gift an individual can give. The criteria to determine if an organ is suitable for donation is based on a set of medical standards and not dependent on age* or gender. All that is required is a willing and suitable donor.
*If you are below the age of 21 and are interested to donate your organ, parental consent will be required.
Frequently Asked Questions
Frequently Asked Questions on Living Donor Kidney Transplant
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Who is eligible for living kidney donor donation?
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What are the assessments that I will need to undergo?
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Can I change my mind about donating my organ during the evaluation process?
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Can I decide who I want to donate my kidney to?
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What if I am not a good match with my intended recipient?
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What is the Transplant Ethics Committee (TEC)?
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What are the risks involved in donating a kidney?
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What does the operation involve?
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How long will I need to be hospitalised?
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What happens after discharge?
1. Who is eligible for living kidney donor donation?
If you are interested to donate your kidney to your family member, friend or even stranger, you must:
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Be at least 21 years of age*; donors older than 65 years can be considered on a case by case basis.
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Be free from the following conditions:
- Cancer
- Heart disease
- Liver disease
- Diabetes
- Active Hepatitis B or C
- HIV infection
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Have no history of drug use
*If you are below the age of 21 and are interested to donate your organ, parental consent will be required.
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2. What are the assessments that I will need to undergo?
The living donor assessment is a rigorous process to ensure that the potential organ donor is in a good state of health and that the donation will not compromise his/her own well-being. You will need to undergo a range of tests and screenings to ensure that you are a good match with the recipient and also to identify any risks.
Step 1
You will need to undergo several tests and screenings such as:
- Blood type: Your blood type should be compatible, even if it is not the same as the recipient.
O | O | A, B, AB |
A | A, O | B, AB |
B | B, O | A, AB |
AB | A, B, AB, O | NIL |
A blood group-incompatible live donor kidney transplant may still be done, but there is a slightly higher risk of rejection. - Cross-match blood test: This test checks how your antibodies react to the recipient’s, and how high the chance of rejection is.
- Antibody screening: The panel-reactive antibody (PRA) test measures your antibodies against the recipient’s. If the recipient has a wide range of antibodies against yours, there will be a higher risk of organ rejection.
- Tissue type test: This is a blood test for genetic makeup. The more of genetic markers you share with the recipient, the better the match.
- A mental health assessment: You will need to be assessed for any psychological conditions as the donor must not have an active mental disorder or intellectual impairment.
- A counselling session is also arranged to determine your psychosocial state. The session may include personal questions.
Step 2
The kidney transplant doctor will evaluate your condition, including a full physical examination and advise on further tests required. You will then need to undergo a chest x-ray, electrocardiography (ECG) and more detailed heart scans, as well as other investigations as necessitated by your medical conditions. This will take at least two weeks.
Step 3
Appointments will be made for you to see various specialty doctors as required by your medical condition(s). For example, if you have a heart problem, you will need to see a cardiologist. You will also undergo the final step of tests as needed.
You will be seen by:
- A surgeon who will inform you the risks of the operation and discuss the details of the operation.
- A psychiatrist to certify that you are psychologically prepared and mentally fit to give voluntary consent for the kidney transplant surgery.
- Other specialists as recommended by our transplant doctors.
Your potential recipient will also be evaluated alongside this and will be required to undergo blood tests, scans and specialist evaluation. He/she will also be evaluated by a kidney transplant doctor, surgeon and psychiatrist.
Step 4
Once all the tests and appointments are cleared, the application will be reviewed by the Transplant Ethics Committee (TEC) to ensure that there is no commercial transaction taking place before and after the transplant. There is a compulsory one-week cooling-off period after the review.
The transplant surgery can go ahead after the TEC has cleared the evaluation. The surgery will take place at least nine weeks after your first appointment.
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3. Can I change my mind about donating my organ during the evaluation process?
Yes, the decision to donate is 100% voluntary. You can withdraw from organ donation any time, up till the day of surgery. Inform your primary doctor about the withdrawal and your decision will be kept confidential.
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4. Can I decide who I want to donate my kidney to?
You can choose who you want to donate your kidney to, as long as the assessments have deemed that you are healthy and a match to the recipient, and you have made a completely voluntary decision. You may also choose to be an altruistic donor.
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5. What if I am not a good match with my intended recipient?
If your blood group is incompatible with your intended recipient, the transplant team may suggest a paired kidney exchange transplant. This happens when there is another donor who is also incompatible with his/her recipient but both donors are a good match for the other’s recipient. This results in two new compatible pairs, lowering risks of rejection and amount of immunosuppression required. Other patients on the national waiting list are also able to move up.
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6. What is the Transplant Ethics Committee (TEC)?
TEC is a panel of three people, including at least one doctor and one layperson (non-medical), who have been appointed by the Ministry of Health. They will determine whether there has been coercion or financial promises made to the potential live donor.
Both coercion and payment for organs are illegal and punishable under Singapore law.
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7. What are the risks involved in donating a kidney?
You can live a normal healthy life with one kidney. Donating your kidney will not affect your general health, life span or energy level. Compared to the general public, most kidney donors have equivalent or better survival rate.
There are no risks to fertility after kidney donation and female donors can have successful pregnancy and bear children as per normal, although there is a slightly increased risk of high blood pressure during pregnancy.
Donors will be monitored lifelong, as some kidney donors may be at slightly higher risk for having:
- Protein in the urine
- High blood pressure
- Reduced kidney function – the risk of kidney failure is 0.3% after 15 years
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8. What does the operation involve?
There are two types of surgery: open nephrectomy surgery and laparoscopic (‘key hole’) surgery. The surgeon will choose the method most suitable for you.
Kidney donation traditionally utilises the open surgical approach with a flank incision, a 12 to 18cm incision made on the side of your back and upper abdomen to remove the kidney.
Minimally invasive donor nephrectomy has since been shown to lower the disincentives for kidney donation by accelerating recovery from surgery. At NUH, we started our hand assisted donor nephrectomy in 2002. The safety of our donors is of utmost importance. Surgery is now pure laparoscopy for almost all our cases. It involves having two or three small incisions around 0.5cm to 1.5cm in the abdomen or back, where the surgeons will insert a camera and tiny instruments into the abdomen. These are used to separate the kidney and its attachments. After which the kidney is removed through a second incision of five to seven cm at the lower abdomen. As the second incision does not involve cutting the muscle, this method results in faster recovery for the donor than traditional open surgery.
NUH has also pioneered the use of natural orifice surgery to remove the kidney via the vagina, resulting in a virtually scarless surgery. At NUH, the use of clips only for the control of donor renal artery has been eliminated from the surgery, converting to stapler use to ensure donor safety according to international guidelines.
Our living kidney donors are monitored closely in High Dependency hourly for at least 12 hours post-surgery. You will be administered general anaesthesia before the surgery as this is a major operation. You will be asleep throughout the two to three-hour operation. Patients are usually fit for discharge two to three days after the operation.
At NUH, our work has extended to studying and monitoring the impact of residual kidney function of kidney donors and to ensure the best kidney is left behind for the donor. Our efforts in caring for the living kidney donor are now paying off with NUH achieving highest consecutive annual numbers of living kidney donation for the years since 2009.
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9. How long will I need to be hospitalised?
You will need to be admitted one day before the surgery. After the surgery, you will be monitored in a High Dependency Unit for about one to two days before moving to the General Ward for another one to two days. You can be discharged within three days after the surgery if no complication arises.
You will be given four weeks of medical leave after discharge for your recovery before you resume any normal activities.
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10. What happens after discharge?
You will need to be on a month’s long medical leave. Avoid consuming any nonsteroidal anti-inflammatory drug (NSAID) in the meantime. You will need to come back to NUCOT for your follow up appointment:
- Six weeks after surgery, followed by
- Every half a year, for one year and subsequently
- Once yearly
Your kidney doctor will give you specific advice on taking care of yourself in order to reduce any risk of complications during your recovery.
Exercise
Maintaining a healthy lifestyle is important. You should be able to return to normal daily activities two to four weeks after your discharge. Please seek advice from your doctor if you are looking to resume any contact sports or strenuous activities.
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If you would like to donate a kidney to save a life today, you can contact us at our NUCOT Specialist Outpatient Clinic
here.
Frequently Asked Questions on Deceased Donor Kidney Transplant
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Will my medical care be compromised if I am a potential organ donor?
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Can I donate my kidney after I pass away?
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Can I donate more than just the organs listed under Human Organ Transplant Act (HOTA)?
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What is the Medical (Therapy, Education and Research) Act (MTERA)?
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Can I decide who I want to donate my kidney to?
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Will I or my family have to pay the costs for organ donation/recovery?
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If I choose to donate my organs after I pass away, will my body be disfigured after organ donation?
1. Will my medical care be compromised if I am a potential organ donor?
Medicine is an ethical profession. No doctor will risk one life to save another. As a potential organ donor, organ donation will only be considered after every effort to save your life has been exhausted by the medical team. There are seven strict criteria that must be confirmed by two independent doctors, who were not involved in your medical care, before brain death can be certified and organ donation is considered.
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2. Can I donate my kidney after I pass away?
In Singapore, Singapore Citizens and Permanent Residents above the age of 21 and above, and are not mentally disordered, are included under the Human Organ Transplant Act (HOTA) unless they have opted out. HOTA allows for organs (kidney, liver, heart and cornea) to be donated in the event of death for the purpose of transplantation.
Over the years, HOTA has been widened in scope so as to grow the organ donor pool. This has meant more people waiting on the transplant list have successfully gotten a life-saving organ. Despite the widening of HOTA, hundreds of people are still waiting for an organ to become available. This is where living organ donation comes in, an area also under the regulation of HOTA. Living organ donation further increases the chance that a suitable kidney can be found.
Those who are under HOTA will not only have a chance to help others, but also have a higher priority on the waiting lists should they need an organ transplant. For those who had opted out of HOTA, you will receive a lower priority for receiving an organ on the national waiting list should you require an organ transplant in the future. This will apply specifically to the organs which you have opted out from.
If you have opted out before and would like to opt back in, you will need to complete the
Withdrawal of Objection Form and send it to the National Organ Transplant Unit.
For deceased donor organ donation, bodies of those with chronic illnesses or cancer may still be used for education or research purposes under the Medical (Therapy, Education and Research) Act (MTERA).
To find out more about HOTA and MTERA, visit
LiveOn.
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3. Can I donate more than just the organs listed under Human Organ Transplant Act (HOTA)?
Yes, anyone above 18 years old can opt into Medical (Therapy, Education and Research) Act (MTERA) to donate their organs and/or tissues for the purposes of transplant, education, or research after they pass on.
Fill in the
Organ Donation Pledge Form and send it in to the National Organ Transplant Unit. You are encouraged to discuss your decision to pledge your organs and/or tissues with your family members so that they are aware of your decision and can advocate for your wishes in the event of your death.
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4. What is the Medical (Therapy, Education and Research) Act (MTERA)?
MTERA is an opt-in scheme, whereby anyone aged 18 years old and above can pledge your organs or any body parts for the purposes of transplant, education or research, after you pass away. You can choose to donate all your organs and tissues or specify those you wish to donate.
In cases where you have not pledged your organs before passing away, your family members can also decide to donate your tissues and/or organs under MTERA on your behalf, if they wish to do so.
For more details on MTERA, visit
LiveOn.
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5. Can I decide who I want to donate my kidney to?
You will not be able to choose who you donate your kidneys to. Your kidneys will be matched to the blood group, weight and urgency from the pool of patients on the national kidney transplant waiting list.
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6. Will I or my family have to pay the costs for organ donation/recovery?
The hospital bills for any organ removal-related procedures and tests will not be charged to the donor’s family.
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7. If I choose to donate my organs after I pass away, will my body be disfigured after organ donation?
All bodies are cared for with utmost respect. Any incisions made during the removal of organs are carefully repaired during the procedure and you will still be able to have an open casket funeral.
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