01 Mar 2011
Barely out of his teens, mr Tan Chong Neng faced years of dialysis after medication could not stop the deterioration of his kidneys and a donor organ was unlikely for many years to come. When he was just 18, the young man was diagnosedwith a genetic condition that causes kidney failure.
So when the family was counselled about Mr Tan’s treatment alternatives, including a new type of transplant surgery at Singapore General Hospital (SGH) for donor-recipient pairs whose blood groups don’t match, his mother jumped at the option. Mother and son’s blood types don’t match, but they were the only fit as the rest of his family wasn’t suitable for different reasons. Up till then, only people with matching blood types were suitable for kidney transplants at SGH.
“I said, ‘Let’s go.’ I just thought that here was a chance to do something for my son,” said Mdm Tan Ah Ngoh, a 54-yearold housewife.
Hope for a better future
Like the rest of the family, Mdm Tan didn’t want her son to spend nine to 10 years on dialysis, waiting for a donor organ, if a better treatment alternative could be found. It was especially heartbreaking for her as she was the one to ferry her son to and from hospital for tests and consultations, and who witnessed the anger and despair he went through as his body failed to respond to treatment.
She didn’t want him to be robbed of a chance for a transplant by staying on dialysis for too long, as patients can develop complications after years of dialysis, preventing them from undergoing a transplant later. The average waiting time for a donor kidney in Singapore is nine years and five months, according to National Organ Transplant Unit statistics.
The Tans were the first pair of patients to undergo the new surgery, but they weren’t concerned.
After all, SGH’s Renal Transplant Team was the first to successfully perform kidney transplants using organs from older deceased donors in 2010 – after the government lifted the age limit of 60 years for donors. SGH was also able to transplant a kidney from a 75-year-old mother – Singapore’s oldest living kidney donor – to her 46-year-old daughter.
The renal transplant procedure involving incompatible blood groups was a new SGH service, but such transplants have “been practised in Japan since the 1980s with much success”, said Dr Terence Kee, Consultant and Director, Renal Transplant, Department of Renal Medicine, SGH.
The transplant team, he added, took a year to study the techniques from Japanese experts and to develop the service with a multidisciplinary team. “The team went to Japan several times to understudy the experts, so we were well prepared for all possible complications and outcomes,” said Dr Kee.
Before the transplant – named ABOincompatible kidney transplant after the main A, B and O blood groups – in November 2009, Mr Tan’s immune system had to be suppressed to a level that would not cause a kidney from a donor with an incompatible blood type to be rejected.
Left to themselves, the antibodies in the receiver’s immune system would immediately attack the donor kidney – much like how the body produces antibodies to fight germs. Mr Tan went through the procedure, which is similar to dialysis, to remove the antibodies in his blood “every alternate day till the antibody level was reduced (to an extent considered safe for transplant) before he could undergo transplant surgery”, said Dr Kee.
Rejection of the donor organ is an issue that all organ recipients face, but in transplants involving blood types that don’t match, the risk is higher. Mr Tan will have to take immuno suppressant drugs for the rest of his life. As his immunity was suppressed, Mr Tan became more prone to infections and stayed away from school and other crowded places till his condition became stable.
More than a year later, Mr Tan is now a first-year business management undergraduate at the Singapore Institute of Management.
“Before this, I used to just laze around at home or go out with friends. During the four months I was in hospital, I realised what an aimless life I led. Now, I want to make the best of every moment and live my life to the full,” he said.
Mr Tan, who shares a close relationship with his mother, became even closer to her during his illness. Her support and encouragement gave him strength to face his illness.
“She’s my best friend,” he said.
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Dept of Renal Medicine
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