How to Promote Transplant Services in Rural Areas by Dr Lei, College Surgeons Annual Meeting 11 May 2018

Academy College of Surgeons of Malaysia, Annual Scientific Meeting, Ipoh

11 May 2018

How To Promote Transplant Services In Rural Areas 

Clarence Lei, Consultant Urologist & Renal Transplant Surgeon

Universiti Malaysia Sarawak

   Honorary Consultant Urologist, HKL and SGH

 c/o Normah Hospital, Kuching, SARAWAK.

The objective of this presentation is to review & improve the current status of kidney transplantation, especially from the perceptive of the rural  Sarawak.  The data is from the author’s personal involvement with kidney transplantation in Malaysia since 1987, updated with data from the National Renal Registry (www.msn.org.my/nrr) & National Transplant Resource Centre (www.dermaorgan.my). Haemodialysis and peritoneal dialysis have been available since the Institute of Urology and Nephrology, GHKL was set up in 1974.  Indeed, the first kidney transplant in Malaysia was done on 15.12.1975 for a teenager whose donor was his adolescent younger brother, from rural Bau of Sarawak. Since then, about 50 transplants were done yearly. There were only sporadic cadaveric transplants until cadaveric donations picked up in 1998.  In the early 1990s, the average number of transplants from rural Sarawak was about 6 per annum, with a handful contributed in the later years by the cadaveric programme. In 2015, the deceased organ donors in Malaysia was still very low, 0.6 per 1 million population, whereas it is 39.7 in Spain.  In neigbouring Indonesia, the kidney transplant programme only took off in 2011 when Cipto Hospital in Jakarta reported 491 transplants (mostly living related) for the period from 2011 to 2017.  However, there are 11 other centres across Indonesia doing only a handful of transplants per year.  Kidneys are ideally suitable for transplantation across distances as the kidney can tolerate cold ishaemia of up to 48 hours.   However, a review of literature indicated that patients who are of lower educational status and living in rural areas (even in USA, JAMA. 2008;299(2):202-207) are less likely to be on the waiting list and to be transplanted.  The problems confronting renal transplantation in rural areas may include: the lack of transplant medical personnel, lack of coordinating teams, lack of funds especially for the transportation of the medical team & patients in rural areas.  In addition, the patient factor may include education and cultural attitudes adverse to organ donation and transplantation.  As the earning power and the insurance scheme for rural areas are less,   economic priorities may have to be concentrated in other areas of need, e.g. communicable diseases, cancers, accidents, maternal and child health.  There is a need to intensify  the multi-prone strategy which includes significant government funding as well as community involvement.