IN Malaysia, the figures are staggering. According to the Ministry of Health, there are over 10,000 new patients starting dialysis each year, while about 50,000 individuals with end-stage kidney disease underwent chronic dialysis in 2023. This figure is expected to double by 2040.

There is a rising trend in the number of individuals diagnosed with chronic kidney disease every year and once the kidneys fail, dialysis is the only option until a kidney transplant becomes available.

UM Specialist Centre (UMSC), a quaternary hospital consultant nephrologist Associate Professor Dr Ng Kok Peng says diabetes is the major contributing factor to end-stage kidney failure, with 61 per cent of new dialysis cases stemming from diabetic nephropathy. Hypertension is the second leading cause.

UMSC consultant nephrologist Professor Dr Ng Kok Peng says diabetes is the major contributing factor to end-stage kidney failure.

LONG WAIT

Due to critically low organ donation rates in Malaysia, most patients with end-stage kidney failure have to wait five to 10 years for an organ from a deceased donor.

With living donors, the waiting time is one to two years provided a compatible donor is available among the patient’s relatives or spouse.

“In Malaysia, living donors account for 70-80 per cent of transplants due to cadaveric shortages,” says Dr Ng.

Where kidney transplants are concerned, public hospitals have a longer waiting time than private hospitals, but cost differences are stark, he adds.

UMSC consultant urologist Professor Dr Shanggar Kuppusamy says Malaysia’s kidney transplant numbers remain far below patient needs.

“Currently, nearly 50,000 patients are on dialysis, with about 10,000 kidney failure patients on the transplant waiting list. The biggest factor remains the shortage of donors — both living and deceased.”

In Malaysia, deceased organ donation rates are among the lowest in the region, often due to lack of awareness, cultural misconceptions and family hesitancy, explains Dr Shanggar.

TRANSPLANT WOES

However, the shortage of donors is only part of the challenge. Systemic factors also play a significant role.

Malaysia currently only has four public hospitals performing kidney transplants nationwide.

There is also a need to train and produce more renal transplant surgeons among urologists, he adds.

Furthermore, the process of matching and assessment for transplants is time-consuming, which also contributes to long waiting periods.

To improve the provision of renal transplant services, we must increase public education, streamline donor evaluation processes and strengthen hospital transplant programmes nationwide, says Dr Shanggar.

“The need is enormous and while the system is still catching up, there has been encouraging progress too.”

UMSC consultant urologist Professor Dr Shanggar Kuppusamy says to improve the provision of renal transplant services, we must increase public education, streamline donor evaluation processes, and strengthen hospital transplant programmes nationwide.

UMSC consultant urologist Dr Ahmad Nazran Fadzli points out that since 1975 only 3,349 organ transplant surgeries have been performed in the country. The number of patients needing transplants far exceeds this number.

There are 10,239 people currently waiting for transplants, of which 10,197 are waiting for a kidney.

The reasons for this are multifactorial, says Dr Ahmad, aside from the fact that only four government hospitals are offering renal transplant services.

The learning curve, particularly for recipient surgery, can be quite steep and take some time to master.

Kidney transplant surgery also requires two teams — the donor nephrectomy and the kidney implantation team. This is sometimes a bit difficult to obtain in a private setting, he says.

However, we are now seeing an increasing number of private centres in Malaysia offering kidney transplant services.

But the number of new organ donor pledgers is still low, only 2,319 as of this year, he adds.

“Awareness on the need for a larger organ donor pool is still limited in Malaysia. Furthermore, not all patients are suitable for transplant. Some are not medically fit while others have anatomical abnormalities.”

Dr Shanggar says the good news is that modern transplant medicine offers more flexibility. In some cases, doctors can perform kidney transplants across different blood types — known as ABO-incompatible transplantation — using special treatments to remove antibodies from the recipient’s blood.

“This means even a friend, colleague or neighbour could potentially be a donor, provided medical evaluation confirms it is safe and feasible,” he says.

However, it is important to note that there are strict legal frameworks governing this process in Malaysia. Commercial organ donation is prohibited.

Living donation is permitted from close relatives or those with a proven emotional relationship to the recipient.

Friends or other altruistic donors must undergo rigorous evaluation and scrutiny before official approval is granted.

UMSC consultant urologist Dr Ahmad Nazran Fadzli points out that since 1975 only 3,349 organ transplant surgeries have been performed in the country.

POST TRANSPLANT

Once they have received a kidney, patients do need to make adjustments to their lifestyle to ensure they stay healthy.

Dr Ng says this includes limiting sugar and sodium in their diet, consuming adequate fluids, moderate intake of protein, and ensuring proper weight management. Exercises such as walking, swimming and cycling are also encouraged.

Using sunscreen is also mandatory as the immunosuppressant drugs patients take significantly increases their risk of skin cancer.

It is also crucial that transplant recipients avoid non-steroidal anti-inflammatory drugs and use acetaminophen instead, says Dr Ng.

“Smoking should be completely avoided as it doubles the risk of cardiovascular mortality among transplant recipients,” said Dr Ng.

After surgery, the focus shifts to preventing rejection of the organ and infection, adds Dr Shanggar.

In the long term, the patient will be closely monitored for rejection episodes, infection risks from immunosuppression drugs and the management of other health conditions such as diabetes or cardiovascular disease.

“It truly is a lifelong partnership between the patient and their transplant team,” he says.

END-STAGE KIDNEY FAILURE – SIGNS

*Uremic symptoms – metallic taste, pruritus, anorexia, and nausea.

*Fluid overload leading to pulmonary edema (shortness of breath) and peripheral edema (ankle swelling).

*Functional decline – fatigue so severe it affects daily functioning.

POST TRANSPLANT COMPLICATIONS

Complications for the donor are rare. The common complications for the recipient are:

* Bleeding and haematoma, which if large may need re-exploration.

* Infection.

* Rejection of the organ, which can be immediate, early or after many years.

* Vessel blockage which requires immediate revision.

* Urine leak or narrowing of the ureter.