By Mavis Toh

For many kidney patients here, the new year can't come fast enough.

They are confident that once the Human Organ Transplant Act (Hota) is amended early next year, they will get a new lease of life.

Last week, Health Minister Khaw Boon Wan announced that the law will be changed to allow people who donate their kidneys to get monetary compensation from the recipient or a voluntary organisation.

For kidney patients, the new law will mean a bigger pool of available donors.

The 12 kidney patients The Sunday Times spoke to were all excited about the move and hopeful that it would increase their chances of a transplant.

'This is definitely good news, a light at the end of the dark tunnel,' said kidney patient Agatha Lau, 40. 'Hopefully, Singaporeans would be receptive to the scheme.'

Ms Lau has been waiting for a transplant since she found out her kidneys were failing in 1991. But being the only child to elderly parents, she did not have family members who could donate a kidney to her.

Three times a week, the assistant manager has to rush for her four-hour-long dialysis sessions after work. She spends $2,000 a month on dialysis.

She had toyed with the idea of heading overseas for a transplant but was put off after hearing 'horror stories'. Her heart condition complicates matters, making it risky for her to have major surgery abroad.

But things might now be different.

'If we're allowed to compensate donors in Singapore and have the transplant here, I'll definitely do it if I find a match,' she said.

Like her, many of nephrologist Pary Sivaraman's patients are excited about the upcoming change to the law.

'They like the idea and are very positive that something is going to be done,' he said. 'They are hopeful that it will give them the opportunity to get a transplant.'

About 1,000 people in Singapore lose the use of their kidneys every year. Many who go on dialysis die within the first few months.

Hairstylist Jobina Yau, 54, can't wait for the change. 'Time is of the essence, the faster we can find a donor and have a transplant, the better. Having a transplant is like being reborn.'

She should know because she already had a transplant, thanks to her husband's donation, which lasted her 13 years. Three years ago, however, both her kidneys started failing and she had to return to dialysis.

She had been planning to get a transplant in China but delayed it because of the costs involved.

'A transplant there will cost about $40,000. If I can do it in Singapore, hopefully I can use my Medisave. Without the subsidy, I can't afford it.'

Every year, 20 to 30 Singaporeans go abroad for kidney transplants. Desperation drives them to run afoul of the law and take on the risks of an overseas operation. Most head for China, India, Indonesia and the Philippines.

Kidney patients said that a transplant in China costs between $30,000 and $40,000. Some hospitals are even able to find a match within three days.

Those headed to other countries usually engage middlemen who source for a suitable donor and who get a cut for linking up the donor and the recipient.

(Page 1 of 2) Although such options are available, most patients here would still prefer to have the transplants done in Singapore where medical standards are high, they said.

Retiree Foo Ming Tong had initially considered getting a transplant in China but abandoned the idea when his ex-colleague's wife died during a transplant there.

Patients interviewed said that a mid-five figure sum would be reasonable compensation, and one that most people would be able to afford.

'For some, $10,000 is already a lot of money,' said Ms Yau. 'If the price is capped lower, more would be able to get transplants, or perhaps the Government can step in to help.'

But even with financial help, poorer patients are worried that they would lose out to those with the means to reimburse a donor and miss their chance of getting a kidney.

Mr Mohammad Salim, 46, a renal patient for six years, no longer has any savings after paying for his treatments and medication.

He said: 'I heard there are plans for kidney help groups to pay the reimbursement for poor kidney patients like myself. I hope I won't stand a smaller chance of getting a donor just because I need financial help.'

Most saw the change in the Act as a follow-up to the high-profile case of retail magnate Tang Wee Sung.

He was jailed for a day and fined $17,000 for organ trading and lying under oath that a potential organ seller was a relative.

'There's been discussion about the issue but it was only after MrTang's case that this change is coming about,' said Ms Lau. 'People not in our predicament do not understand how tough it is to live with kidney failure.'

National Neuroscience Institute director Lee Wei Ling also lauded the move and said that it should be implemented as soon as possible. She added that Mr Tang is not the first, and won't be the last, to look overseas for an organ.

'Why do we want to interfere with life-saving procedures?' asked Dr Lee. 'If buyer and seller agree, who are we to say it's right or wrong?'

But even with the law change, doctors and patients still believe that few Singaporeans would step up to donate.

'It's very rare to find a Singaporean desperate enough to sell a kidney,' said Dr Lee. 'The bulk of the donors will be foreigners, not just from Asia but even from developed countries where 'organ trading' is illegal.'

Besides compensating donors, two other changes are on the cards for Hota.

One is to allow for paired donations where a donor, whose kidney is not a match for a relative, gives it to someone else who also has a relative willing to give up a kidney.

The other is to remove the 60- year age limit for cadaveric donors. Similarly, the current 60-year age restriction for recipients will be abolished.

This means that kidney patients above 60 will be allowed back onto the waiting list and given a chance to have a transplant should there be a suitable donor.

Retiree Diana Yuen, 58, a kidney patient, thinks this is definitely a good move for older kidney patients.

'Everyone should be given a fair chance to live, why take us off the list at 60?' she asked. 'Old people shouldn't be penalised. To grow old is not a sin.'

But retiree Mr Foo, 63, thinks that priority should still be given to younger patients. 'A patient at 40 would definitely need the kidney more than me. I've already lived much longer than him,' said Mr Foo, who found out he had kidney failure at 19. 'I wouldn't fight for it.'

But doctors said that the move was long overdue.

Consultant nephrologist Gordon Ku said that as long as a patient has no other organ problems or infections, a transplant when he is above 60 is not a problem.

But an older donor would also mean lower-quality kidneys. Doctors said that most often, these donors would have already suffered multiple health problems before death and their kidneys are often 'not in a very good state'.

The solution, kidney specialist Akira Wu said, is to give these marginal donor kidneys to older patients.

Dr Sivaraman said: 'An old kidney that lasts only five years may not make a lot of sense to a young person, but is more likely to benefit someone above 60 years old.'

Dr Wu added that the move would also translate into more dialysis machines being freed up for waiting patients, as more go through transplants.

The National Kidney Foundation said that at present, it has 2,200 haemodialysis patients. Each year, between 300 and 350 new patients are admitted into its subsidised dialysis programme.

Dr Ku warned that although a transplant can improve a patient's quality of life, it is not a full solution but the beginning of a different set of problems.

A transplant could even be fatal if complications occur. On average, doctors said that a living donor kidney can last a patient 15 to 20 years while a cadaveric kidney lasts about 10 to 15 years.

'People think that a transplant will solve everything but they don't know that dialysis and transplant are complementary,' said Dr Ku.

'Life is not a bed of roses even after a transplant.'

mavistoh@sph.com.sg

This story was first published in thesundaytimes on Nov 9, 2008.

For more The Straits Times stories, click here.