By Dr Hasdy Haron
Senior clinical organ donation manager, National Transplant Resource Centre, Hospital Kuala Lumpur.
Donating your organs – whether by pledging them for use after your death or donating them while you’re alive – is indeed a noble deed. Oftentimes, doing so means you are literally saving the organ recipient’s life, as they would be in danger of imminent death due to their affected organ already being in the last stages of failing.
The sad truth is that the vast majority of patients on the organ transplant list die while waiting and hoping to get a new organ. The main reason for this is the insufficient number of donors who have pledged their organs. Simply put, the demand for donated organs far outstrips the supply.
Since 1997 to April this year, there have been a total of 2,641 solid organ transplants performed in Malaysia – solid organs are those that have a firm tissue consistency and are not hollow (e.g. the stomach and intestines) or fluid (e.g. blood). The vast majority of these were kidney transplants, of which there were 2,403 procedures during these past 25 years. The other transplants involved the liver (198), and the cardiothoracic (heart and lung) system (40).
Most of these organs were donated by living donors: 1,752 for kidney and 92 for liver. The remaining organs were donated by deceased donors, who numbered 767.
Like all other areas of healthcare, the Covid-19 pandemic had a big impact on organ transplants in our country. Not only were living donor transplantations halted for a period of time due to the fear of transmitting the SARS-CoV-2 virus to the parties involved, but the number of deceased organ donors also dropped dramatically.
For example, there were only seven deceased organ donors for the whole of 2021. This is likely due in large part to the restrictions during the Movement Control Order (MCO) as most eligible deceased organ donors in Malaysia pass away due to road traffic accidents.
Fortunately for those on the organ transplant waiting list, the number of transplants for this year have already increased past last year’s total. From January to April this year, 69 transplants have already been carried out, with 59 involving the kidneys and 10 involving the liver. Most of the donors were living, with 41 donors giving their kidney and one donating part of their liver. The remaining 12 donors were deceased.
However, there are still over 10,455 patients on the organ transplant waiting list in Malaysia as of April 2022, representing a great need for more organ donors to step forward to pledge their organs.
As noted above, there are two types of organ donors: living and deceased. In Malaysia, healthy adults can donate one of their kidneys or one lobe of their liver to their spouse, or first or second degree relative.
First degree relatives are a person’s parents, children or full siblings. Second degree relatives are a person’s grandparents, grandchildren, aunt, uncle, niece, nephew and half siblings. In rare cases, a person may donate to a more distantly-related relative or a non-family member; however, this is subject to evaluation and approval by an independent committee appointed by the Ministry of Health.
Children, mentally and/or physically unwell adults, and prisoners, are not allowed to become living donors, with the only exception being if a prisoner wishes to donate to a close relative who is in a life-threatening situation due to their organ failure.
Deceased donors are those who had pledged to donate their organs upon their death while they were still alive. These donors would usually have experienced brain death, but the rest of their body is still functional, or kept going via artificial means, in order to harvest their organs for transplants. Such donors can give multiple recipients a renewed lease on life as they can potentially donate many organs, e.g. their heart, lungs, liver, pancreas, intestines and kidneys, among others.
As mentioned earlier, most deceased, or cadaveric, donors in Malaysia pass away due to road traffic accidents. Therefore, their ability to donate their organs is also dependent on the condition their body is in at the time of brain death. Only organs that are intact and still functioning well will be transplanted into a recipient.
Around 50-60% of those who pledge their organs are in the 18-to-40-years age group. This is likely due to increased awareness and acceptance towards organ donation amongst this group. Unfortunately, there are still some myths people tend to believe about organ donation.
One of the most common myths is that the procedure will cause mutilation to the deceased’s body. Another is that allowing the harvesting of organs from a braindead donor will cause delay to the burial rituals.
However, the medical team that performs the removal of organs from a braindead donor always does so in a very respectful manner, ensuring that there is no mutilation of the body. The procedure is also performed in a timely manner, so that the donor’s family will be able to take and prepare their loved one’s body for burial within the appropriate amount of time.
As a multicultural and multireligious nation, it should be noted that organ donation and transplantation is accepted and allowed in all the religions practised in our country. In Islam, which is the most widely-practised religion in Malaysia, organ donation and transplantation is considered “harus” (permissible), according to the National Fatwa in 1970.
The impact an organ donor has is priceless as it often saves a patient’s life and vastly improves their quality of life. It will also have a positive impact on the recipient’s family and friends as they will get to be with their loved one for a longer period of time. Similarly, a deceased organ donor’s family will also be able to feel some level of comfort that their loved one had been able to give life to others as their final charitable act on this earth.
While living donors are strictly forbidden from receiving any reward or compensation for their organ donation – whether in the direct form of cash or other inducements such as property, cars, shares or career advancement, etc – they do receive certain benefits from the Ministry of Health. These include first class treatment in government hospitals, as well as free medical follow-ups related to their organ donation. The organ donation procedure itself is, of course, also free for the organ donor. Civil servants are also allowed to take up to 42 days of unrecorded leave during their recovery period.
It is vital that as a society, we make the culture of organ donation a norm in our communities. Choosing to be an organ donor can be among the most meaningful acts of your life. It costs you nothing to sign up to donate your organs after your death.
So, do go ahead and pledge your organs for donation. Equally important, do let your family know that you wish to donate your organs after death as their permission is also necessary for the medical team to harvest your organs.
* The views expressed herein are strictly the personal opinion of the writer and do not necessarily represent the views of YamCha Time.
