Revamp organ donor ecosystem, says kidney specialist

PETALING JAYA: Very few patients with kidney failure get a transplant as the support for organ donation and transplants is discouraging, says National Heart Institute consultant nephrologist Datuk Dr Ghazali Ahmad (pic).

“The richer countries are doing more transplants, something between 40 and 50 transplants per million population, but for us, the highest I think we ever got was three transplants per million population.

“Instead, we are doing more than 200 dialysis per million population per year,” he said.

Dr Ghazali added that the whole ecosystem for organ donation and transplant here was not very supportive.

“When you look at the data in the international registries, we are the lowest in the world with regard to the number of patients with kidney failure who get a kidney transplant for every 1,000 patients on dialysis treatment.

“We are very successful in dialysis, but we are very weak where there is a low number of patients who get a kidney transplant,” said Dr Ghazali, who has more than 30 years’ experience treating kidney patients.

“While dialysis is successful, it is not the best form of kidney replacement therapy, and transplant is the best form of treatment for end-stage renal disease because they would be free from the lifelong requirement of needing to be tied to a machine, and their life survival expectation would also be better,” he added.

He said that organ transplantation was low not just for kidney transplants but for other organs as well.

Dr Ghazali, who is Asian Society of Transplantation president, is a fervent advocate for organ donation and transplantation.

He noted that dialysis was much more expensive in keeping kidney-failure patients alive compared to transplantation.

Developed nations such as those in Europe, North America and others that have access to resources are doing more organ transplants compared to Malaysia, a middle-income country, he said.

Dr Ghazali said rich and developed nations were spending their money on the better option of transplantation, which is cheaper and provides a higher quality and survival option.

“We can’t improve on this unless there is a whole restructure from the top that creates the policy and provides the resources to the people on the ground – from non-governmental organisations, civil society, and the man on the street – to make this a culture where donation is second nature to them,” he added.

Dr Ghazali, 63, was recently awarded the inaugural Kirpal Chugh Award at the virtual 19th Asian Pacific Congress of Nephrology in Thailand.

The Kirpal Chugh Award honours outstanding nephrologists from the Asia Pacific region who make substantial contributions to capacity building in the field of nephrology including education, training, service development and advocacy.

The award will be given out every two years.

Dr Ghazali said the award came as a surprise to him.

“I take that as a recognition of Malaysian nephrology and Malaysia as a country. This shows that we are not a small player with regards to professional recognition by our peers in the region.

“We have done many things in this field, and they have recognised that,” he added.

Dr Ghazali’s contribution to the field includes training physicians and renal nurses from Indonesia and Papua New Guinea between 2000 and 2018. He also assisted in the development of the national renal registries in South Africa, Indonesia and Brunei when he was the chairman of the National Renal Registry in Malaysia.

Over the years, he has also shared his expertise in the field by delivering lectures on nephrology, dialysis and organ transplantation in various countries.

He is also the Health Ministry’s former national head of nephrology services and former senior consultant and head of the Nephrology Department at Hospital Kuala Lumpur.

He is also the Malaysian Society of Nephrology and the Malaysian Society of Transplantation past president.