Transplant
Heart Health
Bone Health
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Dr Lye Wai Choong
Renal physician
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When a diseased kidney is unable to function properly, waste products and dangerous levels of fluids and electrolytes accumulate in the body.
Chronic kidney disease can lead to kidney failure, which means that one or both of the kidneys will no longer function properly on their own.
When the kidney fails, there are 2 types of treatments: dialysis and transplantation.
Kidney dialysis
Haemodialysis
A dialysis machine filters the blood and infuses it back into the body through a vein in the patient’s arm. This treatment is carried out at dialysis centres or at home 3 times a week and lasts 4 hours per session.Peritoneal dialysis
A permanent tube is surgically inserted into the abdomen to pump and drain 1.5 – 2 litres of a solution into the body. This is carried out at home and performed 4 times daily.
Kidney transplant
A kidney transplant is a major surgery in which a patient receives a new kidney from a living or deceased donor.
With a kidney transplant, you will have better quality of life. You will be free from the pain and complications of dialysis and have fewer dietary restrictions to contend with. A working kidney helps regulate your body’s fluid and electrolytes, and produce the necessary hormones for good bone health and red blood cell production. Female patients can also plan for children.
A successful kidney transplant is the leading form of treatment for end-stage kidney failure.
What are the types of kidney transplants?
In Singapore, there are 2 sources for kidney transplants:
- Living donor
- Deceased donor
In a living donor kidney transplant (LDKT), a kidney from a healthy living person (the donor) is removed and placed into someone with end-stage kidney disease (the recipient). This is usually done without the removal of the recipient's own kidneys.
In Singapore, there is a gap between organ demand and supply of deceased donor organs, leading to a long wait time for a suitable deceased donor kidney transplant.
Living kidney donation is critical in addressing the ongoing problem of organ shortage. Compared to deceased donor kidney transplantation, living donor kidney transplantation also has significantly better graft and patient survival in the long term.
Why is a living donor kidney transplant (LDKT) important?
In a living donor kidney transplant (LDKT), a healthy kidney is taken from a living donor and implanted into a patient to take over the function of their diseased kidneys. A new kidney, whether donated by family, friends or an altruistic stranger, can save a life.
With an LDKT, you will have a shorter waiting time for a kidney compared to waiting for a deceased donor, better survival outcomes, and flexibility in scheduling the transplant date. Blood group incompatible kidney transplantation can also be done for some patients.
The survival rates for LDKT are high in Singapore, at 93.6% after 5 years and 85.3% after 10 years*.
Learn more about living donor kidney transplants.
Source: Singapore Renal Registry Annual Report 2019
Am I eligible for a living donor kidney transplant (LDKT)?
You may not be eligible for the surgery if you have:
- A medical condition that puts you at very high risk of surgery
- Extreme obesity
Who can be a living kidney donor?
If you wish to donate your kidney, you must:
- Undergo assessments conducted by an independent team of doctors, which includes blood and urine tests, to ascertain his/her medical fitness to be a kidney donor.
- Be interviewed by the transplant coordinator and social worker to confirm their socioeconomic background and motivation for kidney donation.
Learn more about donor eligibility and becoming a donor.
What can I expect as an LDKT patient?
At Mount Elizabeth, our dedicated transplant care team will provide you with personalised care throughout the entire journey. We will work closely with you to guide you before, during and after the surgery, and offer you and your family support and resources to keep you informed at every stage.
A living kidney transplant process involves:
Finding a compatible and healthy living kidney donor. The first step in this journey begins with finding a suitable candidate, and this person could be a next-of-kin, relative or close friend.
Going through a thorough pre-transplant assessment to determine you and your donor's eligibility. Both you and your donor will have to undergo a rigorous medical examination and psychosocial evaluation.
Meeting the donor with your family members for a family conference.
Preparing and taking medications to ensure you are in optimal health for the transplant.
Seeking approval from the Transplant Ethics Committee (TEC), as required under the Singapore Ministry of Health's Human Organ Transplant Act (HOTA). After your application is approved by the TEC, there is a compulsory 1-week cooling off period for the donor. The earliest the transplant can happen is 1 week after the approval date. If you are undergoing dialysis, you will continue with it until your surgery date.
Going for the transplant surgery. A living donor kidney transplant is a complex and demanding procedure that lasts 3 – 4 hours. Learn more about what to expect during and after the surgery.
Post-transplant surgery and care. You should begin to experience an improved quality of life especially after the first month from your LDKT. Provided your recovery goes well, you can look forward to returning to work and resuming your normal activities within a few months.
Your doctor may schedule 2 – 3 appointments a week to check on your recovery in the first month after surgery. They will continue monitoring you closely and will schedule regular appointments to check on your kidney function. The frequency of clinic reviews will decrease over time.
Our kidney transplant care team
At Mount Elizabeth Hospitals, our kidney transplant team brings decades of experience and know-how in caring for and helping kidney transplant patients in Singapore prolong and improve the quality of their lives.
You will be in the good hands of our skilled and compassionate team, which comprises a multidisciplinary group of medical experts including kidney transplant physicians, urologists, nephrologists, general surgeons and anaesthesiologists.
In addition, you will also be supported by our:
- Clinical transplant coordinators who play the important role of working closely with patients and donors to facilitate all aspects of the transplant process
- Social workers who can provide patients with emotional support and practical advice to help address any psychosocial or financial needs
Our team members all share a common mission – to provide comprehensive, compassionate and customised care to our kidney transplant patients.
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More information for LDKT recipients
If you are a patient considering an LDKT, you may have many concerns. Here are answers to some commonly asked questions.
An LDKT recipient may face complications including:
- If your body does not recognise the new kidney, the immune system may attack it instead, leading to acute rejection.
- The use of immunosuppressants may lead to decreased immunity from other diseases. There may also be side effects from the medication, such as new-onset diabetes and high blood pressure.
- Recipients also face an increased risk of developing cancers, especially certain virus-associated cancers.
- Risks during surgery include blood clotting, bleeding or infection.
For Singaporean patients, you can reach out to our Transplant and Cellular Therapy (TACT) executive office at sg.tact.executiveoffice@parkwaypantai.com for more information.
For international patients, please contact our international offices where our representatives will be able to advise you on all transplant-related enquiries.
Once you have found a compatible living kidney donor, you will both undergo a pre-transplant evaluation by the transplant team. You will need to be psychologically prepared and mentally fit for a LDKT. In the meantime, you will should continue with your dialysis (if you are already on dialysis) until your surgery date. You may need to modify your lifestyle (e.g. quit smoking, eat healthily and exercise) or take medication to ensure optimal health for the transplant.
Learn about how to prepare for a living donor kidney transplant.
You will need to undergo robust testing to give yourself the best chance of a successful transplant. These tests include:
- Blood type and cross-match to ensure compatibility with the donor. If your living kidney donor’s blood type is not compatible, you could still have a blood-group incompatible LDKT, but it carries a higher risk of rejection.
- HLA Antibody screening
- Tissue typing
- Chest X-rays, electrocardiography (ECG) and other heart scans
- A comprehensive physical examination
- A mental health assessment
Only one donated kidney is required to replace both the recipient’s failed kidneys. The diseased kidneys are not usually removed in a LDKT.
A kidney transplant can take between 3 – 4 hours. During this time, the surgeon will implant the donated kidney through an incision in your lower abdomen.
Blood vessels and the urine tube from the donor kidney will need to be connected. Once these are joined and working well, the incision will be closed.
After the procedure, you can expect to:
- Stay in the hospital for around 10 days for monitoring and to continue receiving care from your transplant team.
- Recuperate at home for several weeks, with 2 – 3 appointments with your doctor a week in the first month. Your new kidney’s health will be monitored closely through regular clinical reviews, which will decrease in frequency over time.
- Be vulnerable to infections, especially in the first few months. You will need to take extra care when meeting people, avoid eating raw foods, and get prompt treatment at the first sign of infection.
In just about a month after your transplant, you will be enjoying an improved quality of life. While you will need to take immunosuppressant medications for the rest of your life (to prevent your body rejecting the new kidney), you can and should take regular exercise and follow a wholesome diet to get in top form.
Female patients may find that their menstrual period becomes more regular. While this means that you have a higher chance of getting pregnant, it is recommended that you wait a year after your transplant to do so. Do keep your transplant doctor informed should you plan to have a child, for a better prospect of a safe and successful pregnancy.
Learn more about living donor kidney transplants.
More information for LDKT donors
As a potential kidney donor, you will have your own concerns. Here are answers to some commonly asked questions.
You can lead a normal life with one kidney. Your general health, energy and longevity will not be affected adversely. In fact, most kidney donors live as long as or longer than the average person.
However, there are potential risks for donors in an LDKT.
- The risk of death is 3 – 5 in 1,000 living donors.
- There is a chance of premature kidney failure, around 0.3% after 15 years.
- You have an increased risk of hypertension and/or having protein in your urine later in life.
- Female donors have a slightly increased risk of high blood pressure during pregnancy.
Your health checks, laboratory tests, donation operation and follow-up medical visits can be reimbursed under the Human Organ Transplant Act (HOTA). If you are self-employed or a daily-wage worker, you are also eligible for limited compensation for your loss of earnings.
Once a compatible recipient has been identified, you will both undergo a rigorous assessment of your psychosocial and physical suitability. You may need to take medication to ensure optimal health for the transplant. Medical tests include blood and urine tests.
A kidney transplant can take between 3 – 4 hours, during which one of your kidneys will be removed for immediate implantation. This may be through open surgery, via a 12 – 18cm incision on your abdomen, or through minimally invasive laparoscopic key-hole surgery, involving 2 or 3 incisions about 1 cm long and another 6 cm incision in the lower abdomen.
After the surgery, you will be monitored and taken care of in the hospital for 5 – 7 days.
In the early recovery period you may experience some pain and discomfort, which can be controlled with pain medications. You will have to use a urinary catheter for several days.
You may resume your usual activities after 6 – 8 weeks. Monitoring of your kidney health will continue with an annual urine and blood tests.
This page has been reviewed by our medical content reviewers.
