A kidney for sister, hope for others
The Straits Times
WHEN his elder sister's kidneys failed in 2009, operations manager Yow Kok Kheong wanted to give her one of his.
Then, antibody tests showed they were not a match.
But, early this year, 38-year-old teacher Yow Sok Fun successfully received a kidney from her brother, 35.
This was after Singapore General Hospital (SGH) had devised a way to condition her body to accept an incompatible transplant.
The public hospital joins two others in offering kidney transplants from incompatible donors.
National University Hospital has performed 14 such procedures since 2009, while Mount Elizabeth Hospital had at least seven in the past five years.
For SGH, Ms Yow was its first.
The latest development offers yet another avenue for patients who have trouble finding a suitable donor, said surgeon Terence Kee, who heads SGH's renal-transplantation programme.
"We can reopen the transplant option to patients who are on the waiting list for a kidney," he said.
Figures from the National Organ Transplant Unit showed that the number of deceased donors hit a five-year low last year, at only 23. This is down from 36 in the preceding year.
But the waiting list for kidneys is many times longer, with more than 400 requiring one each year.
The average wait is about nine years.
"Chances are bleak for these patients," said Dr Kee, who operated on the siblings in January. "Still, we always try to find a compatible donor first. The new protocol is the last resort."
About two years ago, the Yow siblings had failed the "T-cell cross match" test that determines if there are antibodies that will cause rejection.
Ms Yow, who is married with two schoolgoing children, had very high levels of problematic antibodies due to previous pregnancies and blood transfusions.
In such situations, doctors normally will not proceed with the transplant due to the high risk of rejection - more than 80 per cent.
But the hospital, for the first time, tried an approach in which she received regular infusions of a blood product in the months leading up to the operation, to reduce the amount of "bad antibodies".
The blood product, called intravenous immunoglobulin, is extracted from donated blood. One of its functions is to help "switch off" the production of the bad antibodies. After this, Ms Yow's blood was filtered through a machine to remove the antibodies.
Dr Kee said not everyone is suitable for the latest approach. For instance, they have to be healthy enough for the blood-filtering procedure, which may lead to a heart attack or stroke in vulnerable patients.
Since the operation, Ms Yow has recovered without complications and is looking forward to returning to full-time work. "I was touched that my brother was willing to take the risk, sacrifice his career and go through the pain of surgery."
Her brother, however, said his sacrifice was a "no-brainer".