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Who is eligible for a kidney transplant?
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Who can I get a donor kidney from?
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What are the criteria for me to be added to the national waiting list?
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How long is the wait time for a deceased donor kidney transplant?
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How does the evaluation process work?
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What is the Transplant Ethics Committee (TEC)?
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What do I need to prepare before the surgery?
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What are the risks involved during surgery?
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What happens during the surgery?
1. Who is eligible for a kidney transplant?
The transplant team will assess your suitability for a kidney transplant based on:
- Your medical history: Not everyone is suitable for a kidney transplant. You must not have conditions such as:
- Severe heart disease
- Stroke
- Cancer
- Active psychiatric problems
- Significant peripheral vascular disease with above or below knee amputations
- Any other condition where kidney transplantation may not be a suitable option
- Your health: Your body needs to be healthy enough to undergo surgery and tolerate post-transplant medications.
- Your discipline: Recommendations from the transplant team must be followed strictly and you will need to take the medications regularly for the lifespan of the transplant.
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2. Who can I get a donor kidney from?
A donor kidney can come from a deceased donor or from a living donor.
Living Donor
A living donor kidney donation can be from relatives (e.g. spouses, siblings, parents, uncles, aunties, cousins), friends or even a stranger (altruistic donation). We all have two kidneys and a healthy individual only needs one kidney to live normally.
The living donor will need to undergo tests and screenings to determine if he/she is suitable to donate his/her kidney to you.
Deceased Donor
In deceased donor kidney donation, the organ is retrieved from deceased donors who are certified brain dead and have not opted out of Human Organ Transplant Act (HOTA) or have opted in to Medical (Therapy, Education and Research) Act (MTERA).
A brain dead patient does not have any brain function and will never regain consciousness again, although the other organs such as the kidney may still function normally. It is different from being in a coma, where a person is unarousable but tests confirm that some brain functions are still present. A comatose person may still recover or regain consciousness. Organs are never taken from a person in a coma. To be certified brain dead, two independent doctors will perform thorough clinical tests and they must not have been involved in the care or treatment of the patient being certified, or belong to the transplant team.
Once a patient is diagnosed brain dead, it is recognised both medically and legally as death of the person in Singapore and organ donation can then proceed. In cases where the patient had not pledged his/her organs before passing away, family members can decide to donate his/her organs under MTERA. Assessments will be done to determine if the organs are suitable for donation.
For more information on HOTA and MTERA, visit
LiveOn.
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3. What are the criteria for me to be added to the national waiting list?
You must be:
- A Singaporean or Permanent Resident
- Deemed medically suitable
- Less than 70 years old
Once you have decided to go ahead with a transplant, you will be placed on the national waiting list, where you wait for a suitable organ from a deceased donor to be available. You will still be eligible for a deceased donor transplant if you have a living donor and the living donor evaluation is ongoing.
For those who are not medically suitable or more than 70 years old, you will only be eligible for a living donor transplant.
Both you and the potential living donor will be required to go through a series of tests to ensure the transplant can proceed, and an operation date will then be scheduled.
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4. How long is the wait time for a deceased donor kidney transplant?
As of 2020, the average waiting time for a deceased donor kidney transplant is 9.3 years in Singapore1.
Each time a deceased donor kidney becomes available, it will be matched to the blood group, and urgency of the patients on the waiting list, as well as some other factors according to a complex algorithm. The best-matched patient will receive the kidney.
The wait can be a difficult and long one. It is normal to feel worried and uncertain. There may be some false alarms, for instance, if the donor organ is not ideal for transplant or if you happen to be ill that day. Our transplant team will be there to offer support during these challenging times.
Be sure to keep your contact details updated so that you can be readily contacted when an organ becomes available.
1Source: NOTU Annual Report 2020
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5. How does the evaluation process work?
In the time leading up to a transplant, our team will work to ensure that you are in the best of health, both physically and emotionally.
Living Donor Kidney Transplant
You will need to undergo a range of tests and screenings to ensure that you are a good match with the donor, and to identify any risks involved.
Step 1
You will need to undergo several tests and screenings such as:
- Blood type: Your blood type should be compatible, even if it is not the same as the donor.
| O | O | A, B, AB |
| A | A, O | B, AB |
| B | B, O | A, AB |
| AB | A, B, AB, O | NIL |
A blood group-incompatible live donor kidney transplant may still be done, but there is a slightly higher risk of rejection. - Cross-match blood test: The test checks how your antibodies react to the donor’s and this determines how high the chance of rejection is.
- Antibody screening: The panel-reactive antibody (PRA) test measures your antibodies against other people's. If you have a wide range of antibodies against others, there is a higher risk of organ rejection, and it may take longer to find a suitably matched organ. You may need to undergo special treatment so that your body can accept the donor organ.
- Tissue type test: This is a blood test for genetic makeup. The more genetic markers you share with the donor’s, the better the match.
- A mental health assessment: You will need to undergo a counselling session and be assessed for any psychological issue.
Step 2
The kidney transplant doctor will evaluate your condition including a full physical examination, and advise on further tests required. You will then need to undergo a chest x-ray, electrocardiography (ECG) and more detailed heart scans, as well as other investigations as required. This will take at least two weeks.
Step 3
Appointments will be made for you to see doctors from various specialties as required by your medical condition(s). For example, if you have a heart problem, you will need to see cardiologist. You will also undergo the final step of tests as needed.
You will be seen by:
- A surgeon who will inform you the risks of the operation and discuss the details of the operation.
- A psychiatrist to certify that you are psychologically prepared and mentally fit to give voluntary consent for kidney transplant.
- Other specialists as recommended by our transplant doctors.
Your potential donor will also be evaluated alongside this and will be required to undergo blood tests, scans and specialist evaluation. He/she will also be evaluated by a kidney transplant doctor, surgeon and psychiatrist.
These pre-transplant assessments are aimed at ensuring the best chances for a successful organ transplant. The more matches there are, the more likely your body will accept the new organ.
Step 4
Once all the tests and appointments are cleared, the application for transplant will be reviewed by the Transplant Ethics Committee (TEC) to ensure that there is no commercial transaction taking place before and after the transplant. There is a compulsory one week cooling off period after the review.
The transplant surgery can go ahead after the TEC has cleared the evaluation. The surgery will take place at least nine weeks after your first appointment.
Deceased Donor Kidney Transplant
You will also need to undergo several tests and evaluation by a kidney transplant doctor to ensure that you are suitable and fit to undergo deceased donor kidney transplant. Once you have cleared the evaluation, you will be added to the national waiting list.
While you are on the national waiting list, you will be required to provide regular blood samples so that we have this on file to match with a potential donor when the time comes. You will also be seen at NUCOT regularly so that our medical team can ensure that you remain healthy and suitable for a transplant. A match from a deceased donor is likely to be from a person who has the same blood type as you.
As in other countries, Singapore faces a continuous struggle with organ shortage. With changes to HOTA in 2009 by the Ministry of Health, the upper age limit of a kidney donor is now removed. This means that increasingly, older expanded criteria donors (ECD) will be used. With ECD, both kidneys will need to be transplanted if we assess that a single kidney transplantation may not be able to prevent dialysis after transplantation.
Dual kidney transplantation started at NUH in 2009. Explant kidney biopsies performed during organ procurement helped decide whether the kidneys should be a single or dual implant and this has been shown to be better than clinical parameters. At NUH, we provide the availability of dual kidney transplantation to patients with adult polycystic kidney transplantation by performing synchronous native nephrectomy to create adequate space. Though complex, this has opened access to patients who might have been turned down for dual kidney transplantations.
Organ procurements for children started in 2010 through MTERA. With the availability of small kidneys, paediatric-en-bloc kidneys could then be performed. Advances in surgical expertise means we can now utilise healthy organs from extreme ends of the age spectrum to save more lives through organ transplantation.
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6. What is the Transplant Ethics Committee (TEC)?
TEC is a panel of three people, including at least one doctor and one layperson (non-medical), who have been appointed by the Ministry of Health. They will determine whether there has been coercion or financial promises made to the potential live donor.
Both coercion and payment for organs are illegal and punishable under Singapore law.
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7. What do I need to prepare before the surgery?
To ensure that you are fit for transplant, the kidney transplant coordinator will contact you regularly to arrange for health checkups. You will need to take good care of yourself, especially while on dialysis.
Some ways to increase your chances of a successful transplant include:
- Take your prescribed medications on time
- Turn up for all your medical appointments
- Keep to a healthy diet and exercise regularly to maintain a healthy weight
- Quit smoking
For living donor kidney transplant, you should fast eight hours before your surgery.
For those on the national waiting list, it is important to remain contactable as a deceased donor kidney may be available any time. You must come down to NUCOT at NUH for the transplant immediately as the surgery must happen within a few hours after the organs are removed from the deceased donor. Do not eat or drink once you have been contacted.
You can prepare a standby bag with necessities for your hospitalisation needs.
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8. What are the risks involved during surgery?
Some of the risks include:
- Blood clots or bleeding
- Infection on surgery site
- Leakage from or blockage of the ureter that links the kidney to the bladder
Your surgeon will explain the risks in detail to you during your appointment.
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9. What happens during the surgery?
The transplant operation is a major procedure and your medical team will need to monitor you closely while it happens. While you are under general anaesthesia, a number of drips and devices will be put in.
- Central venous catheter (CVC or ‘central line’) to receive medication and retrieve blood for tests
- Intravenous (IV) line to receive saline or medication
- Endo-tracheal tube (ETT) to help you breathe during the operation
- Nasogastric tube to drain stomach secretions
- Urinary catheter to drain urine
- Drainage tubes to drain away fluid and blood from the operation site
An incision will be made in the lower abdomen, at the front. The donor kidney will be placed on one side of the lower abdomen.
The blood vessels from the donor kidney will then be connected to your blood vessels. The urine tube from the donor kidney will also be connected to your bladder. Your kidneys are usually not removed during the surgery.
The surgery will take about three to four hours.
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