Organ donation in Singapore: Her daughter's death gave two children the gift of sight

GRATEFUL: Thank you cards sent to Madam Tang Siew Ngoh's family from the people who received her dead sister's organs. TNP PHOTO: TAN TAM MEI

For the Tang family, the decision to donate their dead loved one's organs was not easy.

What made it harder was not knowing how long they would have to wait for the organ donation process to complete, said Madam Tang Siew Ngoh.

Her younger sister had suffered a brain aneurysm and was pronounced brain dead.

Madam Tang, 64, said that even after giving the go-ahead for her sister's organs to be harvested and saying their goodbyes, they had to watch her remain hooked up on the life support machine for two more days.

Added the part-time editor: "We were in limbo. We were ready to let her go, but we had to wait for the drugs they had used on her to clear from her system (before the organs could be harvested), and nobody knew how long that would take.

"In the end, we waited two days, which felt like the longest time."

Madam Tang believes the process of organ donation could have been handled better if they had been given an estimated waiting time, and if there was more communication between transplant coordinators and families.

"It would be good if we could have been told about the kinds of tests the body would be subject to, or given an estimate of how long we would have to wait. Knowing this beforehand could have made the wait more peaceful," she said.

GRIEF

Despite their grief, the family agreed to donate her sister's kidneys, heart, liver and corneas - the "compulsory" organs under the Human Organ Transplant Act - as well her skin, pancreas and iliac arteries.

Although the process was emotionally draining, the Tang family do not regret their decision.

Listed as the immediate next-of-kin, Madam Tang's mother, Madam Lam Lai Loke, 85, a retiree, had given consent for her organs to be donated.

She said: "(My daughter) was already dead, and the organs would have been cremated. So instead of the healthy organs going to waste, they can save someone else."

URGENT: Dr Alfred Kow said delays in the organ transplant approval process may mean the patient may die before the transplant takes place. PHOTO: NATIONAL UNIVERSITY HOSPITAL

The number of organ donations is not meeting the demand of those waiting for transplants.

This is despite the fact that Singapore has implemented an opt-out system that has increased the number of potential organ donors.

Over the years, changes were also made to the Human Organ Transplant Act (Hota) that included Muslims as donors and lifted the age cap previously set for deceased donors.

Under deceased organ donations covered by Hota, potential donors become suitable for organ donation only after a brain death test is done.

Said Dr Alfred Kow, consultant at the National University Centre for Organ Transplantation (Nucot) at the National University Hospital: "At times, our ICU colleagues face concerns from the patients' family members for brainstem function testing... to be done."

Brainstem function testing is a requirement to test for brain death.

Concerns of family members include the feeling that the patient still has a chance to recover as he or she is still breathing, and uncertainty over the patient's thoughts on organ donation.

"As a result, a potential donor will pass away and we will lose the chance to help save the lives of other patients who need organ transplantation," he said.

Last year, 411 people were on the waiting list for kidney, liver and heart transplants, but only 58 such organs were transplanted from deceased donors. There were also 58 living donor organ transplants for kidneys and livers last year.

"The number for deceased organ transplantation for kidney, heart and liver (has) remained low for the past 10 years," a spokesman for the Ministry of Health told the Straits Times.

The Straits Times also reported that the average wait for a kidney is still nine to 10 years and one to two years for a liver and heart.

Eye donation counsellor Zhang Jia Qin from the Singapore Eye Bank told The New Paper that every year more than 400 cornea transplants are done, but there were only 222 local cornea donations last year.

ORGAN IMPORTS

She said that while the number of local cornea donations has risen over the years, from 167 in 2010, demand remains high and Singapore has to import corneas from countries like Sri Lanka.

She added: "Even after importing hundreds of corneas, there are still people on the waiting list."

Professor A. Vathsala, co-director of Nucot, said one way to encourage deceased organ donations was for people to have conversations about death and after-death while they are still alive.

"More conversations about end-of-life care while the person is well would help.

"It shouldn't just take place on the death bed or after the person dies," she said.

CALM: Singapore Eye Bank tissue coordinator Christine Marquez.

Within the stressful time frame of 30 to 45 minutes, she remains calm and retrieves the corneas from the deceased with utmost precision.

Ms Christine Marquez, 38, a tissue coordinator at Singapore Eye Bank, works closely with eye donation counsellors and transplant surgeons to ensure a smooth corneal procurement and transplant process.

Ms Marquez said: "When consent is received, the eye donation counsellor will call me and I'll rush to the hospital to harvest the corneas as soon as possible."

She also explained several misconceptions such as cornea procurement being a long process and that it has to be done in a surgery room.

She said: "Of course, I'll scrub my hands to ensure that they're sterile before performing the procedure by the bedside.

"Everything has to be done within 12 hours and for the harvesting procedure, it's 30 to 45 minutes so that we can minimise the amount of contamination and store the corneas as soon as possible."

For eye donation counsellor at Singapore Eye Bank Zhang Jia Qin, 41, her role is to get consent from grieving families to donate their loved one's corneas.

She said: "I'll always have to be prepared to approach the grieving families politely so that I don't aggravate them after they've lost their loved ones."

"No one has ever reacted violently before. If they are not keen, they will just say no and walk away."

Once she gets the family's consent, Ms Zhang will inform Ms Marquez immediately.

National University Hospital transplant coordinator Winnie Chong, 28, also said that broaching the subject of organ donation has to be done tactfully.

Her role is similar to that of Ms Zhang's, and she has to work quickly to give doctors sufficient time to retrieve the organs and also counsel patients and the family on the transplant process.

CONFERENCE

After consent is given, Ms Chong will conduct a conference involving the family, doctors and a medical social worker.

"We will bring them (the family) through an estimated time frame of the entire organ donation process. Family members will be reassured that we will provide them timely updates on the process," she said.

"(When speaking to the family) I have to give them a lot of assurance that the entire process would be smooth-sailing and I would also be around to provide them timely updates on the progress of the donation.

I'll always have to be prepared to approach the grieving families politely so that I don't aggravate them after they've lost their loved ones. No one has ever reacted violently before. If they are not keen, they will just say no and walk away.

- Eye donation counsellor at Singapore Eye Bank Zhang Jia Qin