In standard kidney transplants, both donor and recipient must belong to a common blood group. If not, the kidney will be rejected automatically by the recipient's body. This also applies when other organs such as the heart or liver are transplanted.
The procedure, known as the ABO incompatible kidney transplant, allows for a kidney to be accepted by the recipient even when blood types do not match.
The ABO transplant was first done in Sweden in the 1970s and, later, more commonly carried out in Japan in the 1980s. It caught on in the United States and Europe only in 2000, although just a handful of hospitals carry out the procedure.
ABO incompatible transplants were unheard of in Singapore because of high risks, extensive preparations and exorbitant costs, Dr Lye told The Sunday Times.
'Normal kidney transplants have a 98 per cent success rate. But in ABO incompatible transplants, the success rate is 85 to 90 per cent. Given a choice, not many patients may want to take the risk,' he said.
But Dr Lye recommended the procedure to Mr Khairul as it is his only chance. Mr Khairul's heart is so weak that if he does not get a kidney soon, he will not live beyond 18 months.
Dr A. Vathsala, director of the adult renal transplantation programme at the National University Hospital (NUH), said transplant nephrologists have been talking to patients about exploring the possibility of an ABO incompatible transplant over the past few years.
But many are reluctant to be the first patient to undergo such a transplant here.
Although the surgery is carried out the same way as normal kidney transplants, extensive preparation is needed beforehand to remove antibodies from the recipient and prepare him for the transplant.
This involves highly sophisticated and expensive machinery and medicines. This is why ABO incompatible transplants are so expensive.
While a standard kidney transplant can cost about $60,000, an ABO incompatible transplant can easily cost two to three times as much. Mr Khairul's transplant is expected to cost $120,000.
Also, few doctors have the expertise to carry out and monitor this process. The Sunday Times understands that there are only four such doctors in Singapore, one of whom is Dr Lye.
There were 555 renal patients in Singapore waiting for a kidney last year. The average wait is nine years.
In 2006, 139 patients were taken off the kidney waiting list, mostly because they were no longer fit to undergo surgery even if a suitable kidney donor came along.
Renal specialists said this first ABO incompatible transplant would be a significant breakthrough for Singapore's medical scene.
Said kidney transplant surgeon James Tan: 'In the past, many patients stood no chance of getting a kidney. Every kidney is so precious that it's given only to the person with an exact match. But now with ABO incompatible transplants, we can have a bigger donor pool.'
Renal specialist Pary Sivaraman agrees. 'About 20 to 30 per cent of kidney donors are usually rejected because their blood types don't match. This transplant pushes the limits.'
Restructured hospitals are also gearing up and preparing themselves to perform future ABO incompatible transplants.
The Singapore General Hospital renal transplant programme has set up a special team to perform such transplants.
Said Dr Vathsala from NUH: 'Our restructured hospitals have the facilities and expertise to carry out such high-risk transplants. However, it is not a standard therapy and is still experimental. The risks and benefits must be properly weighed.'
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