SINGAPORE - When his father's kidneys started failing, Dr Eric Lim (right), 37, insisted on donating one of his own to the older man.
It was not an offer that was easy for his father, Dr U.H. Lim (left), 68, to accept.
In the end, the older Dr Lim, a retired general practitioner in Johor Baru, Malaysia, did because he knew that a kidney transplant would give him a better quality of life compared with being on dialysis.
For the younger Dr Lim, who used to work in a kidney transplant unit in Britain, it was a no-brainer.
Among him and his two siblings, he was the best match and he knew he could have a normal life with one kidney.
But his attitude is not shared by the majority of people in Singapore.
The number of people who received kidney donations from living donors fell from 37 in 2007 to 25 in 2010. However, it went up to 31 in 2011.
In 2011, more people - 36 - received kidneys from cadaveric donors than from living donors.
There were more than 400 people waiting for a kidney transplant in 2011.
The number of living donors has not risen significantly despite a change in the Human Organ Transplant Act - which allows organs of citizens and permanent residents to be donated for transplants on death - in March 2009 to allow living donors to be reimbursed for expenses.
These include the cost of health checks, laboratory tests, surgery, hospitalisation and follow-ups, as well as loss of income as a result of the donation.
This is probably because money is not the main concern when it comes to organ donation, a study suggests.
The study carried out by medical social workers and doctors at the Singapore General Hospital (SGH), and published in the Progress In Transplantation journal last year, found that out of 1,460 respondents, only 48 per cent were willing to donate a kidney while they were alive.
More than eight in 10 of those who were unwilling to donate cited fear of surgical risks and poorer health after donation as the main reasons.
Those willing to donate tended to be younger, with higher education and no dependants.
Progress In Transplantation is the official journal of the Organisation for Transplant Professionals, an international organisation, and provides peer-reviewed original research, case studies, international papers, review articles and policy papers.
Dr Terence Kee, a senior consultant at the department of renal medicine and programme director for kidney transplantation at SGH, said the results are a cause for concern.
The waiting time for a cadaveric transplant is nine years on average, he said, and an average of seven patients on the kidney waiting list die per year based on statistics over the last 10 years.
They may also develop complications related to long-term dialysis, such as cardiovascular disease.
Dialysis compromises the quality of life for kidney patients. They find it hard to hold on to jobs because of poor health and having to undergo dialysis treatment three times a week, said Dr Kee.
The number of kidneys from cadaveric donors is shrinking mainly because of the ageing population.
"Potential donors in the intensive care units are less likely to be suitable due to other health issues. Or they die prematurely before they can be evaluated as potential donors," he added.
The only way to grow the pool of kidney donors now is for living donors to come forward.
But Singapore's living donor rate is very low.
SGH doctors and medical social workers are now doing another study on the quality of life and clinical outcomes of living kidney donors to counter the misconceptions.
"If we can publish data to show that quality of life and clinical outcomes of living donors are comparable with normal, healthy people, we have more data to increase acceptance of living kidney donors," said Dr Kee.
A low-risk option
A low-risk option
It was this knowledge that living kidney donors do go on to lead healthy lives that convinced the elder Dr Lim to accept his son's gift of life.
He had known since he was a medical student that his kidneys would eventually fail.
His creatinine level back then was just above the normal range at 130 micromoles per litre.
Creatinine, which measures how much waste the kidneys are removing, is a fairly reliable indicator of kidney function.
An elevated creatinine level shows impaired kidney function or kidney disease.
The elder Dr Lim does not know the reason for his elevated creatinine level, but hazards that it could have been due to an allergy to sulphur which was in some medication he took as a child.
He kept kidney disease at bay for 40 years through exercise, a healthy diet and high blood pressure medication.
But two years ago, he knew his kidneys were beginning to shut down when his creatinine levels climbed in a short period of time from 300 to over 600 micromoles per litre.
His options were to go on haemodialysis, peritoneal dialysis or get a transplant.
Peritoneal dialysis uses a membrane inside the body as a filter to clear wastes and extra fluid, while in haemodialysis, the blood circulates outside the body of the patient and goes through a machine that has special filters.
He knew that dialysis was time consuming and would still not give him optimal health, so he explored transplantation.
His wife, a 69-year-old former nurse, was willing to donate her kidney but she has mild hypertension, which rules her out because she would have been at risk of more severe high blood pressure after donating a kidney.
Their son, Eric, who is now a registrar at the National Heart Centre, also wanted to donate his kidney.
Difficult to accept
Gift of life
"It was difficult for me to accept," said the elder Dr Lim.
He considered going overseas to get a kidney, but his doctors advised against it because of the uncertainty of getting good quality medical care.
In the end, he accepted the kidney from his son because a transplantation was far better than dialysis.
He said extensive studies had been done in Europe which showed that donors live a longer life for a number of reasons.
"They are chosen. If there had been the slightest defect, they would have been rejected as donors," said the elder Dr Lim, referring to the fact that donors tend to be healthy people.
After donating a kidney, donors also tend to be more careful about their health.
The Lims are also more open to kidney transplantation as they have a relative who had a living donor transplant more than 20 years ago. Both donor and recipient are doing very well today.
The elder Dr Lim's kidney transplant was performed in November 2011 at SGH. Two months later, the younger Dr Lim, fully recovered, went on a skiing holiday.
He said: "If you have a choice, always choose a transplant. I did not want my father to have to undergo dialysis."
The elder Dr Lim now drives himself between Johor Baru and Singapore every week and travels with ease. He is also able to eat anything he wants.
He said: "Now, I have a part of Eric in me. I told him that he has given me something precious. I must look after it. It's a gift of life."
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