Speech by Director of Medical Services, Professor K. Satku at the NKF'S 41st Anniversary Celebration

05 Apr 2010

By Professor K Satku

Venue: NKF’S 41st Anniversary Celebration

1. Let me begin by congratulating the National Kidney Foundation (NKF) on the occasion of its 41st Anniversary. NKF has come a long way since it humble beginnings in 1969. Over the years the Foundation has grown and continues to play a significant role in the health scene in Singapore, improving the well-being of many people with kidney failure.

The Conundrum of Medical Advancement

2. It is paradoxical that your contributions to improving the care of patients with kidney disease through dialysis have created an increased obligation on you.

As patients live longer the numbers needing dialysis increase and more resources are necessary. This is an inevitable development and is a measure of your achievements. Together we will find the resources to provide for these unfortunate individuals.

3. While we secure the resources for these individuals we must also strive to prevent kidney failure through primary prevention and to manage kidney failure through organ transplant.

Prevention

4. The leading causes of kidney failure here in Singapore are diabetes and hypertension. Hence to reduce the incidence of kidney failure we need to direct our efforts towards promoting healthy lifestyles to prevent or delay the onset of these diseases.

We also need to screen those at risk regularly to detect the onset of these diseases and to manage them effectively.

5. Leading a healthy lifestyle is often said to be a personal responsibility but the environment too must change to assist people to lead a healthy lifestyle.

Too often we do not put enough effort in this latter strategy, that is improving the environment, and hence as a society we continue to suffer the burden of lifestyle diseases.

6. Over the years NKF has led by example. Working with stakeholders including my Ministry, NKF raises the community’s awareness of the importance of kidney disease prevention through public education. It also provides health screening for various sectors of the public to promote early detection and management.

Increasing demand for dialysis

7. Despite our efforts, the number of new patients requiring dialysis has been increasing. During the last decade, there were about 6,500 new patients with kidney failure who went on dialysis.

NKF has been exemplary in its mission in ensuring that dialysis is within the reach of all patients with kidney failure.

However, dialysis offers only a temporary solution and is not a permanent cure for kidney failure. Patients on long term dialysis often suffer from various medical complications, emotional stress and social inconveniences.

Deceased donation

8. While we continue to support these patients, we should aim to take as many patients off dialysis as possible. The treatment for these patients on dialysis is transplantation.

We have made significant progress in developing our deceased donation programme to address the needs of organ failure patients. Last year my Ministry made several legislative amendments and removed the upper age-limit for deceased donation under the Human Organ Transplant Act (HOTA).

The amendments were well received by the public. Only about 2500 or 0.5% of those aged 60 years and older chose to opt-out of HOTA. Since the amendments in November, 8 patients, out of which 2 were patients with kidney failure, have already benefited by donations from older deceased donors. Our efforts have been in the right direction.

However, if we look at some international models like Spain, we see that we still have a long way to go to maximise deceased donation. Annually, we have 11 cadaveric kidney transplants per million population, compared to Spain’s 45.

In the years ahead, we will continue to promote the deceased donation programme and strive to achieve the standards set by countries such as Spain.

Living donation

9. Deceased donation alone will not be sufficient to have a significant impact on the long waiting list for an organ. For this we need more living donations by family members and relatives of the patients.

This is not an unachievable aspiration. In Norway, living kidney donation is the first option for each new patient with kidney failure. Dialysis is only considered as the stop-gap option for the patient till the transplant is done.

As a result, Norway leads the world with about 21 living kidney transplants per million population, and their waiting list for a kidney has been relatively constant. In contrast we have about 7 living kidney transplants per million population. Norway is another example that we can follow to strive towards self-sufficiency in transplantation, and better care for our people.

Living Donor Welfare

10. Living donors will always have concerns about organ donation. Dr Dorry Segev, the author of a recent study on living kidney donation published in the March 10 issue of The Journal of the American Medical Association, had this to say - "After donating a kidney, a person can live exactly the way they lived before donating – a long, healthy, active life with virtually no restriction at all."

11. My Ministry recognizes that organ donation is a very altruistic and generous act of sacrifice by an individual. We have, therefore, strengthened donor welfare including long-term medical follow-up after donation. We have set up a Donor Care Registry to monitor the health of living donors.

NKF’s decision to complement our efforts with its Live Donor Support Programme provided a timely and significant boost to donor welfare. We are grateful to NKF for this important initiative.

In his speech, Mr Gerard Ee shared that living donors have started benefitting from this Programme. I am heartened by this and we look forward to working together to improve the welfare of donors.

But beyond the numbers, the strength of this Programme is illustrated by the impact on the quality of life of both, the donors and their recipients. Patients can receive the gift of life from their loved ones and have the assurance that costs will not be a barrier for their donor’s long term medical follow-up. As Singapore’s largest voluntary welfare organization supporting kidney failure patients, NKF’s effort in this direction gives a message of hope to these patients.

12. The decision to donate an organ is not an easy one but we are hopeful that with your efforts to help living donors, more people will come forward to help their loved ones suffering from kidney failure.

Conclusion

13. In closing, over the past forty-one years, NKF has played a vital role in the care of patients with kidney failure - from prevention to dialysis, and now, promotion of kidney transplantation.

It has been a long journey and as I look ahead I see an equally long and an equally satisfying journey. We will continue to support NKF in its journey.

14. Thank you and I wish you every success in your mission.