Heart and Lung Transplantation
Kidney Transplantation
Liver Transplantation
Cornea Transplantation
Bone Allograft Transplantation
Skin Donation and Transplantation
Heart Valves, Vascular Tissues and Trachea Transplantation

Heart and Lung Transplantation

Heart transplantation is a surgical procedure to remove a damaged or diseased heart and replace it with a healthy donor heart. A heart transplant prolongs the life of a patient who would otherwise succumb to his illness and pass away. The quality of life improves dramatically after a heart transplant and patients are able to lead a more active lifestyle, including returning to work, and even starting a family.

The first heart transplant in Singapore was carried out in July 1990. The National Heart Centre performs all deceased donor heart transplants in Singapore and provides post-transplant care and follow-up treatment for recipients.

A heart donation and its subsequent transplant is a complex procedure involving the coordinated effort and teamwork of many doctors, surgeons, nurses and transplant coordinators. Timing is also critical, considering a donor's heart is not able to sustain prolonged periods of being outside a human body. Due to the complexity of the procedure, strict medical criteria is imposed on the assessment of whether a donor's heart is suitable for transplant, and also whether a potential recipient is suitable to receive the transplant. Combined with the scarcity of donors, deceased donor heart transplants are performed, on average, 3 - 6 times a year.

For end-stage lung disease, lung transplantation involves removing the diseased lung or lungs from the recipient and replacing either one (single lung transplant) or both (bilateral lung transplant) of them with healthy ones from the recently deceased donor. Usually the last resort treatment for lung failure, a lung transplant can substantially improve a patient's quality of life.

To date, more than 8,000 lung transplants have been done worldwide. Singapore embarked on the lung transplant programme in the year 2000. But with strict medical criteria and suitability of lung donors, as of the end of 2007, only 7 lung transplants have been performed.

Kidney Transplantation

The first deceased donor renal transplant in Singapore was performed in 1972, with the first live transplant four years later in 1976. To date over 850 deceased donor transplants and over 600 live transplants have been performed here.

Kidney transplantation remains the best form of treatment for patients suffering from end-stage renal failure. Recipients of a kidney transplant stand a better chance of survival. They also experience better mobility and fitness, subsequently being able to return to work. Some have even managed to bear children after receiving their transplant.

Kidney transplantation is the replacement of primary non-functioning kidneys with a healthy kidney or "graft" from a donor. A person can live normally with only one healthy kidney. With better surgical techniques and post-transplant immunosuppressant treatment regime, the ten-year graft survival rates for the transplants have been steadily increasing, both for deceased donor transplants and for live transplants.

Nevertheless donor availability is always the major problem. More than 550 patients currently await a suitable deceased donor kidney transplant. The waiting time for a transplant may take any period from 7 years to 16 years. In 2007, the median waiting time for those who received a kidney transplant was 9 years.

The situation is further compounded by the increasing number of people being placed on the active waiting list for a deceased donor kidney transplant. Diabetes, or more accurately diabetic nephropathy, was identified as the major cause for new cases of kidney failure in Singapore (Source: National Renal Registry, 2006). An earlier study in 2004, the National Health Survey, estimated diabetes was present in about 10% of the country's population.

Any Singapore Citizen or Permanent Resident, who, after being reviewed by a nephrologist, fulfils the medical criteria for a kidney transplant, can be placed on the National Transplant Registry. Live kidney transplantation is also highly encouraged as a treatment option for patients who have willing and medically suitable donors. They can be from parents, siblings and other relatives such as cousins, aunts/uncles. Unrelated donors, for example, the patient's spouse, may also be considered. However, the respective hospital's Transplant Ethics Committee must give their necessary approval for such transplants, both related and unrelated, to proceed.

Liver Transplant

As the largest internal organ in the human body, one of the important functions of the liver is to break down toxins. Liver disease leads to cirrhosis, essentially the hardening of liver tissues, and a loss of liver functions. End stage liver failure is often case fatal.

Offering hope to patients stricken with end-stage liver disease, liver transplantation involves removing the diseased liver and replacing it with healthy liver graft from a donor. Donor livers can be obtained from deceased donors, but also from a family member who may choose to donate a portion of his/her liver to the patient. Amongst the restructured hospitals, NUH and SGH are liver transplant centres, performing both live liver transplants and deceased donor liver transplants. Live liver transplants are also performed in the private sector.

Established in 1990 in the National University Hospital, the Liver Transplant Programme has performed over 100 liver transplantations in both adults and children. In 2005, a second transplant centre was established at Singapore General Hospital.

The development of effective immunosuppressive drugs and management therapies, as well as the refinement of surgical techniques has led to remarkable improvements in the long-term success of liver transplantation.

Further inquiries can be directed to:
Ms Hamidah Mistam
Liver and Kidney Transplant Office
National University Hospital
Tel: 67724457

Ms Lee Hwei Ling
Organ Transplant Liver
Singapore General Hospital
Tel: 63214512 / 62366355 / 62223322

Cornea Transplantation

Singapore Eye Bank
Corneal donation restores vision to those blinded by corneal disease. The cornea is the clear transparent window in front of the eye, and allows light to enter the eye. A damaged or cloudy cornea can be replaced surgically with a healthy, normal cornea, donated by another individual, during a corneal transplantation. Vision is restored after a successful transplant.

Established in 1993, the Singapore Eye Bank (SEB) is located within the Singapore National Eye Centre and responsible for the retrieval and supply of deceased donor cornea tissues and amniotic membranes (fetal membranes derived from the placenta) for transplantation in both restructured and private hospitals. Furthermore, the SEB maintains the national register for corneal transplant recipients and plays a pivotal role in research and ocular tissue engineering programmes of the future.

The SEB currently retrieves cornea tissues from local non-heart beating donors through the development of joint Hospital Eye Donation Programmes (HEDP) with Singapore General Hospital and Tan Tock Seng Hospital. Retrieval of corneas from HOTA deceased organ donors and MTERA pledgers who choose to donate their corneas, also comes under the purview of SEB.

For more information please call the Singapore Eye Bank at 6322 8311 or visit the website at http://www.snec.com.sg/clinical/corneal_2_1.asp

Bone Allograft Transplantation

Musculoskeletal Tissue Bank
Transplanted bone, tendons, cartilage and skin are used extensively in orthopaedics, neurosurgery, as well as plastic, general and dental surgeries. Bone allograft transplantation may be performed on cancer patients to fill bone voids following tumour surgery. Or, athletes who need reconstruction of their knees may opt for an allograft.

The National University Hospital (NUH) Tissue Bank was first established in October 1988 as a research bone bank, going by the name, the National University of Singapore (NUS) Bone Bank. Bones were procured from both living as well as deceased donors.

The first deceased donor procurement was carried out on 15 November 1991. The bank provides small and long bones to all hospitals in Singapore. In 2005, bones were procured from one deceased donor and nine live donors. One of the biggest challenges faced by the bank is the shortage of donors and continuous effort is being made to educate the public on bone donation and the benefits of bone transplantation.

In September 1995, the bank was inaugurated as a hospital bone bank and re-named the NUH Tissue Bank. At present, the bank is the regional centre for training and research in musculoskeletal banking. It has been the prime mover in the establishment of bone banks in countries like Malaysia, Hong Kong, Japan, Vietnam, Sri Lanka, Indonesia, Korea, Myanmar, Zambia, Cuba, Brazil and Argentina. The rapid increase in the national demand for bone and soft-tissue allografts saw a tremendous growth in the clinical function of the bank.

Between the first transplantation on 14 June 1989 to 2005, 969 allograft transplantations have been performed in Singapore, with 21 grafts performed for the year 2005. Allograft transplants are performed in both restructured hospitals and private hospitals.

Skin Donation and Transplantation

SGH Skin Bank
The skin is the largest organ on a human body and yet not many know of its life-saving properties in skin donation. For patients suffering from severe burn injuries, their own skin is so badly damaged that it no longer functions to protect against infection and bacteria, much less allow the healing of flesh and tissue.

Donor skin was found to be an effective treatment option for such patients, by acting as a temporary dressing to allow and promote healing, until the patient is ready for grafting using his own skin. Its natural membranous properties surpass alternative dressings made with biosynthetic materials.

With this in mind, the Singapore General Hospital's (SGH) Skin Bank was set up in 1991 to build up an ample supply of donated skin for patients who sustained major burns; ostensibly burns in excess of 30% of total body surface area.

In 1998, the Skin Bank stored its first deceased donor skin using cryopreservation (freezing down) technique. A one-year clinical study conducted in 2000 found that grafting performed using cryopreserved allografts was useful and effective in the management of severely burned patients.

Over the years, the amount of skin retrieved from local donors has unfortunately fallen to very low levels. There were six donors in 2003 who donated a total of 17,500 square cm of skin. In comparison, there was only one donor in 2007 - an organ pledger who had pledged to donate under MTERA, contributing 1,200 square cm. The number of burns patients treated has conversely been increasing each year. The shortfall of skin is made up by the import of skin from USA and Australia, and most recently from the Netherlands. Grafts using overseas skin now constitute more than 96% of all such treatment in 2007.

With the current trend on skin donation skewed towards graft use, public awareness on skin donation is of utmost importance. The Skin Bank collaborates with the Singapore Burns Support Group in organising regular public forums and exhibits, in addition to press advertisements. Hopefully, more people will understand how donated skin can be used to save lives.

Heart Valves,Vascular Tissues and Trachea Transplant

National Cardiovascular Homograft Bank (NCHB)

In line with its vision to deliver quality healthcare, the National Heart Centre Singapore (NHC) established Singapore's first National Cardiovascular Homograft Bank (NCHB) in early 2008 to create a readily available supply of locally cryopreserved heart valves, vascular tissues and trachea homografts for transplantations.

What Are Heart Valves, Vascular Tissues and Trachea ?

1) Heart valves are important structures that stop blood from flowing backwards when the heart pumps.

2) Vascular tissues are tissues that carry blood in our blood circulation around our body.

3) Trachea, the 'windpipe', is a cartilaginous tube descending from the larynx to the bronchi and then into the lungs.

Donated heart valves can help:

1) Children who are born with abnormal or missing valves.

2) Patients whose hearts have stopped working effectively. These patients may suffer from acquired heart or vascular diseases such as infective endocarditis, stenosis

(hardening and narrowing of valves) or regurgitation ('leaky' valves).

A donated trachea can help patients who suffer from the hardening and narrowing of their windpipe.

Human heart valves have many advantages over other alternatives which include good durability and high resistance to infection. Fewer drugs are also required to fight the side effects associated with mechanical or animal tissues. These are important for women of childbearing age, children, and for those who are very active and prone to injuries.

In Singapore, congenital heart disease (CHD) affects about 0.81% of total live births, or approximately 300 new cases annually. There is a waiting list of patients for suitable donated heart valves. The need for suitable heart valves for adult heart patients are also expected to rise, as the number of CHD patients who will survive into adulthood, as well as the number of patients with acquired heart disease increases.

Although human heart valves are the replacement of choice for many valvular conditions, its usuage has been largely limited by availability and timeliness. Without a suitable human heart valve, these patients may ultimately have to undergo a less ideal operation or at times, experience postponement in surgery.

As at 1st August 2009, 8 patients in Singapore have received donated heart valves from NCHB for their transplant operations.

For more information on this programme, please call the National Cardiovascular Homograft Bank at (65) 6436 7576 or email homograftdonation@nhc.com.sg

Visit - http://www.nhcs.com.sg/NCHB