Doctors hope HOTA can be expanded to include lungs
By Claire Huang, Channel NewsAsia | Posted: 06 November 2009 2123 hrs

	Photos  of

SINGAPORE: Doctors are hoping that the Human Organ Transplant Act (HOTA) can be expanded to include lungs. They said on Friday that few lung transplants take place in Singapore because of a shortage of donors.

Smoking is the leading cause of Chronic Obstructive Pulmonary Disorder (COPD) for some 60,000 people here, and lung transplant is most often used to treat severe COPD when medication is no longer effective.

Tony Chua, a former smoker of 30 years, is one such example. The consultant, who is in his 50s, was given a new lease of life after undergoing a lung transplant in December last year.

"(Now) I can go out with my friends, walk the same pace as them, go to places where I couldn't go before. Before (the transplant), I couldn't go to hawker centres because there were no carparks or that the carpark was very far away. I couldn't walk... Now, I can even go overseas!" said Mr Chua, who had to wait two and a half years for a suitable donor.

In Singapore, about three to five people require lung transplants every year and the average waiting time is about one and a half years.

Since the start of the lung transplant programme in 1998, only nine transplants have been conducted. Doctors said the programme here is small, primarily due to the lack of donors.

Dr Lim Chong Hee, director, Heart and Lung Transplant Unit, National Heart Centre, said: "The donor issue has always been alluded to because for the brain-dead donors, only 20 per cent will be suitable for lung transplant, even if they've given consent. That's because lungs are always the first organs to be damaged in a patient who is in the ICU. There's always a risk of infection.

"We usually use several parameters to look at suitability for donation of lungs. One, of course, is the blood gas. We look at the donor's blood gas by giving them oxygen for half an hour. We do that to see how good gas exchange in that lung is.

"Second criteria, we do a chest X-ray to see if there is any damage in the lungs like infection or trauma. The mechanism of injury for the death of the donor is also important, like chest trauma would be injurious to the lung."

There were six patients on the waiting list last year, but three of them died while waiting for a transplant.

Dr Jagadesan Raghuram, a visiting lung transplant consultant, National Heart Centre, said: "We have to get consent if we want to get lungs from a donor. We also have to consider the suitability of donors, particularly in multi-harvest situations. Lungs, in many cases, are found to be unsuitable for one reason or another, either due to infection or to trauma."

The recent advancements in HOTA, such as including Muslims and extending the age criteria, are aimed at increasing the donor pool. Still, expanding the Act to include lungs would require some time as talks with authorities have just been initiated.

Currently, HOTA covers four organs – kidney, liver, heart and cornea. The Act came into effect in 1987 to help kidney patients. It was later expanded to include liver, heart and cornea in 2004.

Doctors here said they see about one to two new COPD cases every week and they are worried about this growing trend.


- CNA/so