Advancements in Organ Transplantation: A Comprehensive Guide to Singapore’s Leading Facility
Singapore’s healthcare system is hailed as one of the best in the world,. According to Statista, the country had a health index score of 86.9 out of 100 in 2023, which is the highest for that year.
Many factors contribute to Singapore’s world-class care, several of which are due to the strong oversight and regulation by the Ministry of Health (MOH). Apart from this, the country’s technology-driven landscape has enabled both its public and private healthcare facilities to incorporate state-of-the-art medical technologies into their services, giving them the opportunity to make further advancements to procedures like organ transplantation.
There are several facilities that provide excellent organ transplant in Singapore and the National University Hospital (NUH) is one of them. NUH is the country’s first university hospital, and it’s also where the National University Centre of Organ Transplantation (NUCOT) is located. NUCOT is Singapore’s leading and only centre that provides adult and paediatric organ transplantation. It offers a comprehensive, multidisciplinary suite of medical specialty services that utilise advanced surgical techniques.
Moreover, NUCOT’s medical team is composed of healthcare professionals from different disciplines who are dedicated to delivering top-notch organ transplantation services, as well as finding ways to enhance their programmes and Singapore’s healthcare system as a whole. Let’s take a look at some of the most recent advancements in organ transplantation below:
Using Hypothermic Machine Perfusion (HMP) in Kidney Transplantation
To help increase the number of suitable kidneys for transplantation, NUCOT uses hypothermic machine perfusion (HMP) to give less-than-ideal kidneys for transplantation better outcomes. Typically, organs are preserved using static cold storage (SCS), which is the standard method of organ preservation. It involves storing organs at low temperatures without any blood flow. While SCS works well for the majority of organs, it has its limitations.
In particular, kidneys that have been preserved through SCS have their blood circulation temporarily cut. It is only when they’re introduced to the recipient’s system, that the blood flow is re-established. However, this stopping then restarting of blood flow can lead to ischaemia-reperfusion injury (IRI)—tissue damage caused when blood supply returns to the tissue after a period of lack of oxygen. This heightens the risk of graft malfunction and prolongs the recipient’s road to recovery.
With HMP, the blood circulation of the kidneys used in transplantation isn’t cut. Instead of storing the kidneys in low temperatures, very cold preservation fluid is pumped into the organs by a specialised machine for 3 to 4 hours before implantation. This technique is designed to simulate how the body circulates fluid, enhancing the washout of toxins and microclots in the blood while minimising the risk of IRI. Moreover, preserving kidneys through HMP prepares them for immediate function, ready to accept the blood flow of the patient’s body upon transplantation.
Apart from ensuring that kidneys remain healthy before, during, and after implantation, the technology used in HMP can also help doctors select viable kidneys for transplantation. This makes it easier and quicker to weed out suboptimal and irreparable kidneys that could end up failing. NUCOT is looking to collaborate with the MOH in hopes of accelerating the implementation of HMP organ preservation on a national scale.
Various Transplantation Programmes
The National University Centre of Organ Transplant offers five transplantation programmes that target a specific organ and age group. These programmes are handled by experienced transplant care teams that have successfully completed hundreds of transplantations. Using highly advanced medical instruments and equipment, they’re able to provide their patients with life-changing transplants.
Kidney Transplantation (Adult)
This programme offers complex transplant services for suitable donor-recipient pairs. These include cross-match positive living donor transplants, paired exchange kidney transplants, and blood group (ABO) incompatible living donor transplants. In addition to these services, NUCOT also has training and research in transplantation, which are accredited by the International Society of Nephrology.
Kidney Transplantation (Paediatric)
NUCOT’s paediatric kidney transplantation doesn’t only handle transplantation; it also offers long-term dialysis for infants, children, and adolescents up to the age of 21. The paediatric kidney transplant team is experienced in the peri-transplant management of children with chronic kidney disease. They also manage post-transplantation complications such as post-transplant infections and rejection.
Liver Transplantation (Adult)
Over 70% of Singapore’s liver transplantation procedures are performed at NUCOT annually. Among the reasons behind this large percentage are NUCOT’s comprehensive interventional radiology and endoscopy services, which are key elements to improving graft and patient survival. Their transplant coordinators are also allied health professionals who are dedicated to providing the required support and education to their patients and their caregivers.
Liver Transplantation (Paediatric)
The National University Centre of Organ Transplant’s paediatric liver transplantation programme recognises the importance of a good transition of their paediatric patients to adult care. That’s why the team managing the programme runs the Adolescent and Young Adult Liver Transplant Transition Clinic, where children and their parents are prepared for a smooth transition to adult care.
Pancreas Transplantation (Adult)
As of this writing, NUCOT is the only transplantation centre that offers pancreas transplantation in Southeast Asia. The programme’s services include pre-transplant medical assessments, surgical and micro-surgical specialised services, and post-transplant intensive care and recovery. Although the National Pancreas Transplant Programme has been approved as a mainstream service since 2021, NUCOT had its first simultaneous pancreas-kidney (SPK) transplant in 2012 while the programme was still in its pilot stage. NUCOT has performed five SPK transplants to date.
With its technology-driven society and strong support from the government, Singapore’s public and private healthcare facilities can provide world-class services—including life-saving organ transplantations—to their patients. In the coming years, we can expect even more medical programmes and advancements that will continue to establish that Singapore’s healthcare system is second to none.
