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Nurturing & sustaining a transplant surgeon, where do we begin?
Dr Clarence Lei Chang Moh, Consultant Urologist & Transplant Surgeon,
Normah Medical Specialist Centre, Sarawak.
Although the first kidney transplant was performed in Malaysia in 1975, the rates of kidney transplantation in Malaysia is one of the lowest, at 2-5 pmp (per million population) for the last 10 years. However, the incidence of end stage kidney failure is now amongst the highest, at 1584 pmp. Small group focused interviews were conducted amongst the surgeons involved to gather data. Relevant publications and a chatGPT deep research were reviewed. In the Ministry of Health Malaysia, kidney transplants were performed by most urologists working in Hospital KL and Hospital Selayang, as part of usual work. This practice is poorly sustained as most urologists leave for private practice; kidney transplantation surgery is not lucrative. In August 2023, the head of urology service arranged for all urologists in the MOH to carry out any procurement in their area. The Ministry of Health delegated the co-ordination of training of urologists to the Board of Urology. With the recent surge in renal transplantation, the Board of Urology initiated new moves to nurture and sustain transplant surgeons. AVF arteriovenous fistula, procurement and assistance in recipient kidney transplants are made core procedure for trainees. New trainees sign a pledge to work 5 years in government departments after passing exit exams. This pledge is repeated as an "oath" in final year. However, surgery is only one important part of kidney transplantation. Other resources that are needed includes nephrologists, para medical team, laboratory, nursing, coordinators, posts, courses and scholarships. Such resources need a lot more priority by managers and politicians. |
