Brunei Darussalam is a small Muslim country with a high prevalence and incidence of kidney disease. At present, there is no local transplant program for patients on the renal replacement therapy program. In order to assess feasibility of a local transplant program, we decided to conduct a survey to assess public opinion on renal transplantation. The majority of the 300 respondents (78.7%) were willing to donate their kidneys if needed. Even after learning of the small theoretical risks of kidney failure, 72.33% of all respondents were still willing to proceed with transplantation. Respondents who had relatives on dialysis and who had a higher education level were more willing to donate their kidneys. There was no significant difference between Muslims and non-Muslims. Most respondents (59.7%) preferred to have transplantation done locally. This study shows that most Bruneians are receptive of the idea of living related kidney donations, which augurs well for the sustainability of a new program. More work is needed to overcome other barriers like the availability of surgical expertise and facilities and cost-benefit considerations.
Brunei Darussalam has one of the highest incidence and prevalence of end-stage renal disease (ESRD) in the world. Diabetes mellitus and hypertension are the two major contributing diseases, which together account for more than 70% of all causes of ESRD. There are currently more than 500 patients on renal replacement therapy; of these, 83% are on hemodialysis, 12% are on peritoneal dialysis, and 5% have functioning transplants.1 Due to the growing number of patients with diabetes mellitus and hypertension, it is expected that more patients will join the renal replacement therapy program in the next few years.
Renal transplantation is widely regarded as the most effective form of renal replacement therapy. Long-term survival rate is more favourable in patients who have undergone renal transplantation compared to those who remain in the waiting list to receive kidneys.2 Renal transplantation is more cost-effective compared to dialysis therapy, even when accounting for the cost of the transplant procedure, treatment of adverse events, and immunosuppressive therapy.3 In addition, patients with functioning renal grafts have a markedly improved quality of life when compared to patients on the other modalities of dialysis.4 This can partly be explained by a greater freedom to pursue leisurely activities and improved earning potential from work.
Patient and graft survivals after transplantation worldwide are now highly successful. Over the past decades, advances in transplantation procedures had increased tremendously especially in immunosuppressive therapy, postoperative care, and transplant-associated infections. As a result, graft and patient survival rates have improved, and the internationally accepted 1-year graft survival rate is now over 90%.3 It is anticipated that graft survival rates will improve further over the next few decades.
Considering the numerous benefits of renal transplantation, the Ministry of Health, Brunei Darussalam, has strived to improve the rate of renal transplantation in Brunei over the past few years. As there is no local transplant program, patients are now regularly sent on government sponsorship abroad for renal transplantation if there is a suitable living donor. This is also in part to deter patients from going abroad to pursue commercial transplantations, which give rise to numerous ethical and health risk issues. Over the past few years, there have been a number of health promotion campaigns and public forums aimed at increasing public awareness in Brunei, most notably during the annual World Kidney Day events. As the majority of the population is Muslim, religious leaders have helped with disseminating health benefit information to the Muslim public through the mass media and at religious gatherings. Patients on dialysis and their relatives are also regularly counseled by doctors, nurses, and other allied health care professionals on the benefits of transplantation.
However, despite these measures, transplant numbers in Brunei are still small and certainly not in keeping with the incidence rates of new ESRD cases. As a result, the local ESRD population continues to grow and this will cause a significant financial burden on the government. This gives extra motivation and incentive to set up a local transplant program, which can potentially offset the financial and social burden of ESRD on the society. Apart from the discussed benefits of transplantation, a local transplant program can offer other anticipated benefits: (1) patients who are unable or unwilling to go abroad can now be transplanted locally; (2) costs of sending patients for transplantation abroad could be reduced if done locally; (3) new skills can be acquired by local health care personnel, which can help the local service in the future; (4) improvement of the image of the local hea