Ong Ying Fei Vienna, 16

School: Dunman High School

Topic: Letter to a friend suffering from kidney failure

Award: Distinction, Senior Category, 2021

Dear Blake,

How are you? Attending the doctor’s consultation with you yesterday made me realise the severity of the situation. This is such a difficult and painful decision to make and I cannot imagine the whirlwind of emotions you are feeling currently. I admire you for your courage and optimism amidst this trying time. I understand that you may need some time and space to consider your choices wisely. Since yesterday, I have done some research on the two options your doctor has mentioned - to start on dialysis soon or have a kidney transplant - and hope to share with you my findings as well as my personal opinion on which treatment option will be the best one for you.

One advantage of dialysis is that you will not need to wait for long to start. As your doctor has mentioned, if you were to choose to have a kidney transplant, you will be put on a waiting list. According to the National Kidney Foundation (NKF), I have found that the median wait time for an individual’s first kidney transplant is 3.6 years and can vary depending on health, compatibility and availability of organs. Over 3,000 new patients are added to the kidney waiting list each month. In 2014, 4,761 patients died while waiting for a kidney transplant while another 3,668 people became too sick to receive a kidney transplant. On the other hand, your doctor said that you may choose to start dialysis soon. This means that you need not wait for a transplant and deal with feelings of uncertainty and anxiousness every day, hoping for one before it is too late. However, a disadvantage of dialysis is its shorter life expectancy. I came across this section on the NKF’s website that explained how life expectancy can vary depending on your other medical conditions and how well you follow your treatment plan. Average life expectancy on dialysis ranges from five to ten years. however, many patients have lived well on dialysis for 20 or even 30 years. The foundation recommends patients to talk to their healthcare team about how to take care of themselves and stay healthy on dialysis. You have always been compliant and attentive to any set of instructions given to you so I am sure you will be responsible enough to follow your doctor’s orders strictly. Furthermore, you have always been health conscious and mindful about keeping fit as you exercise regularly and maintain a well-balanced diet. Hence, with your positive mind-set, I am certain that you can live much longer. Besides, your parents will be there with you every step of the way to guide and remind you of any small details you may miss out.

On a different tangent, an advantage of having a kidney transplant is being able to lead a better quality of life. The Main Line Health wrote that kidney transplant patients enjoy being able to return to work, travel more freely, and live without diet and fluid restrictions. This means that you do not have to worry about missing classes or being too tired to attend them from being on dialysis three times a week and four hours each time. You will be able to carry on with your normal school life as before and your free time after school will also not be restricted. I am sure that this is extremely important to you, given your usual busy schedule, from soccer training to piano lessons. Yet, one major disadvantage for having a kidney transplant lies in the high failure rate for teenagers. The Reuters Health reported that teenagers who undergo a kidney transplant are more likely to have their new organ stop working within a few years than both younger and older recipients, according to a new study. Dr. Beth Foster, who has studied kidney transplants in children and teenagers at McGill University in Canada, said that, “most people believe that at least part of the reason for the higher risk during adolescence is due to poor medication adherence”. He also mentioned that an enhanced immune response during adolescence could be another reason and this is beyond anyone’s control. Besides, according to the American Society of Nephrology, when young patients are given old kidneys, they deteriorate long before the patient dies. This leads to returning the patients to dialysis or being re-transplanted, which further increases the number of patients on the burgeoning waiting list. Hence, even after receiving a kidney transplant, nothing is certain.

After conducting a thorough research on both treatment options, I have come to a conclusion that starting dialysis may be the better one for you. Although this means that you have to cut down on your after school activities and may risk missing some lessons, starting a dialysis offers some flexibility. You may choose to either go to the hospital and let the doctors help you with it, or carry it out by yourself or with the help of your loving parents at home. Peritoneal dialysis can be carried out while you are asleep too, so you do not have to worry about not having enough time or energy. Furthermore, as mentioned previously, you can start on dialysis almost immediately and need not wait for a kidney transplant, which may or may not work, due to your body’s immune system. I think that it is very risky to rely on a kidney transplant, especially at your age, as your immune system will be very strong and organ rejection may occur. Although your life expectancy varies with dialysis, it can be increased as long as you follow closely to your doctor’s orders, which I trust that you will. Therefore, I will recommend you to start on dialysis soon.

I hope that I can help you to see things from a balanced viewpoint and please understand that I am in no way trying to impose my opinions onto you. I believe that you will conduct your own research and consult your family and doctor again before making an informed decision. I will always be by your side to support and comfort you no matter which option you choose. Please rest well and take good care of yourself. I look forward to hearing from you soon and to seeing you again.

Yours truly,
Kyzo

Disclaimer: Please note that the views and opinions expressed in the essays for the Live On Festival 2021 are those of the participants and are not endorsed by the National Organ Transplant Unit (Ministry of Health).

To learn more about organ donation and organ transplantation in Singapore, please visit www.liveon.gov.sg