Recently, a troubling case came to light: a patient diagnosed with end-stage renal failure (ESRF) in a private hospital in a northern island state was told by a nephrologist that renal transplant services are not available in Malaysia. This is shocking, especially as the country celebrates 50 years since renal transplant services began in 1975.
This wasn’t an inexperienced doctor, the nephrologist in question has been practicing in Malaysia for years, during a time when transplant services were very much available. Even if they were referring to the lack of such services in that particular state, such misinformation reflects a worrying gap in professional responsibility and awareness.
Sadly, this is not an isolated incident.
Patient advocates continue to report delays in transplant workups at various government hospitals:
Patients not receiving follow-up appointments.
Clinics do not answer calls.
Nurses and doctors do not respond in time.
Lack of communication regarding essential tests
These aren’t one-off mistakes, they are symptoms of a larger systemic issue. Overstretched staff, limited resources, and overwhelming patient loads are crippling the ability of nephrology departments across Malaysia to provide timely and complete care.
Why Is Transplant Often Overlooked?
Despite being the definitive treatment for ESRF, many patients are not being offered transplants as an option, especially in private hospitals or dialysis centres.
In Malaysia, many patients start on haemodialysis (HD) and are then left behind, tethered to tubes and machines three times a week, four hours each session. They often feel exhausted before and after treatment. Many lose their jobs and family support. The longer a patient stays on dialysis, the shorter their lifespan. Data shows increased mortality and a 50% higher rate of cardiac events in those who remain on dialysis long term.
Are patients ever counselled about kidney transplantation after starting dialysis? Unfortunately, many Malaysians first present to hospital as ‘crash-landers’ , breathless from fluid overload, severely anaemic, sometimes acidotic.
They are immediately started on acute dialysis via an internal jugular catheter. Once stabilised, they are scheduled for a fistula (for long-term HD) or a Tenckhoff catheter (for PD) and then referred to dialysis centres outside the hospital. These centres may be NGO-run, GLC-linked, or privately operated, but all must have a designated nephrologist.
Here lies the challenge: each nephrologist may only visit once every three months and may be responsible for multiple centres, each with up to 60 patients. Even with a full day dedicated to seeing patients, there is simply not enough time to have meaningful conversations about kidney transplantation.
Dialysis as a Default, Not a Bridge
Dialysis was never meant to be a lifelong treatment; it’s a bridge to transplant. But in Malaysia, patients often remain on dialysis indefinitely. Many become physically and emotionally drained, lose employment, and face isolation. Studies show higher mortality and cardiovascular risk in long-term dialysis patients, with declining quality of life.
In truth, most government nephrologists try their best to mention transplant as an option. But when a single doctor is responsible for ward patients, clinic patients, and satellite dialysis centres, it’s nearly impossible to have in-depth transplant discussions.
In the private sector, time is money. Long consultations to explore transplant options may drive patients to seek faster service elsewhere. This disincentivises long-term planning in favour of short-term solutions.
A Flawed Policy Landscape
Compounding all of this are policies that have, historically and still today prioritised dialysis first. Despite efforts to promote peritoneal dialysis (PD), haemodialysis (HD) remains dominant, driven by fear, lack of information, and because it is financially rewarding for those running dialysis operations, which continue to receive government subsidies. Dialysis centres also make for great political photo opportunities; transplantation does not. Dialysis centres are subsidised and politically popular, they make for good photo ops and ribbon-cuttings.
Meanwhile, who’s talking to patients about kidney transplant?
Often, no one.
Today, over 50,000 Malaysians are on dialysis, with 10,000 new ESRF cases expected annually. Dialysis is becoming a booming industry, but at what cost?
Although renal transplant is both cheaper and offers better long-term outcomes, it continues to be under-prioritised because Malaysia’s long-standing “dialysis-first” policy is deeply entrenched, politically, financially, and operationally.
Dialysis centres receive subsidies, create jobs, and have strong vested interests behind them (from machine suppliers to private operators), making it difficult to shift the narrative towards transplant as the “first-line treatment.” Policy change will inevitably face resistance, particularly from stakeholders who benefit from maintaining the status quo.
Yet the reality is stark: relying on dialysis alone will cost more lives and drain public funds. Transplant and dialysis must co-exist, with transplant offered as the main treatment and dialysis used as a bridge, not a destination. This requires open dialogue across all stakeholders, from nephrologists and dialysis centres to policymakers and urgent political will to place patients, not profits, at the centre of renal care.
The truth: renal transplant is more cost-effective, has better long-term outcomes, and allows patients to return to productive lives. But shifting the system won’t be as easy as flipping a switch. Vested interests - dialysis providers, equipment suppliers and politicians may resist.
The Way Forward
To change this, we must start talking.
Hold town halls with patients, nephrologists, nurses, and dialysis centre operators.
Convene a national steering committee involving the Ministry of Health and Ministry of Higher Education.
Brief Parliament and policymakers to dispel myths and foster support.
Patients need to know that transplant is not a luxury, it is a right, and for many, a lifeline. Dialysis has its place but should not be the only path offered.
We need a healthcare system that puts truth, sustainability, and patient survival first. It’s time we stop looking away and start fixing what’s broken, because the longer we delay, the more lives we risk losing.
Please note that the views expressed in this article are those of the author and do not necessarily reflect the opinions or positions of Vital Signs.
