With the increased incidence of chronic disease leading to organ failure, there is a gap between organ demand and supply of donor organs.
As of 2020, more than 50 people are on the liver transplant waiting list. The average wait time for a suitable organ donor is one year.
Living liver donation is key in easing the ever-present problem of organ shortage. Compared to deceased donor liver transplantation, living liver transplantation has significantly better graft and patient survival in the long term. Other than improved viability of the donated organ, recipients can undergo the operation earlier in a better state of health.
The success rate for living donor liver transplantation is over 99%, although over 20 years or so, some liver transplants are lost to rejection or other causes.
Living donation is a sacrifice and anyone can be a potential organ donor. It is the noblest gift an individual can give. The criteria to determine if an organ is suitable for donation is based on a set of medical standards and not dependent on age* or gender. All that is required is a willing and suitable donor.
*If you are below the age of 21 and are interested to donate your organ, parental consent will be required.
Frequently Asked Questions
Frequently Asked Questions on Living Donor Liver Transplant
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Who is eligible for living liver donor donation?
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What are the assessments that I will need to undergo?
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Can I change my mind about donating my organ during the evaluation process?
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Can I decide who I want to donate my liver to?
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What if I am not a good match with my intended recipient?
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What is the Transplant Ethics Committee (TEC)?
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What are the risks involved in donating a liver?
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What does the operation involve?
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How long will I need to be hospitalised?
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What happens after discharge?
1. Who is eligible for living liver donor donation?
If you are interested to donate your liver to your family member, friend, or even stranger, there are some criteria you have to fulfill. You must be:
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At least 21 years of age; donors older than 65 years can be considered on a case by case basis.
- Free from the following conditions:
- Cancer
- Heart disease
- Liver disease
- Diabetes
- Hepatitis B or C
- HIV infection
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2. What are the assessments that I will need to undergo?
You will need to undergo a range of tests and screenings to ensure that you are a good match with the recipient and also to identify any risks.
Step 1
You will need to undergo several tests and screenings such as:
- Blood type: Your blood type should be compatible, even if it is not the same as the recipient.
O | O | A, B, AB |
A | A, O | B, AB |
B | B, O | A, AB |
AB | A, B, AB, O | NIL |
A blood group-incompatible live donor liver transplant may still be done, but there is a slightly higher risk of rejection. - Imaging tests: Using imaging techniques such as CT or MRI scans to create pictures showing your liver. It will help the doctor to determine whether it is safe for you to donate while saving the recipient.
- A mental health assessment: You will need to undergo a counselling session and be assessed for any psychological issues.
Step 2
The liver transplant doctor will discuss the results with you approximately one week after the tests are done. You will then need to undergo a chest x-ray, electrocardiography (ECG), and more detailed heart scans, as well as other investigations as necessitated by your medical conditions.
Step 3
Appointments will be made for you to see various specialty doctors as required by your medical condition(s). For example, if you have a heart problem, you will need to see a cardiologist. You will also undergo the final step of tests as needed.
You will be seen by:
- A surgeon who will inform you the risks of the operation and discuss the details of the operation.
- A psychiatrist to certify that you are psychologically prepared and mentally fit to give voluntary consent for liver transplant.
- Other specialists as recommended by our transplant doctors.
Step 4
Once all the tests and appointments are cleared, the application will be reviewed by the Transplant Ethics Committee (TEC) to ensure that there is no commercial transaction taking place before and after the transplant. There is a compulsory one-week cooling-off period after the review.
The transplant surgery can go ahead after the TEC has cleared the evaluation. Typically, it will take at least four to six weeks for the surgery to go ahead after your first appointment unless it is an urgent transplant.
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3. Can I change my mind about donating my organ during the evaluation process?
Yes, the decision to donate is 100% voluntary. You can withdraw from organ donation any time, up till the day of surgery. Inform your primary doctor about the withdrawal and your decision will be kept confidential.
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4. Can I decide who I want to donate my liver to?
You can choose who you want to donate your liver to, as long as the assessments have deemed that you are healthy and a match to the recipient, and you have made a completely voluntary decision. You may also choose to be an altruistic donor.
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5. What if I am not a good match with my intended recipient?
If your blood group is incompatible with your intended recipient, the transplant team may suggest a paired liver exchange if there is another donor who is also incompatible with his/her recipient but both of you are a good match for the other’s recipient. This results in two new compatible pairs and allows others on the national waiting list to move up.
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6. What is the Transplant Ethics Committee (TEC)?
TEC is a panel of three people, including at least one doctor and one layperson (non-medical), who have been appointed by the Ministry of Health. They will determine whether there has been coercion or financial promises made to the potential live donor.
Both coercion and payment for organs are illegal and punishable under Singapore law.
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7. What are the risks involved in donating a liver?
Donating your liver will not affect your general health, life span, or energy level. Your liver will regenerate, grow back to its normal size, and function normally after a few weeks.
There could be minimal risks such as wound infection at your surgical site. Your surgeon will explain the risks in detail to you during your appointment.
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8. What does the operation involve?
There are two types of surgery, traditional open surgery, and laparoscopic surgery. Not everyone is suitable to undergo laparoscopic surgery, especially overweight donors or those with limited space in their upper abdomen. The surgeon will choose the method most suitable for you. You will be administered general anaesthesia before the surgery and will be asleep throughout as this is a major operation.
For traditional open surgery, a 20cm to 25cm J-shaped incision is made on the side of your chest and upper abdomen to remove the liver. The operation is about six to eight hours long.
Laparoscopic surgery, also known as keyhole surgery, is a new, minimally invasive approach for liver transplantation. Laparoscopic surgery involves having two small incisions around 0.5cm to 1cm on the abdomen, where the surgeons will insert a camera and tiny instruments. These are used to separate the part of the liver and its attachments after which the liver is removed through a second incision of around five cm at the lower abdomen. As the second incision does not involve cutting muscle, this method results in faster recovery for the donor than traditional open surgery. The operation is about four to five hours long.
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9. How long will I need to be hospitalised?
After the surgery, you will be monitored in a High Dependency Unit for about one to two days before moving to the General Ward for another one to two days. You can be discharged within one week after the surgery if no complication arises.
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10. What happens after discharge?
You will not need to consume any long-term medication but will need to come back to NUCOT for your follow up appointment to ensure that you are well:
- Two weeks after surgery, then
- Once every quarter for half a year, then
- Once yearly
Your liver doctor will give you specific advice on taking care of yourself to reduce any risk of complications during your recovery.
Exercise
Maintaining a healthy lifestyle is important. You should be able to return to normal daily activities two to four weeks after your discharge. Please seek advice from your doctor if you are looking to resume any contact sports or strenuous activities.
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If you would like to donate a liver to save a life today, you can contact us at our NUCOT Specialist Outpatient Clinic here.
Frequently Asked Questions on Deceased Donor Liver Transplant
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Will my medical care be compromised if I am a potential organ donor?
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Can I donate my liver after I pass away?
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Can I donate more than just the organs listed under Human Organ Transplant Act (HOTA)?
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What is the Medical (Therapy, Education and Research) Act (MTERA)?
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Can I decide who I want to donate my liver to?
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Will I or my family have to pay the costs for organ donation/recovery?
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If I choose to donate my organs after I pass away, will my body be disfigured after organ donation?
1. Will my medical care be compromised if I am a potential organ donor?
Medicine is an ethical profession. No doctor will risk one life to save another. As a potential organ donor, organ donation will only be considered after every effort to save your life has been exhausted by the medical team. There are seven strict criteria that must be confirmed by two independent doctors, who were not involved in your medical care, before brain death can be certified and organ donation is considered.
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2. Can I donate my liver after I pass away?
In Singapore, Singapore Citizens and Permanent Residents above the age of 21 and above, and are not mentally disordered, are included under the Human Organ Transplant Act (HOTA) unless they have opted out. HOTA allows for organs (kidney, liver, heart and cornea) to be donated in the event of death for the purpose of transplantation.
Over the years, HOTA has been widened in scope so as to grow the organ donor pool. This has meant more people waiting on the transplant list have successfully gotten a life-saving organ. Despite the widening of HOTA, hundreds of people are still waiting for an organ to become available. This is where living organ donation comes in, an area also under the regulation of HOTA. Living organ donation further increases the chance that a suitable kidney can be found.
Those who are under HOTA will not only have a chance to help others, but also have a higher priority on the waiting lists should they need an organ transplant. For those who had opted out of HOTA, you will receive a lower priority for receiving an organ on the national waiting list should you require an organ transplant in the future. This will apply specifically to the organs which you have opted out from.
If you have opted out before and would like to opt back in, you will need to complete the
Withdrawal of Objection Form and send it to the National Organ Transplant Unit.
For deceased donor organ donation, bodies of those with chronic illnesses or cancer may still be used for education or research purposes under the Medical (Therapy, Education and Research) Act (MTERA).
To find out more about HOTA and MTERA, visit
LiveOn.
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3. Can I donate more than just the organs listed under Human Organ Transplant Act (HOTA)?
Yes, anyone above 18 years old can opt into Medical (Therapy, Education and Research) Act (MTERA) to donate their organs and/or tissues for the purposes of transplant, education, or research after they pass on.
Fill in the
Organ Donation Pledge Form and send it in to the National Organ Transplant Unit. You are encouraged to discuss your decision to pledge your organs and/or tissues with your family members so that they are aware of your decision and can advocate for your wishes in the event of your death.
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4. What is the Medical (Therapy, Education and Research) Act (MTERA)?
MTERA is an opt-in scheme, whereby anyone aged 18 years old and above can pledge your organs or any body parts for the purposes of transplant, education or research, after you pass away. You can choose to donate all your organs and tissues or specify those you wish to donate.
In cases where you have not pledged your organs before passing away, your family members can also decide to donate your tissues and/or organs under MTERA on your behalf, if they wish to do so.
For more details on MTERA, visit
LiveOn.
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5. Can I decide who I want to donate my liver to?
You will not be able to choose who you donate your liver to. Your liver will be matched to the blood group, weight and urgency from the pool of patients on the national liver transplant waiting list.
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6. Will I or my family have to pay the costs for organ donation/recovery?
The hospital bills for any organ removal-related procedures and tests will not be charged to the donor’s family.
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7. If I choose to donate my organs after I pass away, will my body be disfigured after organ donation?
All bodies are cared for with utmost respect. Any incisions made during the removal of organs are carefully repaired during the procedure and you will still be able to have an open casket funeral.
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