Living Related Liver Transplant
There currently exists a huge disparity between organ demand and supply in transplantation. Consequently as organ availability decreases and the need for organs increases, the NUH Transplant Programme is continually trying to augment the supply by offering living related liver donation as an option. The decision to be a living donor is a tremendous selfless act of giving. All potential donors are carefully screened to ensure that they are physically healthy and would not be harmed through the act of donation.
Adult to Child (Left Lateral Segment)
The majority of this procedure have been done in children using a smaller portion (usually the left lateral segment) of the donor's liver. Donors are usually one of the parents.
Right lobe Adult to Adult
Because of the growing need for adult livers, larger portions (total right lobe) have now been removed for transplantation. The right lobe of an adult donor has been successfully transplanted into another adult.
Cadaveric Liver Transplant
Whole liver transplant
The diseased liver is removed and replaced with a whole healthy liver.
Split Liver transplant
Because of the scarcity of cadaveric (brain death) liver donors, the options of split liver transplants were made available. Improvement in liver reduction techniques has enabled us to split a whole cadaver liver to be shared between an adult and a paediatric patient. A person needs only 40 percent of a liver because in one month, it would grow to normal size.
The 'two-for-one' procedure requires a large team because all procedures must be done simultaneously to improve the chances of successful outcome and to reduce potential damage from prolonged preservation of the organ. NUH plans to do split liver transplants from all cadaver livers so that two patients can benefit and thus reduce our waiting time. NUH had it's first successful split liver transplant in 1997. Both patients are doing well.
Transplanted patient Mrs Murugaiyan (in green) with transplant coordinators
Mdm Ng Ah Huay before the transplant
Mdm Ng Ah Huay after the transplant
Our Transplant Coordinators with our young transplant patients
Hanif and mum who was his donor
Hanif, 6 years post transplant with transplant coordinator Maureen and A/Prof Quak Seng Hock
A/Prof Quak Seng Hock and Dr Marion Aw with 2 young transplant patients
The National University Hospital (NUH) Liver Transplant Programme was established in 1990. Since then, over 100 liver transplantations have been performed in both adults and children.
Liver transplantation offers new hope for most patients with end stage liver disease. Due to a shortage of liver donors, 60% of patients die every year while waiting for their transplant.
With the advent of improved surgical techniques and medical care, there is an 85% success rate for liver transplantation in Singapore. Both cadaveric and living donors have been utilised.
Liver failure is associated with a high mortality. Treatment for such patients is liver transplantation if the candidate is considered. However, even if the patient is a suitable candidate for liver transplantation, the wait for a cadaveric organ may prove too long. These patients may therefore be candidates for the proposed liver dialysis machines to provide a bridge towards liver transplantation. The aim is to "buy time" either for the liver to recover or for a cadaveric organ to become available.
In NUH, the Molecular Absorbent Recirculating System (MARS) liver support therapy was first done in Feburary 2000. The approach of this therapy aims to replace the detoxifying function of the liver which, when absent in liver failure, is life threatening. The principle of MARS is based on an albumin-filled circuit recirculating through a charcoal column and a cholestyramine column. This allows for the removal of water soluble and protein bound toxins, which accumulate in liver failure.
To date, we have treated more than 85 patients with MARS liver dialysis in NUH. The level of total bilirubin was significantly reduced after each treatment in all patients. In some of these patients, there was improvement in the grade of encephalopathy after the first treatment. Some patients may have improvement in the hemodynamics and renal function. Not all patients will benefit from this intervention, as they may already be too ill when MARS dialysis is attempted.
Other published reports from other centers have also utilised this therapy with similar results, and it has proven to be of value as a useful bridge to transplantation especially for fulminant patients. Studies are still ongoing to determine the beneficial effects and its future role in the management of liver failure.
Many people do not realise that in order to donate organs such as the liver, heart, corneas and kidneys, a person must be the victim of a severe enough brain injury to be declared "brain dead", but still have an intact circulatory system.
Brain death is defined, by the medical profession, as irreversible cessation of all functions of the brain, confirmed through the demonstration of absent brain stem function. The brain stem is the part of the brain responsible for basic body functions - breathing, heart rate, blood pressure and temperature control.
Organ donation is one of the greatest gifts that you can ever make. Singapore has both an opt-out system (HOTA) and an opt-in system (MTERA) to allow more lives to be saved. This is because experience has shown that in Singapore and other countries, relying solely on an opt-in system has no significant impact on the number of pledges.
The Human Organ Transplant Act (HOTA)
All Singapore Citizens and Permanent Residents between the age of 21 and 60 years are included under HOTA. They will have priority in receiving a cadaveric organ if they need one. However, they can also opt out of HOTA if they do not wish to donate their organs upon their death.
HOTA allows for one's kidneys, liver, heart and corneas to be removed in the event of death for the purpose of transplantation.
Medical (Therapy, Education and Research) Act (MTERA)
The Medical (Therapy, Education and Research) Act (MTERA) is an opt-in scheme, where people can pledge their organs or any body parts for the purposes of transplant, education or research after they pass away.
Find out more information about organ donation here.
The Liver and Kidney Transplant Office
National University Hospital
5 Lower Kent Ridge Road
Main Building 1, Level 2
Tel: (65) 6772 4439 / (65) 6774 5212
Fax: (65) 67787913
Opening hours: 9am - 5.30pm (Mon - Fri)
(Closed on weekends and public holidays)
Liver Link Newsletter
This newsletter is a joint effort between patients, doctors and interested parties to provide information on liver transplantation.
Our aim is to provide you with stories about patients requiring liver transplants, those who have undergone such a monumental undertaking, as well as the sad stories for those whom the wait was just too long.
Patients and their relatives, as well as the public have many questions about the process of liver transplantation, as well as what happens after the transplant. This hopefully will provide the forum for such concerns to be aired and discussed.
Links to Liver Link Issues
Issue 1, Volume 1
Issue 1, Volume 2
Issue 1, Volume 3
Issue 2, Volume 1
Issue 2, Volume 2
Issue 2, Volume 3
Issue 3, Volume 1
Issue 3, Volume 2
Issue 3, Volume 3
Issue 4, Volume 1
Issue 4, Volume 2
Issue 6, Volume 2
2007 Issue 1
2007 Issue 2
2007 Issue 3
2007 Issue 4
2008 Issue 1
Our multidisciplinary team's approach is designed to give comprehensive, individualised care to the transplant patients. This specialised group includes transplant surgeons, transplant physicians, anaesthetists, pathologist, transplant coordinators, nurses, social workers, dietitians and many others.
The transplant coordinators play an important role. They are usually the first people that the patient and family will have contact with at the transplant unit. They work closely with the doctors and update them with all medical data available on the patient and act as a personal liaison between the transplant team and the patient.
Liver transplantation is the surgical replacement of a diseased liver with a healthy liver graft. Patients who require this operation suffer from end-stage liver disease. This is characterised by reduced liver function, muscle mass loss, fatigue, encephalopathy, signs of portal hypertension, poor blood clotting and jaundice.
A variety of liver diseases can lead to end-stage liver failure. Some of these causes include viruses (Hepatitis B and C), toxic drugs or chemicals, excessive use of alcohol, genetic and metabolic disorders and problems concerning the bile ducts (biliary atresia, primary biliary cirrhosis and primary sclerosing cholangitis).
If the doctor thinks that the patient's liver disease is progressive, and that transplantation may be a suitable option, they are then referred to the Liver Transplant Coordinator who will arrange for the patient to be assessed.
- Assessment and waiting for a liver transplant
- Prior to transplantation, a multidisciplinary liver transplantation team evaluates potential liver recipients.
- A variety of tests are carried out to confirm the diagnosis, assess the extent of the disease and gauge the suitability for liver transplantation.
- The patient and their family get to know the team and vice-versa.
- The patient and family have an opportunity to ask questions and learn more about liver transplantation.
Once the assessment is completed and the doctors agree that transplantation is the right choice of treatment, the patient will be placed on the waiting list for transplantation. The waiting time depends on the patient's blood group, size and general medical condition. On average, the wait is six months.
- The New Liver
Donor livers come from different sources. Usually, they are obtained from a cadaveric donor, a person diagnosed as "brain dead" but whose other organs and systems are functioning properly. Consent must be given by the next-of-kin. Donor livers can also be obtained from a family member who donates a portion of his/her liver to the patient (living-related donor).
The usual liver transplantation operation takes between 6 to 12 hours. The diseased liver is removed and replaced with the healthy liver. During the operation, patients are under the care of the team of surgeons, anaesthetist, nurses and technical staff who are involved in the operation. After the surgery, patients are taken directly to the intensive care unit (ICU).
After the operation, patients begin taking medication to prevent the new liver from being rejected by the body. Complete recovery may take several weeks. The quality of life for transplant patients usually improves dramatically and most will lead a healthy, normal life.
Liver Transplant Support Group
The Liver Transplant Support Group was officially launched on 5th October 1997. The group consists of liver transplant patients, doctors, nurses, family and friends, and staff instrumental in the recovery process.
To the average person, being told that they have only months to live and would die without a liver transplant is certainly a scary position to be in. This is where the Liver Transplant Support Group steps in.
The Liver Transplant Support Group aims to:
- provide emotional support, encouragement and assistance to patients and their families during their wait for a liver transplant
- raise funds for needy patients
- promote organ donation and transplant awareness
- programmes and information
- establish and distribute educational programmes and information on the transplant patients' needs and concerns before, during and after surgery
- NUH Patientcare Charity Fund- Zachary Liver Fund
In September 1999, the NUH Patientcare Charity Fund - Zachary Liver Fund (ZLF) was established to help paediatric liver patients who need financial support during pre and post-surgery care. It also assists in raising public awareness of liver diseases.
On March 2000, a Walk-A-Jog was held on the hospital grounds to officially and publicly launch the ZLF, as well as raise money for the fund.
The Liver Transplant Support Group / ZLF has held yearly events and activities for our liver transplant patients.
If you would like to join us as a volunteer in the Liver Transplant Support Group or support Zachary Liver Fund, please call: (65) 6772 4439.