'You can have my liver, Mum'
When there is no cadaveric donor in sight, a living organ donation is a gift of life
by Eveline Gan | TODAY Online
JOHNSON Tan has lost track of the Mother's Day gifts - handbags, earrings and shoes, among other things - he has given his mother, Mdm Theresa Yee, over the years.
On Mother's Day last year, however, the 28-year-old presented his mother with a gift both of them will never forget. He gave her half of his liver.
Mdm Yee was diagnosed with autoimmune liver disease in 2007. Last year, she was told that she needed a liver transplant and was subsequently placed on the waiting list for a liver from a cadaveric or deceased donor. By April, her illness took a turn for the worse.
"One night, I suddenly started vomiting blood. I remembered vomiting all the way from home to the hospital until I lost consciousness," said the 55-year-old homemaker, recounting the awful experience.
Her condition was critical and there was still no cadaveric donor in sight. There and then, her husband and son both volunteered to be her donor. Although both of them were eligible to become Mdm Yee's donor, Johnson was eventually chosen as his liver was in a "better" condition.
Living organ donation
Just three decades ago, this gift of life between two living people was unheard of in Singapore.
As of June 30 this year, there are 472 people on the National Organ Transplant Waiting List, according to a spokesperson from the Ministry Of Health (MOH). The Human Organ Transplant Act (Hota) allows for the organs (kidney, liver, heart and cornea) of Singapore citizens and permanent residents to be donated for transplantation in the event of death.
Currently, the liver and kidney are the only organs that can be donated by living donors here. The number of living organ transplants have increased over the years. Last year, 123 living organ transplants were performed here, an 8.8-per-cent increase from 2007, according to MOH.
Singapore's first living kidney transplant was performed in 1976, six years following its first cadaveric kidney transplant.
Singapore's first cadaveric liver transplant was performed at the National University Hospital in 1990. It wasn't until 1996 that the first live liver transplant occurred.
A gift of life
An organ transplant is often required to treat those battling end-stage organ disease. This is especially so for those suffering from liver failure.
"Unlike kidney transplants, we currently don't have any effective options to artificially maintain liver function, so a liver transplant really is a gift of life," explained Associate Professor Tan Chee Kiat, director of the Liver Transplant Service at Singapore General Hospital (SGH), which carried out 12 liver transplants last year.
While waiting for a suitable organ, it is possible for a person with kidney failure to survive on dialysis. When the liver fails, there is often no hope.
"If a person's liver is failing, it can no longer break down food, repair cells and clear the body of toxins. This can lead to swelling of the abdomen and legs, drowsiness, blood infections and even coma," said Assoc Prof Tan, who is also a senior consultant at SGH's gastroenterology and hepatology department.
Assoc Prof Tan estimated that each year, some 20 to 30 liver disease patients progress to a stage where they would need a liver transplant.
A lifeline from a living donor
For these urgent cases, a living donor becomes, quite literally, the patient's lifeline.
"Finding a living donor reduces waiting time and eliminates uncertainty and possible detriment caused by waiting for a deceased donor liver," said Assoc Prof Tan.
There are also other reasons why living organ transplants are preferred over deceased organ transplants.
With a living donor, the graft is also "healthier" as the surgery can be coordinated so that the organ can be quickly transplanted into the recipient, added Assoc Prof Tan.
According to Assoc Prof Tan, anyone can become a living donor. However, he stressed that the donation is an "entirely voluntary act" and the donor can change his mind right up until the point when he goes for the transplant surgery.
What are the risks?
Given today's medical advancements, doctors said live organ donation procedures are relatively safe. However, many people still have misconceptions about it (see box).
In the case of liver transplants, Assoc Prof Tan said donors do not face significant long-term health risks of organ failure. "In fact, the donor's remaining liver rapidly regenerates within the first two weeks and is back to its normal size by about two months post-transplant," he said.
"However, as with other types of major surgery, there are risks of pain, infection and blood clots. There is a low risk of mortality related to the surgery."
A year and a half on, life is back to normal for both Johnson and Mdm Yee.
For Johnson, who now sports a six-inch vertical scar on his belly, giving up half of his liver for his mother had not been a tough decision to make.
"There wasn't much time (to hesitate). My mum's condition was serious," he said.
On the contrary, it was Mdm Yee who, despite being in critical condition, had worried about Johnson's health.
"I felt that it was a dangerous thing to do, and since I was already so old, it didn't matter if I recovered or not.
"But thank God for giving me such a good son," she said.
Debunking myths
Myth 1: I am at a higher risk of ill health if I live with only one kidney.
According to doctors, donors do not face significant long-term health risks of organ failure.
Dr Terence Kee, director of renal transplantation at SGH, said studies have shown that the risk of kidney failure and other health problems are the same, if not lower than the general population. This is because donors need to be healthier than most people to qualify as one.
"Donors can also have children and, like others, are encouraged to lead a healthy lifestyle. But they will need to avoid contact sports to minimise risk of injury to the remaining kidney," said Dr Kee.
Myth 2: I will have to live with a smaller liver for the rest of my life if I donate part of my liver.
A living donor can donate up to 60 per cent of his liver for a transplant.
However, according to Assoc Prof Tan, the remaining liver rapidly regenerates within the first two weeks and is back to its normal size by about two months post-transplant.
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