[Top: A picture of Madam Narindar Kaur and some renal clips.]

By Ng Wan Ching

WHEN did the clips found in Madam Narindar Kaur's body get dislodged from the artery they had clamped? And could the blood loss alone have killed her?

According to testimony given in court yesterday, the answer to be first question is: Possibly during autopsy.

And to the second question: Unlikely.

That was part of the evidence given by Professor Christopher Cheng, head of Singapore General Hospital's urology department.

Madam Kaur died after donating her kidney to her husband in 2005. Hers is believed to be the first living kidney donor death here.

Her autopsy report said she died as a result of bleeding from the open left renal artery due to 'apparent slippage' of the clips used to clamp the artery.

Her husband, Mr Surender Singh, has brought a medical negligence suit against her surgeons, Dr Li Man Kay and Dr David Consigliere, and the National University Hospital.

Prof Cheng was commenting on Associate Professor Gilbert Lau's autopsy findings.

Assoc Prof Lau had earlier said he found four closed clips (meaning they had been used to clamp something) attached to soft tissues near the renal artery.

Prof Cheng said that in the act of evisceration (removal of the abdomen's contents) during autopsy, such clips could be dislodged.

He also found it highly unlikely that four clips had been applied on the donor renal artery.

Madam Kaur's family asserts the surgeons wrongly used four clips, instead of two, to clamp her renal artery, and the intense pressure they caused made them slip, leading the 33-year-old mother to bleed to death.

Assoc Prof Lau had earlier testified that he found four identical Hem-o-lok clips around the open end of the renal artery.

Prof Cheng said that the renal artery left behind after the removal of the kidney was not long enough to have had four clips applied to it.

It was also in his experience with this type of surgery that applying two clips is the normal practice.

'While it is not impossible to apply four clips, it normally takes too long and removes too much length from the donor artery for it to be appropriate,' he said.

The evidence given so far by the defendants was that all the surgeons remember only two clips being applied, although there is no record of this taken during or soon after the surgery.

Prof Cheng also disagreed with Assoc Prof Lau that 1.5 litres to 1.6 litres of blood loss was sufficient to cause death. He said the estimated blood loss of 1.6 litres was imprecise.

'I think, not all 1.6 litres may be haemorrhage, and even if there was haemorrhage of 1.6 litres, in a normal healthy young individual, while it could contribute to her shock, it's unlikely to be the sole and only cause of her irreversible shock,' said Prof Cheng.

Part of his reason is that Madam Kaur had been 'meticulously worked up, prepared for surgery, monitored and hydrated throughout surgery and during the post surgery period for more than two hours, and she was absolutely stable'.

He added: 'She is not a person who was brought in from a road traffic accident and lost 1.6 litres. Even in that scenario, I have come across patients who had 2litres or 3 litres of blood in the abdomen from, let's say, a traffic accident, and we were able to resuscitate those patients.

'So I would say that 1.6 litres causing immediate and irreversible shock as the only cause (of death) is somewhat unlikely.'

Hearing continues today.

ABOUT THE CASE

MADAM Narindar Kaur died on 16 Feb 2005, after a three-hour operation to donate her left kidney to her husband.

The surgery was uneventful and ended at 12.30pm. She was moved to the general surgical ward at 2.30pm, reviewed by a ward doctor and found to be alert and comfortable.

About 1 1/2 hours later, she became breathless, pale, cold and clammy.

An emergency team at the National University Hospital spent about an hour trying to resuscitate her.

Time of death was recorded as 5.17pm.

A 2007 coroner's inquiry ruled out criminal negligence on the part of the medical team.

Early last year, her husband, Mr Surender Singh, and her mother, Madam Minda Kaur, filed a medical negligence suit against the hospital and two surgeons, Dr Li Man Kay and Dr David Consigliere. Hearing started on 11 Feb and is scheduled for 13 days.

f24

This story was first published in The New Paper.