One team for liver transplants in public hospitals

All adult liver transplants in public hospitals will be done by a single team of surgeons when a National Liver Transplant Programme is launched later this year.

The specialists will be drawn from the public sector and operations will be done at either Singapore General Hospital (SGH) or National University Hospital (NUH).

Up till now, liver transplants have been available at both hospitals, although SGH suspended these operations last May after at least two organ recipients died in a short period.

Liver transplants with living donors are also done at the Asian American Liver Centre at Gleneagles Hospital.

People with liver failure face certain death if they do not get a new organ. Ministry of Health (MOH) said six to seven people die each year while waiting for a transplant. With a transplant, eight in 10 recipients survive more than 10 years.

Last year, there were at least 60 people who needed a liver transplant, but only 13 received organs from donors who had died.

Another 13 received part of a liver from a living donor.

The Health Ministry told The Sunday Times that having a single team of surgeons will "enhance the capabilities, standards and outcomes of the liver transplant services in the public sector".

Professor K. Madhavan of NUH will head the joint team with SGH's Dr Prema Raj Jeyaraj as deputy director.

NUH has done liver transplants since 1990. SGH started its liver transplant programme in 2006 with the help of Dr Prema Raj, who was in private practice at that time.

SGH stopped doing liver transplants last May and lifted its self-imposed moratorium last October, but no transplants have been done since, although Dr Prema Raj returned to head the unit this year.

The ministry's spokesman told The Sunday Times that the national programme would result in "better and quality care for the patients and donors, comparable with international standards and benchmarks".

She said that using both hospitals instead of doing all liver transplants at NUH only - with its longer history of such operations - allowed wider access to resources such as operating theatres and beds.

"We will continue to monitor the outcomes and volumes and continuously review the model to best serve our patients requiring liver transplant services," she said.

Compared to other developed countries, Singapore's rate of liver donations from donors who die - or cadaveric livers - is very low at about four per million population each year.

The top five Western European countries see a donation rate of more than 20 livers per million population each year.

That is well ahead of the international average of about 10 to 12 per million, said Prof Madhavan. If Singapore could achieve even this rate, many more lives would be saved.

He said one reason there are so few cadaveric livers could be that doctors in intensive care might not ascertain brain death before pulling the plug on patients.

Livers have to be taken while the blood is still circulating, so a brain-dead person must be kept on life support until the organ is removed. Kidneys can be taken up to three hours after the heart stops.

Prof Madhavan said that in recent years, NUH has been doing more living donor transplants than cadaveric transplants.

Living liver donors carry more risk than kidney donors partly because the donor must give up more than half of his liver. The organ regenerates over time.

So far one living organ donor - a foreigner in a transplant done in the private sector - has died.

Dr Prema Raj said having more cadaveric livers means fewer living donors will be needed to step forward to save lives.

salma@sph.com.sg

This article was first published on March 8, 2015.
Get a copy of The Straits Times or go to straitstimes.com for more stories.