Joan Chew meets the couple behind NUH's most challenging kidney transplant last year.
Security supervisor Mohamad Rafae Asral, 40, admits he is not a romantic man.
He is not given to marking Valentine's Day with gifts or special meals for his wife, Madam Puspawati Mustaffa, to whom he has been married for 20 years.
Mr Rafae, who draws a basic salary of $1,100 a month, but can earn up to $1,800 after clocking overtime, said: "I cannot afford to." The couple have six children, aged 11 to 19.
But then how many other men can claim to have given their wives a new lease of life by donating one of their own kidneys to her?
Madam Puspawati was undergoing dialysis three times a week and facing a bleak future when her husband gave her his left kidney on April 30 last year. Last Sunday, the couple attended Mark of Love, an event at National University Hospital (NUH) to commemorate the hospital's 50th spousal transplant, which took place last month.
Mr Rafae said the decision to donate his kidney was easy as he had had enough of seeing his wife suffer during dialysis and seeing his children miss her presence at home.
For a year, the housewife had to have dialysis sessions lasting up to four hours each time. It hurt Mr Rafae to see the nurse insert two thin needles into the fistula - a surgically modified blood vessel created by connecting an artery to a vein - in his wife's right upper arm that would allow her blood to be transferred into the dialysis machine and back into her body.
Mr Rafae would then take her home in a cab, a luxury mode of transport the family could ill afford.
He would buy her little treats, such as fried fishballs, to reward her after dialysis.
Overall, it was a strain on the family. Mr Rafae took a drastic pay cut at a new job that would let him work nights, so he could take his wife during the day to the National Kidney Foundation dialysis centre along Upper Boon Keng Road.
Finances were tight and on some days, the children went to school without pocket money, he said.
But he was encouraged when his older children stepped up to care for their siblings while their mother was undergoing treatment. "In life, you win some and you lose some. For me, I bit the bullet and carried on."
Madam Puspawati was diagnosed with kidney failure, as well as diabetes, high cholesterol and hypertension, in March 2013. Her mother had died of kidney disease at the age of 58 the year before.
Once Mr Rafae resolved to donate his kidney early last year, they were referred to NUH.
Professor A. Vathsala, co-director of the National University Centre for Organ Transplantation, said theirs was the "most complicated transplant" she handled last year.
While other kidney recipients' risk of organ rejection or infection was less than 10 per cent, Madam Puspawati's was 10 to 20 per cent. Her pregnancies meant she had developed antibodies to Mr Rafae's tissue types, so a kidney from him would prompt her antibodies to attack and destroy it. To reduce the likelihood of this, she had plasma exchange and special medicine to suppress her immune system.
In plasma exchange, a machine filtered out Madam Puspawati's antibodies and re-injected plasma from a donor - which presumably did not contain antibodies against her husband's tissue types - back into her body. However, two weeks after the transplant, a biopsy showed her body was rejecting the kidney.
To salvage the new organ, her spleen - a major organ producing antibodies - was removed in another keyhole operation and she had a second plasma exchange procedure, said Prof Vathsala. The spleen is not essential to life as other organs, such as the liver and bone marrow, can take over its functions. But without a spleen, Madam Puspawati was more vulnerable to infections.
When she had to be hospitalised for an injury to her right toe that became infected last May, more than 20 family members donned surgical masks to celebrate her 36th birthday in her ward.
With one kidney left, Mr Rafae watches his diet more carefully and no longer joins his friends in football games. Prof Vathsala said kidney donors have to lead healthy lives and ensure that they do not injure their remaining kidney while engaging in contact sports.
He has also cut down on his smoking habit, from 40 to just five cigarettes a day.
If her husband had not stepped forward to offer his kidney, Madam Puspawati would have had to wait about nine years for a kidney from a deceased donor. Even with dialysis, she may have lived an average of just 10 years, said Prof Vathsala.
The couple are glad the transplant turned out well. "Every day can be Valentine's day," said Mr Rafae, with a big grin on his face.
This article was first published on Feb 12, 2015.
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