A second chance at life with living donor liver transplants

In 2005, Filipino Rene Luis Godinez was suffering from advanced liver failure and didn’t have long to live if he didn’t get a new liver soon.

After failed attempts by doctors back in his hometown to reverse Godinez’s liver failure problem, he came to Singapore to undergo liver transplantation at the Asian Centre for Liver Diseases and Transplantation (ACLDT), with his brother donating part of his liver to him. Today, Godinez is living life to the fullest, living by the ocean which he so loves in Subic Bay, where he goes boating regularly with his family.

If medical treatment/therapy has been proven unsuccessful and the liver is no longer able to function, liver transplantation remains the only option for patients suffering from liver failure. Liver transplantation is a surgical procedure whereby a diseased or failing liver is removed and replaced by a whole new liver from a deceased donor (cadaveric) or part of a healthy liver from a living donor.

In adults, the most common cause for liver failure is cirrhosis which can be caused by viruses such as hepatitis B and C, excessive consumption of alcohol, autoimmune liver diseases, build-up of fat in the liver or hereditary liver diseases. Or, it could be the result of liver cancer – both benign and malignant.

In children, the most common reason for liver transplantation is biliary atresia, a condition in which the bile ducts of the liver are missing, blocked or damaged. This causes the bile in the liver to be retained, leading to liver damage and cirrhosis.

Living Donor Liver Transplantation (LDLT)

In LDLT, the diseased liver is removed and replaced with a part of the liver from a healthy donor. Worldwide, the waiting list for organs, including the liver, is much longer than that of available organs from deceased donors.

“Living Donor Liver Transplantation (LDLT) is an important and effective life-saving option, in particular for those suffering from liver failure and hepatocellular carcinoma (HCC), compared to cadaveric liver transplantation as the shortage of cadaveric organs is a universal problem,” says ACLDT’s Respiratory Physician Dr. Lee Kang Hoe, who specialises in critical care management of all acute liver failure as well as pre and post transplant patients at the Parkway Asian Liver Ward, Gleneagles Hospital.

Dr. Lee says that the main advantage of LDLT is the timeliness because it decreases the risk of complications and death while waiting for match from deceased donors. It allows scheduling of the transplant surgery such that the patient with decompensated liver function can be optimised prior to surgery.

In addition, LDLT can be performed on living unrelated (or emotionally related) recipients and donors at ACLDT. This is unique as Singapore is one of the few countries within Asia that can do so. All organ transplants in Singapore must receive the written authorization of the Transplant Ethics Committee before any transplant surgery is allowed. The other important advantage is that the quality of the graft is better as it is retrieved from a healthy donor.

The transplant journey

ACLDT adopts a multi-disciplinary approach to the clinical treatment and management of patients’ medical conditions. Pre and post transplant evaluation (including the appropriate medical and psychosocial tests and procedures) will be conducted for both the recipient and donor by a group of specialists.

Once it has been determined that a patient requires a liver transplant, the Centre’s Transplant Coordinator will help the patient and his/her family understand the transplant journey and also assist in the necessary documentation and subsequent follow-up after the transplant.

The recipient and the donor are operated on simultaneously by two transplant teams including surgeons, anaesthetists, nurses and technicians in two separate operating theatres. The surgeon working on the donor removes a portion of the liver – between 40 to 60 per cent of it – depending on whether the recipient is an adult or child.  It is then flushed with preservative solution and cooled on ice.

The grafted liver is then transplanted into the recipient as soon as possible to ensure that it will function well after it has been transplanted.  The surgical procedure for the donor – from when the incision is made to the removal of the liver and then closing it up – takes six to eight hours. The other surgeon operating on the recipient will first remove the diseased liver, leaving the major blood vessels clamped and in place. When the grafted liver is available, he will place it into the abdominal cavity and then proceed to connect it with the major blood vessels. Once this is done, the radiologist will do an ultrasound scan to ensure that there is blood flow in the new liver. The transplant surgery on the recipient takes between eight and 12 hours.

The liver has an amazing ability to regenerate. Hence, the donor’s liver will regenerate back to its full size within a few weeks of the surgery without affecting its normal functioning. The transplanted liver will also grow until it is the appropriate size for the recipient’s body.

Even though surgery for the liver donor is safe and often does not require blood transfusions, there remains a risk of complication (up to 15 per cent) and death (up to 0.05 per cent) for all potential donors.

The outcome for liver transplant surgery has improved dramatically over the past two decades. Most liver donors are able to return to a normal quality of life within three months and the recipients within six months.

Special Liver Ward at Gleneagles Hospital

To provide the best possible care and treatment for liver transplant patients, Gleneagles Hospital has a dedicated ward specially for the care of patients suffering from liver diseases including those undergoing liver transplantation.

Complementing ACLDT’s highly successful LDLT Programme is the Parkway Asian Liver Ward, which comprises seven Liver Intensive Care Units (ICU) and ten patient rooms. It is an integrated facility that is co-managed by ACLDT and Gleneagles Hospital, with advanced medical equipment, including the various types of liver dialysis machines and monitoring devices, to ensure that every patient receives the best treatment for his/her liver condition.

Liver dialysis serves as a bridge for critically ill patients with liver failure until their transplant surgery can be performed. “This dedicated facility, which caters to patients with liver diseases and those who require pre and post liver transplant care, allows patient care to be seamless between the ICU and the general ward,” said Dr. Lee.

ParkwayHealth

A leading provider of private healthcare services in Asia, ParkwayHealth’s reputation is the result of quality clinical outcomes and comprehensive care, made achievable with an extensive network of hospitals, integrated healthcare facilities and over 40 years of experience in hospital development.

ParkwayHealth operates three hospitals – Gleneagles Hospital, Mount Elizabeth Hospital and Parkway East Hospital – and several medical centres in Singapore, where specialist care is administered in one place.

ParkwayHealth operates medical services and facilities house over 3,400 beds and 1,200 accredited specialists. Over the years, it has achieved numerous firsts and recorded many milestones, which is a testament to its efforts in healthcare.

ParkwayHealth has several hospitals and medical offices across the globe and also operates a ParkwayHealth Patient Assistance Centre in Sri Lanka.