A Gift of Life: Living Donor Liver Transplant

Mr Satish (Liver Transplant Patient):

We came for a two day trip in July 2024 just for a consultation. I remember walking inside Dr Kieron's office and he immediately saw me and said: "You are able to walk?” Because my tummy was so big. And he just touched me and told me I have around 8 to 10 liters of fluid inside, and it is very life threatening.

Dr Kieron Lim (Gastroenterologist):

The main complication that he experienced then was fluid retention, which is known as ascites, in his abdomen. There was so much fluid that his belly was really tight and it was also affecting his appetite. It was affecting his breathing so much that he looked really uncomfortable. Because of the degree of fluid overload and abdominal distention, I had to admit him immediately to drain the fluid. And in the course of the next 48 hours, I drained 10 liters of fluid from his belly.

Mr Satish (Liver Transplant Patient):

That was when we had a lengthy conversation with Dr Kieron regarding why it is happening again and again and why there are gum bleedings, occasional constipations and gastrics. It occurs every month or every week. Each issue occurs one after another, not all at the same time.

Dr Kieron Lim (Gastroenterologist):

When I first met Satish, his MELD (Model for End-Stage Liver Disease) score was 20 because of the blood parameters and the fact that he had all the other complications of cirrhosis. A MELD score of 20 in general, is equivalent to or is associated with 10% risk of death at three months. If you stretch it out a bit longer, it is about a 20% to 30% risk of death in one year. So this is a man, in his late 40s, who was running a very successful business. He had a young family and it came to a point when his liver disease was actually affecting his quality of life.

Mr Satish (Liver Transplant Patient):

He then guided us, saying this is the end of the process. You have to decide on a liver transplant. You talk to your family and relatives, and let them know it is the right time to consider a liver transplant. We discussed, within our family, how to go about it. And my elder daughter, Winona, she volunteered. She said, “Dad, I am here. I will give my liver to you.” It took us nearly three to four months to decide to go with her. Even though from day one she said, “I am there for you.” It was still a very difficult decision to make. So we fixed the liver transplant dates for July 1st. At that time we met Yuhanis, our liver transplant coordinator.

Yuhanis (Liver Transplant Coordinator):

For liver transplant coordination, it is really a very complex thing because we are involving a lot of people and a lot of different departments. My job is basically to tie everything nicely together, for the time that he has in Singapore and the preparation from evaluation all the way to transplant.

Dr Wong Jen San (General Surgeon):

In living donor liver transplant, we actually do both the donor and the recipient operations side by side simultaneously. And the whole idea is to reduce the amount of time the donor liver is outside of the body, disconnected from blood supply. We have to plan our timing carefully because again, we need to start with the donor first and the donor surgery, like Dr Chan will explain to you, takes about six to eight hours. And we have to then make sure we time the recipient’s surgery to also coincide such that, it takes about two to three hours to remove the native disease liver. Hence, there will be a period when the patient recipient, Mr Satish, will have no liver in his body. So again, we want to reduce the time that he doesn't have any liver in his body. That's where the timing and communication comes in because we must know that the donor surgery is going well, that there are no issues and the liver will come out at a certain time. We also have to time, the time when we take out the liver from Mr Satish. We do not want the donor liver to come out too early, sitting on ice, disconnected from blood and then Mr Satish is not ready to receive it.

Dr Chan Chung Yip (General Surgeon):

For the donor’s surgery, we removed more than 50% of the donor's liver. And this was done in a laparoscopic manner. In layman's terms, this is keyhole surgery and is performed using small incisions. But eventually we would need a slightly larger incision, which is cut below the bikini line so that we are able to remove the liver graft safely for it to be transplanted. The advantage of the laparoscopic surgery is that this makes smaller scars. There is faster healing, lesser pain and the overall satisfaction for the donor is much higher. Because of, again, the pain control as well as the aesthetics of it.

Mr Satish (Liver Transplant Patient):

The medical advancement was very good that I did not feel a single pain, post-operation. I was so amazed. On day one or day two, I asked the doctor, “When can I walk?” Because I did not feel anything. I want to do something. I want to walk. I want to exercise. On day five, the physiotherapists had me start walking, and that was the first time I walked on my own. They were standing right beside me, but I did not need any support. On day six and seven, I started walking nearly 500 meters. And on day eight and nine, I started climbing stairs. So my progress was very good. My energy level was very high. I wanted to keep on doing something. On day fourteen, I think I got discharged.

Dr Kieron Lim (Gastroenterologist):

I'm glad to say that all his metrics, all the blood counts and the platelet counts, everything has normalized, within a month of his transplant. He is on target for flying back home in about two weeks' time. He is also very excited that he may be able to visit his daughter in America in the next few months.

Mr Satish (Liver Transplant Patient):

My daughter is also doing very well. She recovered well, got discharged on the third or fourth day. Now she is in the USA for studies. We did not expect that she could go that fast. We thought, “Why not postpone it to January? Then you go.” She said, “No, I want to go in August.” And doctors are very cool. Her surgeon also said she's perfectly fit to travel.