Sunday, September 4, 2011

A Brother's Love - My first liver transplant

The first time I met Mr E in National University Hospital was on the day before he would take the biggest risk of his life. I was struck by this friendly and cheerful giant. At over 180m tall and more than 100 kg, he clearly towered over me, the unsuspecting tiny surgical registrar. I noticed how much he engaged himself in the conversation as my consultant surgeon explained to him again about the entire procedure, never mincing a single word on how things could go triumphantly right..or even tragically wrong.

            He is one of the healthiest person in the room and we have to be absolutely certain that it. After all, we have subjected him to almost every single laboratory tests and imaging modalities available in this medical centre on a young person who would never need it under normal circumstances. However, Mr E is not a normal fact, he puts all of us to shame for doing something remarkable for his brother. He is giving up more than 70% of his liver although he absolutely doesn’t need to do so. All for the love of his youngest brother, Mr A who could die if he doesn’t get a liver soon.

            What drives a person to this kind of sacrifice? As I prepared myself mentally and physically for the exciting yet arduous task of a living donor liver transplantation on a beautiful quiet Saturday morning in NUH, I asked myself whether I could have done the same for my siblings or loved ones. Why are doctors willing to help be part of this big risk? Why are we not saving more lives this way? Why?

            No choice. There is simply no choice for people like E and his brother. I can only think of these 2 words. Between life and death, they decide to seek life. They travelled all the way from Middle East to Singapore in order to seek the best that liver surgeons, hepatologist, radiologist immunologist, etc could offer.

If only more people step up and say, “I am willing to be an organ donor shall I perish and I am suitable to be one” or “Please doctor, my loved one may be dying, but I want his death to be life for many others”. In dying, we can find life but why are people so unwilling to do so. As many of us search for answers and dwindle on longer and longer based on indecisiveness and fear, courageous people like Mr E and many others embark on this path less travelled – living donor liver transplantation (LDLT). A path fraught with legal red-tapes, financial constraints, personal sacrifices and even death for both donor and recipient. It's never a path taken lightly or without due consideration.

Organ transplantation is not new in this region. In fact, Human Organ Transplant Act (HOTA) has been around for at least 2 decades in Singapore but the numbers of transplantation has been dwindling abysmally over the years. The amount of liver transplants done in this country this year is woeful and augurs poorly for the future. We have less than 10 cadaveric transplantation cases countrywide this year, which was the bread and butter of transplantation surgery.

 As a result, most of the transplants had been the extremely high risk LDLT. This is in comparison to some other Asian centres, like Korea and Japan where it can be an average of 350 cases per hospital per year. This means that there is at least one transplant going on in the operating theatres each day, every single year in these hospitals.

 The saddest part for me is that many people hesitate to donate organs of their dying loved ones due to many reasons. My head spins when I hear of many creative, incredulous reasons why a person in intensive care cannot donate their organ. There are no logical, moral, religious and logistics reasons not to donate organs in this country. My summary of all the excuses so far are captured in 2 adjectives: unwillingness and ignorance.

Every case of transplantation is an exciting journey upon itself but not every transplantation stories have happy endings. They almost never receive the publicity or fanfare they deserve. During my first experience with a liver transplant surgery, my heart was beating in joy and humility for what I was about to experience – it’s literally sharing the gift of life from one person to another. In my little mind, it was one of the best, jaw-dropping, awe-inducing demonstration of surgical knowledge, dexterity & skills, inter-disciplinary teamwork, medical camaraderie and top-notched, dedicated support staff.

This act enables someone who was constantly ill and dying and transforms them into a real human again. They will no longer be dependent on machines and doctors for long term. Although each recipient may face an armamentarium of medicine in the beginning, they will soon be weaned down to one or two maintenance medications and minimal follow-ups with doctors.

What are the highest achievements of a civilization? What is the marker of a successful, egalitarian society? It’s when we stop looking inward and start to look at the common good. It’s when we see our struggling, suffering comrades and in love, extend a helping hand. We must continue to support the transplantation program in this country before it becomes a dying art, a fossil, a relic of past glory.

As of today, Mr A is still resting in intensive care while Mr E is carefully nursed in another high dependency unit. We pray that these 2 young people will recover soon and return heroically to their country within 1 or 2 months.