Wednesday, 22 June 2016

First in Singapore to donate liver to stranger

Liver donor's gift saves 16-year-old's life
Singapore’s first altruistic non-directed liver donation
By Linette Lai, The Straits Times, 21 Jun 2016

Nearly 30 years ago, before the Human Organ Transplant Act made organ donation the default in the event of a person's death, Mr Lim Kok Seng signed up to be an organ donor.

Twenty years later, he started volunteering for clinical drug trials to help advance medical science.

And in January last year, the 54-year-old security concierge decided to take things a step further, by coming forward to donate part of his liver to whoever on the national waiting list needed it most.

That turned out to be 16-year-old Lim Si Jia, whose own liver was unable to break down a compound called glycogen properly.

Following 10-hour surgery at the National University Hospital on March 24 this year, Mr Lim became the first non-directed liver donor in Singapore's 26 years of carrying out liver transplants.

Left untreated, Si Jia's condition could lead to cancerous tumours forming on her liver and prove fatal in the long run.

Professor Krishnakumar Madhavan, co-director of the National University Centre for Organ Transplantation, said the majority of living organ donations worldwide are directed - that is, the donor has a specific recipient in mind. Said Prof Madhavan: "This is the first time in our experience with somebody who steps up and says, 'I want to donate; it doesn't matter to whom.'"

Mr Lim, who simply wanted to be able to help someone, decided not to wait until after his death to donate his liver because he was not sure whether it would still be in good working order by then.

"When you are above 60, you know, complications do come in all forms," he said. "Even if I made the pledge, my liver might not be good (enough) to help any more."

He also wanted to make the donation before he turns 55, as doctors generally recommend that people who want to donate their organs do so before this age.

Typically, potential donors go through a lengthy counselling process over months to make sure they are aware of the risks and still want to go ahead. They are given the option to back out at any time before the surgery. Both sides do not know who the other person is until after the operation - and only if both agree to disclosing their identities - so as to avoid feelings of obligation.

Mr Lim met Si Jia, who now has 60 per cent of his liver, for the first time about a month ago. The rest of his liver will regenerate within three months, doctors said.

Said Mr Lim: "I had only one request, which was that (the liver) be given to a younger (recipient), so that they have much more life ahead of them."

Liver donor's random act of kindness a lifeline for teenager
By Linette Lai, The Straits Times, 21 Jun 2016

It did not come entirely as a surprise when Ms Katherine Chong's third child, Si Jia, was diagnosed with glycogen storage disease eight years ago, when she was eight.

Si Jia's brother, who is two years older, also developed the disorder when he was around the same age. Ms Chong's elder daughter, 21, is the only one of her children who does not have the disease.

"Every parent would be very sad," said Ms Chong, 52, who works in the insurance sector. "But there is a reason for everything, and we had to accept the reality."

The genetic condition is estimated to affect one in every 100,000 people globally. Si Jia, like her brother, would eventually have to get a liver transplant to stay alive. Her brother received a new liver from a brain-dead patient last year.

For Si Jia, now 16, the donor was Mr Lim Kok Seng, 54, who simply wanted to give part of his liver to someone on the national waiting list who needed it the most. It is the first time that a non-directed liver transplant - where the donor does not come forward with a recipient in mind - has taken place in Singapore.

People with glycogen storage disease cannot produce an enzyme that is needed to break down the body's stores of a compound called glycogen. When this happens in the liver, glycogen accumulates and often results in the organ swelling.

As glucose - or blood sugar - is derived from glycogen, people with the disorder often also suffer from low blood sugar levels.

So, Si Jia had to regularly drink a solution of uncooked starch - such as cornstarch mixed with water - before bedtime every night.

While she could attend school like other children, there was still an urgent need for a transplant. At a height of only 1.49m, Si Jia is shorter than the average adult woman here, who is about 1.6m tall.

"If we didn't do a transplant in time, she would remain at her present height throughout her puberty," said Professor Quak Seng Hock, who heads the paediatric gastroenterology, hepatology and nutrition division at the National University Hospital.

A tumour - benign, but which could be potentially cancerous - was also discovered in Si Jia's liver.

Last year, there were a total of 38 liver transplants, 20 of which used livers from dead donors. There were 54 people on the waiting list for a liver transplant last year.

"I'm really grateful to Mr Lim, and I really admire his courage and determination," said Si Jia, who requires lifelong medication to prevent her body from rejecting her new liver.

Mr Lim, a security concierge, said he hopes his altruism will inspire others to do the same. Before the surgery, he had no idea his decision would be such a significant one.

"It never crossed my mind that I would be the first non-directed donor," said the father of two daughters. "For me, it was just a way to save a life and give hope to the next generation... That was my heart's desire."

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