Transplant beyond borders
Singaporean surgeon who performed liver transplant on a Filipino baby talks about how the life-saving procedure is done in Singapore
By Dong de los Reyes, Contributing Editor
What a live act it was!
Martin Nievera wouldn't take a centavo off the proceeds of a concert he did sometime. The back-up band and other performers found out why-and did the gig for free. Concert proceeds went to pay for the liver-transplant operation of a girl barely a year old named after the Greek earth goddess-Gaia Pasamba.
Life's for the liver, as a wit has it, and that kid was seeking deliverance-she was dying. Of biliary atresia, a condition that has no other remedy except a liver transplant. Precious life and febrile body ticked away as a healthy liver donor was sought. Even as her family frantically scraped up funds for her costly surgical operation.
Gaia's family was hoping against hope-the country has existing heart, lung, and kidney centers, but there is not even a ghost of a hospital for liver ailments. That also means specialists in liver transplant are rara avis hereabouts.
Then again, donors of healthy livers are hard to come by. About 20,000 patients a year in dire need of liver transplant throughout Asia wait for less than a few thousand donors willing to give off a chunk of the organ. Or give up their lives and give away some parts of themselves to the living.
And growing a liver from stem cells may happen yet in decades to come; it's not a possibility in the next few years. As demand exceeds availability, patients up for liver transplant may have to cough up an arm and a leg-if they can get hold of a donor.
For another, the cost of the operation is steep. A liver transplant in the United States costs around US$450,000-about PhP21 million. In India, it is US$40,000 (nearly PhP2 million). And in Singapore, which is fast becoming a regional hub of "medical tourism," such an operation can rack costs of up to US$80,000 or about PhP3.7 million.
"Tourist-patients" the world over flock to the city-state as it offers high medical standards, comprehensive health-care facilities, and state-of-the-art technology that provide high-quality patient care and better treatment outcomes.
"Cost is not an issue. It's the track record. Our program in Singapore has a fantastic record of survival after surgery," says liver-transplant specialist Tan Kai Chah. And that cannot be said for similar programs in China or India, he adds.
In the wake of controversies surrounding the harvesting of human organs from dirt-poor donors or prison inmates bargaining away their body parts, Singapore's ministry of health sees to the entire operation-from the procurement of an organ to be transplanted to the selection and assignment of the team for the surgery, says Tan.
Tan has performed more than 800 liver-transplant operations in the United Kingdom alone, including the first-ever living-donor transplant there. Among the pioneering works he took was the first "split-liver" transplant-the donor graft was divided and transplanted to two recipients.
During his tenure as senior liver-transplant surgeon at London's King's College Hospital from 1986 to 1994, he trained 26 surgeons in hepatobiliary and liver-transplant surgery. He also helped draw up and put to work the Irish National Liver Transplant Program in St. Vincent's Hospital in Dublin. He was also a consultant surgeon at Singapore's National University Hospital.
Gaia was barely 10 months old when she went under the knife in April 2006 at Singapore's Gleneagles Hospital. It cost much but it didn't cost the baby's life.
Now two years old, Gaia met up in August with Tan who was on a two-day stay in Manila for the inaugural convention of the Hepatology Society of the Philippines.
Gaia's mom, Lilibeth Pasamba, said Tan's visit to Manila is a welcome relief to her family. It means they won't have to go to Singapore for her daughter's regular checkups, which are critical to monitor the child's postsurgery progress.
Tan was in Cebu City November last year-Gaia and her mom went there for the child's progress checkup, a happy reunion for the now bubbly toddler and her favorite surgeon.
Aside from seeing his Filipino patients, Gaia included, Tan delivered a paper before the HSP convention. He said liver transplantation will be increasingly used to save patients suffering from both liver cancer and cirrhosis.
In the face of this growing trend, he called for the relaxation of existing surgery norms-the stringent Milan criteria-to allow more patients to avail themselves of the advanced procedure. The Milan criteria refer to tumors five centimeters or less in diameter in patients with single HCC (hepatocellular carcinoma) and no more than three tumor nodules, and a maximum of three centimeters or less in diameter in patients with multiple tumors. These criteria are currently used only for liver allocation, in which livers to be transplanted come from cadavers.
In his presentation "Extending the Milan Criteria in Surgery of HCC," Tan pointed out that patients with liver cancer and cirrhosis would benefit immensely from transplantation over other procedures since a newly transplanted liver will be free from cancer tumors that usually recur. "Are we being too stringent? If we don't transplant, are we not denying patients of a life-saving procedure?" he asked.
Tan's recent Philippine visit was made possible by ParkwayHealth, which owns Gleneagles, Mount Elizabeth Hospital, and East Shore Hospital-leading tertiary hospitals in Singapore-plus 11 other hospitals in the Asia-Pacific region.
More information about the Parkway hospitals are available at the Parkway Healthcare Medical Referral Center in Makati, the local representative office of ParkwayHealth with Kelly Low as country manager. They can be reached through telephone numbers +63-2-7518225 and 27.
The local referral center provides Philippine patients access to the right specialist expertise, personalized patient care, and cutting-edge technology available at all Parkway hospitals in Singapore and the Asian region. The office offers free services in connecting patients to relevant medical services in real time.
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