In recognition of this pressing problem and the increasing incidence of liver diseases in Asia today, Gleneagles Hospital launched the Living Donor Liver Transplant (LDLT) programme in April 2002. Conveniently located in Singapore, Gleneagles is a leading private hospital that provides an extensive range of healthcare facilities for local and regional patients.

In April 2002, Gleneagles Hospital became the only private hospital in the region performing this highly complex procedure. LDLT is a procedure in which a diseased liver is replaced with a segment of liver from a healthy human donor (usually a sibling or close family member).

During LDLT, two teams of doctors will perform the donor and recipient operations almost simultaneously, about half the donor liver will be retrieved from the living donor. Once the diseased liver is removed from the recipient, the liver graft that was retrieved earlier is implanted. Both halves of the liver will regenerate and grow to full size in four to six weeks. The donor operation takes six to eight hours and the recipient operation takes eight to 10 hours. After the operation, the donor is nursed in the intensive care unit for 24 hours, hospitalised for six to eight days and closely monitored over several weeks. Typically, the recipient will stay in the hospital for about three to four weeks, initially in the intensive care unit and later in the ward. During this period, the recipient will be closely monitored for signs of rejection and infection.

The programme at Gleneagles is spearheaded by Dr Tan Kai-Chah, who is a pioneer in the LDLT procedure. Having performed almost 530 liver transplants in Britain, Singapore and Malaysia, he leads the team which comprises experts from various specialties, with expertise and extensive experience in major hepatobiliary and liver transplantation surgery. The nucleus of the team is formed by, Transplant and Hepatobiliary Surgeons, Transplant coordinators, Anesthesiologists, Gastroenterologists/ Hepatologists, Radiologists, Pathologists, Infectious Disease/ Microbiologists and Hematologists. In addition, other team members will include nephrologists, Pulmonologists, Neurologists, Psychiatrists and Dieticians.

To facilitate the programme, the hospital is equipped with the latest state-of-the-art medical equipment and a highly experienced nursing team.

LDLT offers new hope to both adults and children with end-stage liver disease, providing them with an alternative to waiting, sometimes indefinitely, for a suitable cadaveric donor liver. To date, seventy successful LDLT procedures have been performed at Gleneagles Hospital. The hospital expects to perform about 50 such procedures a year.

Protocols for recipient and donor evaluation and selection have been drawn up in accordance with internationally accepted guidelines and the regulations of the Ministry of Health of Singapore.

RECIPIENT CRITERIA:

• End-stage liver disease
• Some common diseases where transplantation may be considered include:
• Chronic Hepatitis B / C Cirrhosis, Primary Biliary Cirrhosis, Primary Sclerosing Cholangitis
• Caroli’s Syndrome, Hepatocellular Carcinoma, Wilson’s Disease, Fulminant Liver Failure
• Cholangiocarcinoma, Biliary Atresia, Metabolic Liver Disease, Disease where transplant is not indicated, Extrahepatic malignancy, Systemic sepsis, Evidence of severe cardiopulmonary disease or major systemic illness, HIV antibody positive

DONOR CRITERIA

Age between 21 and 60. Donor between 18 to 20 years of age can be considered if he/she is an immediate family member of the recipient.

Parents / Siblings / Spouse or any other first or second-degree relatives. Donors that are emotionally attached to the recipient can also be considered. Documentary evidence of relationship is required.

• No evidence of significant cardiopulmonary, renal or neurological disease
• No evidence of liver disease
• Compatible blood types
• Normal Haematological and serum chemistry. Normal liver and kidney function; Normal ECG and CXR; Negative serology for Hepatitis and HIV virus
• No history of Diabetes Mellitus
• No history of severe or uncontrolled hypertension (Hypertension is permissible if mild and well-controlled on medications)
• No history of Deep Vein Thromboses or Pulmonary Embolism
• No history of bleeding tendencies
• Serologically negative for Hepatitis B and C and HIV
• Demonstration of adequate liver volume on CT volumetric scan
• Arteriographic documentation of satisfactory arterial supply for the anticipated graft
• Successful completion of a psychiatric assessment

The transplant team shall review these criteria as and when necessary to keep them in line with international practice or with revised guidelines from the Ministry of Health

The Donor Evaluation Process

The prime purpose for the extensive donor evaluation process is to minimise the risk to both the donor and the recipient. It ascertains that the donor is in good mental and physical health, and that the portion of the liver to be retrieved is suitable for the recipient.

The process comprises the following steps and each must be completed before proceeding to the next:

1)The donor is first asked to complete a questionnaire and has a blood test to identify his/her blood type. Liver function tests are also carried out to detect the presence of chronic Hepatitis B and C.

2)Once the blood type is found to be compatible and there is no evidence of liver disease, the donor consults the transplant surgeon to discuss the procedure.

3)The first set of informed consent is completed and submitted to the transplant surgeon.

4)Further blood tests, chest x-ray, ECG, and CT scan of the liver are performed.

5)The donor consults with the psychiatrist and physician independent of the transplant programme.

6)The physician will ascertain that the donor is in good physical health and is able to tolerate the procedure.

7)The psychiatrist will ensure that the donor is in good mental state, understands the risks involved and is not coerced.

8)A volumetric CT scan and hepatic angiography is performed.

9)The donor may be requested to have further cardiac testing as indicated.

10)The case is then discussed by the transplant team. If the donor is found to be suitable, a date is set for the transplant.

11)After the submission of the two sets of consent forms, the donor is given a ‘cooling off’ period to carefully consider his/her decision.

12)Should the donor have second thoughts at any stage of the assessment, the process will be stopped and the recipient may seek other potential donors.

13)All donor medical information will be kept under strict confidence.

Blood will be obtained for autologous transfusion in the peri-operative period.

After the operation

The donor is nursed in the intensive care unit for 24 hours and should be out of bed with assistance after two to three days. The donor is hospitalized for seven days and should be able to resume most light home and work activities within one month, depending on the recovery.

The donor is expected to be closely reviewed by the surgeons over the next several weeks and then as required. There is no dietary restriction but the donor will be prescribed vitamins for the next few months. The total estimated length of stay in Singapore for donor is about 14 days

The recipient on the other hand is expected to stay in hospital for a longer period (usually three to four weeks), initially in the intensive care unit and later in the surgical ward. During this period, the recipient will be closely monitored for infection, rejection and regeneration of the transplanted liver. The total estimated length of stay in Singapore for recipient is about 90 days

Medications

Liver transplant recipients generally require life long: immunosuppressive medications to prevent rejection. Most patients will be maintained on a primary immunosuppressive agent, either Tacrolimus (Prograf) or Cyclosporine (Neoral). Patients usually require a higher dose of these agents immediately following their transplant because rejection more commonly occurs in the first three months. In time, the dose is lowered, but lifelong therapy is necessary.

Some patients may be on additional immunosuppressive agents, such as rapamycin (Rapamune), mycophenolate (Cellcept) or prednisone. Most of the additional agents are given for only short periods of time (two to six months). Each of these agents has its own side effects: your transplant team will discuss these with you in detail, depending on which agent prescribed.

Post Operative Care

Under normal circumstances, there is no further care for the donor other than follow-up until there is full recovery.

As for the recipient, he/she needs to perform an ultrasound abdomen and blood test every week for the first 3 months. Subsequently, the frequency will be reduced to once every 2 weeks. Recipient needs to fax the results of his/her ultrasound and blood test results to the transplant team in Gleneagles hospital at +65 6476 3088. The transplant team will revert to the patient and advise accordingly.

This includes the following, during the package period.

• Transplant Surgeon & Specialists Fees
• Operating Theater Charges
• Psychological Evaluation
• Intensive Care Unit charges for both donor and recipient
• Consumables & Surgical Instruments
• Daily Treatment & Nursing Care
• Drugs / Medication & immunosuppressant during package
• Laboratory Tests including blood and renal functions tests
• Radiology Tests
• Diet and Nutrition
• Hospital Accommodation for an estimated period of one week for the donor (Inclusive of 1 days in ICU)
• Hospital Accommodation for an estimated period of 4 weeks for the recipient (Inclusive of 5-7 days in ICU)
• Does not include pre transplant stabilization/hospitalisation.

Costs for Liver Transplant in Singapore at Gleneagles

Notes:

Please note that the tariffs quoted are averages based on standard treatments. Each patient is different and can have different requirements which require variations to standard treatments. Inclusions & Exclusions are described on this web page to our best ability