Singapore’s first heart transplant



On 6 July 1990, a team of doctors at the Singapore General Hospital (SGH), led by Dr Tong Ming Chuan, performed the first heart transplant in Singapore.1 The donor heart was from Ong Soon, a 41-year-old construction worker, who died in an industrial accident. The recipient was Wee Soo Hup, a 59-year-old retired information officer who was suffering from terminal heart disease.

History
By 1987, two Asian countries, Taiwan and Thailand, had started performing heart transplants.2


Heart transplants became available in Singapore in early 1990, when the Ministry of Health announced its decision to allow heart and liver transplants in the country. A pilot heart transplant programme had already been in place at SGH two years earlier, under which doctors had been training and preparing for heart transplant operations.3 The programme was funded in part by research grants from the Ministry of Health and philanthropic organisations.4 Following the Ministry of Health’s announcement, SGH doctors began looking for suitable donors for its heart patients.5

On 6 July 1990, Wee became the first heart transplant recipient in Singapore. The 59-year-old was a retired information officer at the Ministry of Communications and Information.6 He was suffering from a coronary artery disease and had been waiting for a heart transplant since March that year. It was believed that he had suffered several heart attacks in the few years prior to the operation,7 and was frequently hospitalised because of his medical condition. Just before the operation, Wee was so weak he could hardly walk.8 His life expectancy without a heart transplant was estimated to be less than six months.9

On the afternoon of 5 July 1990, 41-year-old Ong met with an industrial accident at the Tien Wah Press warehouse along Bukit Timah Road. A construction worker, Ong was repairing the warehouse’s fibreglass roofing when he fell nine metres to the ground. He suffered serious head injuries and slipped into a coma. He was taken to Alexandra Hospital and then transferred to Tan Tock Seng Hospital. He never regained consciousness and was pronounced brain dead at 12.15 pm the following day.10

That same afternoon, Tong approached Ong’s family at Tan Tock Seng Hospital to seek their permission to donate Ong’s heart.11 According to the Medical (Therapy, Education and Research) Act of 1972, the family of the deceased had to consent to such an organ donation.12 Ong’s 39-year-old widow, Chua Gun, gave her consent 20 minutes after meeting Tong.13

Description
A team of SGH doctors, led by surgeon C. Sivathasan, went to Tan Tock Seng Hospital to “harvest” the donor’s heart. Other members of the team were surgeons James Wong and Susan Lim, as well as doctors Chow Hong Keong and Jeffrey Chew.14 They started to retrieve Ong’s heart at about 5 pm on 6 July.15

The harvesting of Ong’s heart involved a procedure where two great arteries and two sets of greater veins of the heart were cut. The heart was then injected with special preservatives and placed in a saline ice slush kept at 5 to 10ºC.16

Meanwhile at SGH, doctors selected Wee as the heart recipient from a waiting list, based on blood and tissue match.17 Ong’s B positive blood type matched that of Wee.18 In addition, the difference in weight between Ong and Wee was not more than 10 percent – this meant that their hearts would have been similar in size. Based on these criteria, Wee was selected and put under general anaesthesia in preparation for the heart transplant.19

The operation
Ong’s heart arrived at SGH at about 8 pm on 6 July.20 Wee was then put on the heart-lung machine, which started pumping blood round his body. Surgeons opened his chest cavity by sawing along the breastbone, and removed parts of his heart. The ventricles and origins of the greater arteries were removed, leaving behind the left and right atriums. Next, the donor’s heart was “trimmed” to fit into Wee’s heart cavity. It was then stitched in the following order: left atrium, right atrium, pulmonary artery and aorta. Once completed, Wee’s chest cavity was “wired” together. The entire operation was completed in about three hours.21

The surgical team was led by Tong, who was at the time head of SGH’s Department of Cardiothoracic Surgery. Other members of the surgical team were: surgeons  Sivathasan, Ong Kim Kiat and Lim Yew Cheng; anaesthetists S. S. Dhara, Y. Y. Chong and Shani Tanwere; and cardiologists Arthur Tan (head of Cardiology Department) and Amy Ng, who helped assess Wee’s condition.22

The cost of this first heart transplant in Singapore was estimated to have been between S$70,000 and S$80,000. If performed overseas, it could have cost almost three times as much.23 After the operation, another S$6,000 to S$8,000 per year would have been incurred for medication and regular checks to ensure that the recipient’s body was not rejecting the donor heart.24

Post-operation
Wee, whose heart transplant operation began on the night of 6 July, was taken off the respirator the following morning. He remained under intensive care for the next few days, where he was closely monitored for rejection and infection of the donor organ.25

With his condition improving, Wee made his first public appearance on 20 July 1990, when he received a bedside visit from then Acting Health Minister Yeo Cheow Tong and the media. He was discharged less than three weeks after the operation.26

About S$50,000 in donations was collected for Ong’s widow and children. Goh Chee Wee, then member of parliament for Boon Lay, had organised the collection of contributions for the family. He presented S$10,000 to Ong’s widow, while the rest of the donations went into a trust fund for Ong’s two teenage children.27

Although Wee’s recovery was deemed to have been satisfactory, he died in February 1991, eight months after living with the new heart.28

In 1992, Tong left SGH for private practice, while Lim Yew Cheng left in 1994 to join the University of Malaya in Kuala Lumpur. Ong Kim Kiat, Sivathasan and Wong left SGH in 1995.29



Author
Nureza Ahmad



References
1. Toh, S. (1990, July 7). S’pore team performs first heart transplant. The Straits Times, p. 1; Toh, S. (1990, July 21). Good heart in more ways than one. The Straits Times, p. 1. Retrieved from NewspaperSG.
2. Toh, S. (1989, March 7). Heart transplant in S’pore likely by end of year. The Straits Times, p. 17. Retrieved from NewspaperSG.
3. Toh, S. (1990, July 7). S’pore team performs first heart transplant. The Straits Times, p. 1. Retrieved from NewspaperSG.
4. Toh, S. (1990, July 8). First heart transplant patient is doing well. The Straits Times, p. 1. Retrieved from NewspaperSG.
5. Toh, S. (1990, July 7). S’pore team performs first heart transplant. The Straits Times, p. 1. Retrieved from NewspaperSG.
6. Toh, S. (1990, July 25). Heart donor’s family gets $50,000 in donations. The Straits Times, p. 23. Retrieved from NewspaperSG.
7. Toh, S. (1990, July 8). First heart transplant patient is doing well. The Straits Times, p. 1. Retrieved from NewspaperSG.
8. Toh, S. (1990, July 21). What it is like for Wee living with a new heart. The Straits Times, p. 23. Retrieved from NewspaperSG.
9. Toh, S. (1990, July 8). First heart transplant patient is doing well. The Straits Times, p. 1. Retrieved from NewspaperSG.
10. Man had a heart of gold, says family. (1990, July 8). The Straits Times, p. 2. Retrieved from NewspaperSG.
11. ‘Five years ago we were not ready for it’. (1990, July 8). The Straits Times, p. 2. Retrieved from NewspaperSG.
12. Toh, S. (1990, July 8). First heart transplant patient is doing well. The Straits Times, p. 1. Retrieved from NewspaperSG.
13. Man had a heart of gold, says family. (1990, July 8). The Straits Times, p. 2. Retrieved from NewspaperSG.
14. ‘Five years ago we were not ready for it’. (1990, July 8). The Straits Times, p. 2. Retrieved from NewspaperSG.
15. Toh, S. (1990, July 7). S’pore team performs first heart transplant. The Straits Times, p. 1. Retrieved from NewspaperSG.
16. Singapore’s first heart transplant: How it was done. (1990, July 8). The Straits Times, p. 2. Retrieved from NewspaperSG.
17. Singapore’s first heart transplant: How it was done. (1990, July 8). The Straits Times, p. 2. Retrieved from NewspaperSG.
18. Toh, S. (1990, July 25). Heart donor’s family gets $50,000 in donations. The Straits Times, p. 23. Retrieved from NewspaperSG.
19. Singapore’s first heart transplant: How it was done. (1990, July 8). The Straits Times, p. 2. Retrieved from NewspaperSG.
20. Toh, S. (1990, July 7). S’pore team performs first heart transplant. The Straits Times, p. 1. Retrieved from NewspaperSG.
21. Singapore’s first heart transplant: How it was done. (1990, July 8). The Straits Times, p. 2. Retrieved from NewspaperSG.
22. ‘Five years ago we were not ready for it’. (1990, July 8). The Straits Times, p. 2. Retrieved from NewspaperSG.
23. Toh, S. (1990, July 8). First heart transplant patient is doing well. The Straits Times, p. 1. Retrieved from NewspaperSG.
24. Wee, L. (1997, June 24). No heart grafts here for the last three years. The Straits Times, p. 3. Retrieved from NewspaperSG.
25. Toh, S. (1990, July 8). First heart transplant patient is doing well. The Straits Times, p. 1. Retrieved from NewspaperSG.
26. Toh, S. (1990, July 21). Good heart in more ways than one. The Straits Times, p. 1. Retrieved from NewspaperSG.
27. Toh, S. (1990, July 25). Heart donor’s family gets $50,000 in donations. The Straits Times, p. 23. Retrieved from NewspaperSG.
28. Perry, M. (2001, March 14). Ten years on, heart-transplant patient dies. The Straits Times, p. 6. Retrieved from NewspaperSG.
29. Wee, L. (1997, June 24). No heart grafts here for the last three years. The Straits Times, p. 3. Retrieved from NewspaperSG.



The information in this article is valid as at 2004 and correct as far as we are able to ascertain from our sources. It is not intended to be an exhaustive or complete history of the subject. Please contact the Library for further reading materials on the topic.

 

Subject
Public health
Health and medicine>>Diseases>>Cardiovascular diseases>>Heart disease
Heart--Transplantation--Singapore
Transplantation of organs, tissues, etc.--Singapore
Politics and Government>>Health
Health and medicine>>Medical science>>Surgery