Singapore’s first liver transplant

Background

Singapore’s first liver transplant was successfully performed on 25-year-old Surinder Kaur on 29 September 1990. The transplant was performed by a team of four surgeons and two anesthetists from the National University Hospital (NUH). The team was led by Susan Lim, the second female doctor in the world to perform a liver transplant.

History
Before 1990, liver transplants were unavailable in Singapore. This changed in February 1990 when the Ministry of Health made a landmark ruling that allowed NUH and the Singapore General Hospital (SGH) to perform heart and liver transplants on a pilot basis.¹ While the ministry had estimated that 20 people would need heart transplants and 33 would require liver transplants each year, high costs and difficulty in obtaining donor organs were among the reasons it had previously disallowed heart and liver transplants.²

With the new ruling, the ministry invoked the Medical (Therapy, Education and Research) Act to get donors on a one-on-one basis via transplant coordinators.³ As organ donation is considered an act of compassion intended to save lives, leaders of the main religious groups in Singapore responded positively to the ministry’s announcement by giving their consent to such operations, as long as the donor or donor’s family had agreed to the transplant.⁴

On 29 September 1990, 25-year-old production worker Surinder became the first recipient of a donor liver in Singapore’s first liver transplant. The operation took place at NUH. It took five months before a donor liver that matched Surinder’s blood group and tissue samples was found. Prior to the operation, Surinder was suffering from an auto-immune liver disease that saw her body’s antibodies destroying her liver. Her condition deteriorated to the point where she could not work, walk or eat properly. The doctors at NUH gave her only six months to a year to live if she did not have a liver transplant.⁵

Description
On 28 September 1990, 22-year-old construction worker, Goh Boon Chai, died from head injuries after falling four storeys at his workplace. His family agreed to donate his liver for medical purposes.⁶ Once consent was given, Goh’s liver was removed and a new preparation, named the University of Wisconsin solution, was used to preserve the liver for a period of up to 24 hours, instead of the previous six to eight hours.⁷

The liver transplant took place the following day. Lim was chosen as the lead surgeon as she had been trained in transplant technology at one of the world’s leading organ transplant centres, the Addenbrookes Hospital, in Cambridge, U.K. The 35-year-old was the second female doctor in the world to perform such a transplant. She led a team of four surgeons and two anaesthetists in the five-hour operation. The other three surgeons were Abu Rauff (then chief of NUH’s department of surgery), K. Prabhakaran and Ti Thiow Kong. The anaesthetists were Ashok Kumar and Lai Fook Onn.⁸

Surinder regained consciousness two hours after the operation. On 2 October, she was taken off the respirator as she was recovering well. Post-operation tests conducted by the doctors showed that the donor liver was functioning well and had begun to produce bile. Surinder was given an 80 percent chance of recovery as she did not have liver cancer or viral hepatitis.⁹

The operation cost S$30,000. In addition, the cost of a year’s treatment was estimated at a maximum of S$100,000, which covered the costs of pre-and-post-surgery treatment, outpatient and in-patient treatment, hospital charges, laboratory tests and medication. NUH did not subsidise the surgery as the liver transplant was a pilot project. Surinder’s parents thus had to find a way to cover the medical fees. They appealed to the Sikh community and Sikh temples to assist them with their daughter’s medical bill. Three Sikh temples – Sri Guru Singh Sabha, Central Sikh Temple and the Khalsa Dharmak Sabha – successfully collected donations for Surinder.¹⁰

Post-operation
The liver transplant, which took place three months after doctors from SGH successfully performed Singapore’s first heart transplant, was deemed a success by NUH as Surinder recovered well after the operation.¹¹

On 8 October 1990, then member of parliament for Bukit Batok, Ong Chit Chung, presented the donor’s 52-year-old father, Goh Leng Cheow, with a letter of appreciation and a S$500 cheque from the Bukit Batok Education and Welfare Fund.¹²

Surinder regained her health after the operation, and married Gurchan Singh, a factory worker, a few years later. She gave birth to a healthy baby boy in 1996.¹³

Lim subsequently went on to private practice at Gleneagles Hospital and Mount Elizabeth Hospital, and served as a consultant general surgeon for the Ministry of Health.¹⁴

In 2015, Surinder celebrated her 50th birthday. She leads a normal life after the transplant, but has to take immunosuppressive drugs for life to prevent her body from rejecting her transplanted organ.¹⁵



Author
Nureza Ahmad



References
1. Serena Toh, “S’pore Doctors to Do transplants of Heart, Liver for First Time,” Straits Times, 8 February 1990, 1. (From NewspaperSG)
2. Toh, “S’pore Doctors to Do transplants”; Sandra Davie, “NUH Team Scores First with Liver Transplant,” Straits Times, 3 October 1990, 3. (From NewspaperSG)
3. Toh, S’pore Doctors to Do transplants.”
4. Serene Toh, “Religious Leaders Say ‘Yes’ to Organ Transplants,” Straits Times, 2 April 1990, 18. (From NewspaperSG)
5. Davie, “NUH Team Scores First with Liver Transplant.”
6. V. Prema, “Bill for Liver Graft $30,000 So Far: NUS,” Straits Times, 10 October 1990, 26. (From NewspaperSG)
7. Davie, “NUH Team Scores First with Liver Transplant.”
8. Davie, “NUH Team Scores First with Liver Transplant.”
9. Davie, “NUH Team Scores First with Liver Transplant.”
10. Prema, “Bill for Liver Graft $30,000 So Far: NUS.”
11. Davie, “NUH Team Scores First with Liver Transplant.”
12. Prema, “Bill for Liver Graft $30,000 So Far: NUS.”
13. Allison Lim, “Baby for First Liver Graft Patient,” Straits Times, 23 November 1996, 1. (From NewspaperSG)
14. Jaime Ee, “Putting the Patient First,” Business Times, 15 January 1998, 16. (From NewspaperSG)
15. Eveline Gan, “Singapore’s First Liver Transplant Patient Turns 50,” Today, 5 August 2015, 36. (From NewspaperSG)



The information in this article is valid as at 2018 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.