UM sets up living donor transplant unit
A multispecialty team of healthcare professionals in University of Malaya (UM) has successfully carried out their first living donor liver transplantation last year and since then performed three living donor liver transplants over the past year.
According to Associate Professor Yoong Boon Koon, of the Department of Surgery, Faculty of Medicine, UM, the liver transplant unit in UM is composed of members from many fields, with every member being passionate and dedicated to the cause.
“As you can see, we have a team of surgeons, anaesthesiologist, hepatologists, intensivists, pathologists,psychiatrist, nurses and more.” Yoong, a hepatobiliary and pancreatic surgeon, was speaking at a multidisciplinary meeting involving members of the newly established liver transplant unit in University Malaya Medical Centre. He said: “We just did our third case 6 weeks ago and she is doing well. We are looking at six this year and further upscaling the number to 12 next year.” The team has no doubts as to the uptake of the service—the only question is how many the infrastructure can support.
While the adult living donor liver transplant unit is relatively new, Yoong said it was important to note that a paediatric living donor transplant unit has been in existence for much longer. It is hoped that, with the availability of an adult living donor liver transplant programme in place, the number of end-stage liver disease patients who can be treated will increase exponentially.
According to Yoong, the living donor transplant effort is meant to bring more awareness to the public and to healthcare professionals about the importance of organ donation. Unlike cadaveric donor transplantation in living donor transplantation, two persons must undergo surgery and this means risking a healthy donor.. Yoong urged doctors to start educating patients and public about pledging their organs after death. Cadaver liver donors have dropped over the years, according to Dr Ganesalingam Kanagasabai, a consultant gastroenterologist who was formerly attached to Selayang Hospital’s liver transplant unit. Professor Sanjiv Mahadeva, consultant gastroenterologist, UMMC, said referrals are made to Selayang Hospital should a patient requiring liver transplant be unable to find a living donor in UMMC. Unfortunately, cadaver donors are rare and the liver transplant list is long. Sanjiv said: “As you know, donors are few and far between. The situation isn’t unique to liver alone but for all organs eg, kidneys, hearts and so on. We are encouraging people to come forward to pledge their organs for transplant.”
The liver transplant unit in UMMC handles living donor transplants exclusively while the more established cadaver transplant unit is housed in Selayang Hospital. When asked about the reason for this separation, Yoong said it was because the team at Selayang was already an established cadaver donor transplant unit and hence, it was decided to keep it that way unless situation changed.
Local transplantation procedure will benefit more patients
Directing a message to local healthcare professionals, Yoong said everyone should be actively looking at brain dead patients to be cadaver donors. Due to the shortage of donors in the country, many patients undergo liver transplantation overseas in countries such as India and China. Undergoing such a major operation overseas can come with many problems, chief of which is the risk of complications during or after surgery.
Professor Lee Way Seah, paediatric gastroenterologist and hepatologist, UMMC, said: “You never know when a complication will arise and if you happen to be back home (in Malaysia) and need to get a follow up for a complication, it’s not likely you can make it in time to go back to the country where the surgery took place.” Additionally, Lee said having patients undergo transplants overseas represents a ‘dead end’ to the medical fraternity as there is no skills transfer and the local healthcare professionals will never gain enough experience to treat the general public.
On top of the risks involved in overseas liver transplant procedures is the factor of cost. As an example, Yoong said a liver transplant procedure in Singapore would easily cost S$300,000 or close to RM900,000. “This usually ends the conversation for most patients,” he said. A transplant procedure in UMMC costs around RM120,000—much more affordable than RM900,000. “We want to create more awareness (in the public and among doctors) that liver transplantation can be done in Malaysia, and to get more doctors to recommend or refer their patients for transplant within Malaysia.”
UMMC is also keen to start its own paediatric liver transplant unit, said Lee. He said: “We would like to start as soon as possible—as soon as our surgeons feel comfortable and safe. There’s never a shortage of patients, and unlike adult patients, our potential donors are much younger, with very little comorbidities.” These donors are, of course, the parents of the children and often there is no problem of incompatibility and there is no hesitation to donate a part of their liver to their child. In his population of patients, Lee noted that the most common factor requiring a transplant is biliary atresia, where patients commonly fail to survive beyond 15 months of age should they fail surgical procedures.
The number of Malaysians living with a liver graft was 90 in a 2014 census. The number is small compared to our population of approximately 30 million people. Yoong said: “Compare ourselves to Hong Kong, which has one-third of our population. They have performed about 70 transplant procedures in a year and even then, this is insufficient.”