First heart transplant

History
Heart transplant operations were not available in Singapore before 1990. Two countries in Asia, Taiwan and Thailand, had started heart transplants as early as 1987. Singapore was only ready for it in early 1990 when the Ministry of Health announced its decision to allow heart and liver transplants in Singapore. A pilot heart transplant programme was already in place at the Singapore General Hospital (SGH) two years before where doctors in the programme had been training and preparing for heart transplant operations. The programme was funded in part by research grants from the Ministry of Health and philanthropic organisations. Following the Ministry of Health's announcement, SGH doctors began looking for suitable donors for its heart patients.

On 6 July 1990, Wee Soo Hup, 59, a retired information officer at the Ministry of Communications and Information, became the first heart transplant recipient in Singapore. 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 already suffered several heart attacks in the past few years before the operation. He was frequently hospitalised because of his medical condition. Just before the operation, he was so weak that he could hardly walk. His life expectancy without a heart transplant was estimated to be less than six months.

On the afternoon of 5 July 1990, Ong Soon, a 41-year-old construction worker, met with an industrial accident at Tien Wah Press warehouse along Bukit Timah Road. He was repairing the fibreglass roofing of the warehouse when he fell nine metres to the ground. Ong 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 on 6 July.

That same afternoon, the head of the SGH Department of Cardiothoracic Surgery, Tong Ming Chuan (Dr), personally approached Ong's family at Tan Tock Seng Hospital. He wanted to seek their permission to donate Ong's heart. Consent for such an organ donation had to come from the family of the deceased, according to the Medical (Therapy, Education and Research) Act of 1972. Ong's widow, Chua Gun, 39, consented twenty minutes after meeting Tong.

Description
A team of SGH doctors, led by surgeon C. Sivathasan, went to Tan Tock Seng Hospital to "harvest" the donor's heart. Other doctors in the team were surgeons James Wong and Susan Lim, and doctors Chow Hong Keong and Jeffrey Chew. They started to retrieve Ong's organs at about 5:00 pm on 6 July.

The harvesting of Ong's heart involved a procedure whereby two great arteries and two sets of greater veins of the heart were cut. After this was done, the heart was then injected with special preservatives and placed in a saline ice slush kept at 5 - 10 degrees Celsius. Meanwhile at SGH, doctors selected Wee as the heart recipient from a waiting list based on blood and tissue match. Ong's B positive blood type matched that of the Wee. In addition, donor and recipient's weight should also closely match so that the two hearts would be similar in size. The difference in weight between Ong and Wee was not more than 10 per cent. Furthermore, Ong's heart was in relatively good condition and free from infection. Based on these criteria, Wee was selected and put under general anaesthesia in preparation for his heart transplant.

The Operation
At about 8:00 pm on 6 July, Ong's donor heart arrived. Wee, the recipient, 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 then removed parts of his heart. The ventricles and the origins of the greater arteries were removed, leaving behind the left and the right atrium. Next, the donor's heart was "trimmed" to fit into the recipient's heart cavity. It was then stitched to the recipient's in the following order - the left atrium, the right atrium, the pulmonary artery and the aorta. Once completed, Wee's chest cavity was "wired" together. The entire operation was completed in about three hours.

The surgical team comprised of - Tong Ming Chuan, head of the Department of Cardiothoracic Surgery and team leader; surgeons, C. 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 the Wee's condition.

The cost of the first heart transplant in Singapore was estimated at between S$70,000 and S$80,000. If it was performed overseas, it could cost almost three times as much. Following the operation, it cost about S$6,000 to S$8,000 each year for medication and regular checks to make sure Wee's body was not rejecting the heart.

Post-operation
Wee, whose heart transplant operation began on Friday night, was taken off the respirator on Saturday morning. He remained in ICU for the next few days where he was closely monitored for rejection and infection of the donor organ. With his condition improving, he made his first public appearance on 20 July 1990 where he received a bedside visit from the then Acting Health Minister, Yeo Cheow Tong, and the media. Less than three weeks after the operation, he left the hospital for home.

About S$50,000 was collected for Ong's widow and his children. Goh Chee Wee, MP 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.

Although Wee's recovery was said to be satisfactory, he lived for only several months after the operation. In February 1991, after eight months of living with the new heart, Wee passed away.

The team that performed the transplant left SGH subsequently - Tong Ming Chuan left for private practice in 1992; Lim Yew Cheng left in 1994 to join the University of Malaya in Kuala Lumpur; Ong Kim Kiat, James Wong and C. Sivathasan all left in 1995.



Author
Nureza Ahmad



References 
Heart transplant man goes home. (1990, August 5). The Straits Times, p. 16. 

Man had a heart of gold, says family. (1990, July 8). The Straits Times, p. 2. 

Prema V. (1991, January 1). Heart transplant patient now a picture of health. The Straits Times, p. 17.

Singapores first heart transplant: How it was done; Five years ago we were not ready for it. (1990, July 8). The Straits Times, p. 3.

Toh, S. (1990, July 8). First heart transplant patient is doing well. The Straits Times, p. 1.

Toh, S. (1990, July 21). Good heart in more ways than one. The Straits Times, p. 1.

Toh, S. (1990, July 25). Heart donors family gets $50, 000 in donations. The Straits Times, p. 23.

Toh, S. (1989, March 7). Heart transplant in S'pore likely by end of year. The Straits Times, p. 17.

Toh, S. (1990, July 21). What it is like for Wee living with a new heart; Meet the team behind the transplant operation. The Straits Times, p. 23. 

Toh, S. (1990, July 7). Singapore team performs first heart transplant. The Straits Times, p. 1.


Further Readings
Perry, M. (2001, March 14). Ten years on, heart-transplant patient dies. The Straits Times. 

Wee, L. (1997, June 24). No heart grafts here for the last three years. The Straits Times.

2 surgical firsts recorded in Spore last year. (1991, November 20). The Straits Times, p. 21.


Subject
Politics and Government>>Health
Transplantation of organs, tissues, etc.--Singapore
Health and medicine>>Medical science>>Surgery



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