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First Liver Transplant

Singapore's first liver transplant was successfully performed on Surinder Kaur, a female production worker, on 29 September 1990, by a team of doctors from the National University Hospital. The team of four surgeons and two anaesthetists was led by Susan Lim (Dr), who was the second woman doctor in the world to perform a liver transplant.

History
Before the 1990, Singaporeans had to go overseas for liver transplants. This changed in February 1990 when the Health Ministry made a landmark ruling allowing Singapore General Hospital and National University Hospital to perform hearts and livers transplants on a pilot basis. Although the Ministry estimated that 20 people will need heart transplants and 33 will need liver transplants each year, the high costs and the difficulty of obtaining donor hearts and livers were some reasons why it had disallowed heart and liver transplants earlier. However, with the new ruling, the ministry would invoke The Medical (Therapy, Education and Research) Act to get donors on a one-on-one basis by transplant coordinators. Religious leaders of the main religious groups in Singapore responded positively to the Ministry's announcement by giving their consent to such operations. This was because organ donation was considered an act of compassion that is intended to save lives, as long as the donor or donor's family agreed to the transplant.

On September 29 1990, Surinder Kaur, a 25-year-old production worker, became the first recipient of a donor liver in the first liver transplant. The operation took place at the National University Hospital (NUH) where doctors had waited five months before a suitable donor liver was found, that which matched Surinder's blood group and tissue samples. Prior to the operation, Surinder was suffering from auto-immune liver disease that had her body's antibodies destroying her liver. Her condition had deteriorated to such a stage where she could not walk, work or even eat properly. Doctors at NUH had given her six months to a year to live if she did not have a liver transplant.

Fate intervened when, on September 28, a construction worker, Goh Boon Chai, 22, died from head injuries after falling four storeys at his workplace. His family agreed to donate his liver for medical purposes. Once consent was given, his liver was removed and a new preparation, called the University of Wisconsin solution, was used to preserve his liver for a longer time-period of up to 24 hours instead of the previous six to eight hours.

Description
On September 29, the liver transplant operation began. Susan Lim (Dr), 35, the second woman doctor in the world to perform such a transplant, was the head surgeon. She led a team of four surgeons and two anaesthetists in the five-hour operation. The other three surgeons in the team were - Professor Abu Rauff, chief of NUH's department of surgery; Associate Professor K. Prabhakaran; and Professor Ti Thiow Kong. The anaesthetists were Associate Professor Ashok Kumar and Lai Fook Onn (Dr). Susan 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, Britain.

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

The operation itself cost S$30, 000 but the maximum estimate for a year's treatment was S$100, 000. This covered costs for pre-and-post-surgery treatment, outpatient and in-patient treatment, hospital charges, laboratory tests and medication. Since the liver transplant project was a pilot one, NUH did not subsidise the operation. Instead, Surinder's parents had to come up with their own funds. They appealed to members of the Sikh community and to Sikh Temples to help meet 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.

Post-operation
The liver transplant operation was deemed a success by NUH as Surinder recovered well after the operation. It was a significant moment for NUH as it had committed its top people and resources into preparing and training for liver transplants. The operation came just three months after doctors from the Singapore General Hospital successfully performed Singapore's first heart transplant operation.

On October 8 1990, the donor's father, Goh Leng Cheow, 52, was presented with a letter of appreciation and a S$500 cheque drawn on the Bukit Batok Education and Welfare Fund by the MP for Bukit Batok, Ong Chit Chung (Dr).

Following the operation, Surinder regained her health and a few years later married Gurchan Singh, a factory worker. She fulfilled her dreams of becoming a mother when she conceived and gave birth to a healthy baby boy in 1996.

Susan Lim, went on to private practice at Gleneagles and Mt. Elizabeth hospitals and is a Ministry of Health's consultant general surgeon.



Author
Nureza Ahmad



References 
Davie, S. (1990, October 3). NUH team scores first with liver transplant. The Straits Times, p. 3.

De Silva, G. (1988, October 20). First Sporean to carry out liver transplant. The Straits Times. 

Prema, V. (1990, October 10). Bill for liver graft $30, 000 so far: NUS. The Straits Times, p. 26.

Singapores first liver transplant (1990, October 3). The Straits Times.

Toh, S. (1990, February 8). Spore doctors to do transplants of heart, liver for first time. The Straits Times, p. 1. 

Toh, S. (1990, April 2). Religious leaders say yes to organ transplants. The Straits Times, p. 18.


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

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

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

The information in this article is valid as at 1998 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
Events>>Historical Periods>>Independence and Nation-Building (1965-)
Transplantation of organs, tissues, etc.--Singapore
Women transplant surgeons--Singapore
Health and medicine>>Medical science>>Surgery

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