Liver Transplant

In Singapore, for Deceased donor liver transplant, the donor is Singapore citizen or Permanent residents (PR) who has recently passed away (brain death). All Singapore Citizens & PR who meet the age requirement and are of sound mind will be automatically included as a potential organ donor unless they have opted out.

If deem suitable, the hospital will identify the brain-dead patient as a potential donor. This is the most commonly performed transplant procedure in which the liver is procured from a patient after brain death is certified. The recipient will be the most suitable patient on the top of the National waiting list, prioritized by the medical urgency and waiting time. This program is only applicable for Singapore citizens or Permanent residents (PR) and only performed in the public hospitals.

In Living donor liver transplant, a relative, someone who has a close emotional bond or an altruistic person can be considered as potential donors. The most appropriate donor will be selected, counselled and undergo a series of pre-transplant assessments to ensure their suitability. This can be performed for all patients including foreign patients. Living donor transplant provide an alternative for patients as there is a shortage of deceased donors.

Mount Elizabeth Hospital is the only accredited private Liver transplant centre in Singapore.

A liver transplant, like all major surgery, has possible serious risks such as bleeding, infection, and complications from anaesthesia. In addition, people who have a liver transplant may have side effects from the immunosuppressive drugs they need to take. These medicines weaken the immune system so the body does not reject the new liver. This also means that a patient may be at increased risk of developing infections. Some of the immunosuppressive drugs can also cause high blood pressure and cholesterol, diabetes, and weaken the bones and kidneys. Regular health checks with the transplant team are important after a liver transplant.

Liver transplantation is generally very successful. Most people are able to return to their daily routine within a few months after the transplant, and many of them earlier. Transplant success depends on a number of variables, including health status, age and nature of disease. The overall survival of patients at 1 and 5 years is above 90% and 70% respectively. Without the transplant, many patients will not survive for more than 6 - 12 months due to disease progression.

A common cause of organ failure following a transplant is due to patients not following the prescribed immunosuppression medication regimen. Careful attention to medication schedules, lifestyle changes, diet and close follow-up with the transplant team and primary care physician is important.

Living donation significantly decreases the time a patient has to wait for a liver on the National waiting list, prior to the worsening of the patient’s condition. Livers from living donors are usually of excellent quality because donors are carefully evaluated prior to donation and are only allowed to donate if they are in good health.

The criteria for Living Donor Liver transplant are more liberal than the criteria for the deceased donor program in many centres, extending the eligible pool of patients who can potentially benefit.

The deceased liver transplant program in Singapore is a national program and is only available in public hospitals and requires both recipient and donor to be Singapore citizens or PR. The average waiting time for an available deceased organ in Singapore is about 12 months vs. 2 months for a living donor liver transplant once a donor is deemed suitable.

As with any major surgery, a liver donation carries risks. These include temporary jaundice, bleeding, infection, bile leakage and even death (very rare). However, most donors do very well and those with no complications can usually be discharged within a week and make a full recovery in a few months. Donors are well looked after by the transplant team inpatient and through outpatient follow-ups.

All potential living donors will be informed and well counselled about the donation process, possible outcomes, risks and post-donation care.

The transplant team is not allowed to find a donor on behalf of the patient. Organ trading is prohibited in Singapore and internationally. Anyone who is involved in the buying or selling of organs can be prosecuted by law.

Yes, a person can choose who the intended recipient is, as long as the assessments have deemed that the person is healthy and a match to the recipient, and a completely voluntary decision is made without coercion or financial promises. A non-related person may also choose to be an altruistic donor. Individuals may also donate to any patient on the national waiting list i.e., they do not specify the recipient (non-directed donors).

Once the evaluation is complete and cleared, the application will be reviewed by the Transplant Ethics Committee (TEC) under the auspices of the Ministry of Health, Singapore (MOH) to ensure it is appropriate. There is a compulsory cooling-off period after the review. The transplant surgery can go ahead after the TEC’s approval.

A donor can withdraw from organ donation any time, for any reasons and the decision will be kept confidential.

In Singapore, the Human Organ Transplant Act (HOTA) allows for payments to living donors, only for reimbursing or defraying the expenses or loss of earnings that may be reasonably incurred as a result of organ donation. This includes costs for health checks, tests, surgery, follow-up visits and indirect costs such as loss of earnings.