A dinner conversation with friends made me realise how little people understand about liver transplants and organ donation.
“Can you actually survive that?” asked one. “Don’t you need a liver to, you know, live?” queried another.
It’s safe, I assured them. Livers fully regenerate within a couple of months, I explained, but they believed that only after a flurry of googling.
While donating an organ may sound scary, two donors who spoke to The Pride said it was worth it.
Making the choice to donate
Kumaran Sesshe, 44, made a liver donation to his 65-year-old father, Sesshe, in October 2015, while Alex Quah, 55, gave a kidney to his wife, Eileen, also 55, in July the same year.
Sesshe was diagnosed with liver cirrhosis in 2012, and when doctors told Kumaran that his father would benefit from a liver donation, he jumped at the chance.
“I didn’t know anything about it before making the decision,” said Kumaran. “I should have probably read up more and tried to understand the risks, but I didn’t bother at all. For a moment I just wanted to step up and save my dad.”
Quah’s situation was slightly more complicated. Eileen was diagnosed with advanced kidney failure in 2010, and made adjustments to her diet and lifestyle to delay the need for a transplant. By 2015, her conditioned worsened and a transplant was recommended.
There was a problem: Eileen and Quah are of different blood types, meaning there was a 50 per cent chance her body would reject a kidney donated by Quah.
Quah urgently sought out a donor, but with no success. He even registered himself for a cross-matching programme – where two sets of donors and recipients exchange partners in order to work around the issue of incompatibility – to no avail. And none of Eileen’s eight siblings qualified as a donor for various medical reasons.
So Quah committed to taking the plunge himself.
“I decided to leave it to God and go in with a positive mindset,” he said. “I was fit and healthy, I wanted to donate. With everything, there’s a risk anyway, so I thought: go for it.”
Fear and anxiety
How did Quah deal with the anxiety before the operation?
“You must have faith in the doctor and the transplant coordinator,” he explained. “Do your research. Religion also helped me find peace and clear my mind.”
Kumaran, like Quah, wasn’t without worry.
“They explained to us that there is a small chance for the donor to die,” he said. “It’s a major operation, with anaesthesia and all that, so there’s a chance the donor might not make it.
“I didn’t feel much until the last one month, but as the days started counting down I felt the pressure more.”
There was his family to worry about.
“That was tough. If anything happens to me, what happens to my wife and kid?”
So he prepared for the worst.
“I wrote a secret note and kept it in a safe – it described what to do and where my funds were, if anything happened to me.”
According to the National University Hospital, the risk of death during a liver transplant is 0.2 to 0.5 per cent, and for a kidney transplant, 0.03 per cent.
Consent is paramount
Given the risks, a great deal of care is taken to protect potential donors and ensure their choice is made firmly, and without coercion. Both men described how they were cross-examined by the Transplant Ethics Committee (an independent body governed by the Human Organ Transplant Act) in order to ensure that their donations weren’t made in exchange for financial gain, or under duress.
Quah recalled being told by the committee that they would explain it to his wife if he did not wish to proceed.
“They offered me the option of pulling out anytime, even just before the surgery itself,” added Kumaran.”
Under the knife
Once Kumaran agreed, he recalled nothing until waking up in the evening.
“They gave me anaesthesia, and the next thing I knew, I woke up in the evening and didn’t know what happened. When I woke up, my wife was there, my son was there, and two of my good friends were there.
“It was quite painful, I won’t lie. But after five days I was discharged.”
He noted that the disruption to his work was manageable as well.
“The operation was in October. I cleared some leave and was back at work in January.
“The only thing that changed was that I have a scar now. People like me never take off their T-shirts anyway. It’s not like I got a really hot body or what,” joked Kumaran.
Quah recalled waking up in pain after the operation.
“But I’ve gone through some tough training before, so pain is nothing to me,” said the former commando.
More importantly, the procedure was a success.
“The doctor came in and shook hands with me. Within the second day [post-transplant], the kidney had started working,” said Quah.
“It still belongs to him,” laughed Eileen, patting her side affectionately. “I’ve got to protect it like a new baby.”
Kumaran’s father, too, made a full recovery.
“Dad dotes on my children. He sees them every day when he takes them from school,” said Kumaran. “Now he has got the chance to do all this. It’s been three years since the operation. If I didn’t donate my liver, I don’t know if he would still be around.”
Donating won’t affect your fitness
Both donors maintain an active lifestyle even now.
“I work as Head Keeper for Great Apes at the zoo,” said Kumaran. “It’s quite a physical job.”
And his hobby? Competitive fishing. He showed me a room dedicated to his extensive collection of gear, and said he regularly travels to Sarawak and the US to chase species like Spanish Mackerel, Red Sea Bass, Garoupa, and even Sailfish which, according to him, can weigh over 60kg.
“I wrestle with monsters, bro,” he joked.
Quah’s lifestyle is also remarkably active by any measure. He is a counsellor with the Singapore Armed Forces, and as a regular, he still parachutes annually to keep his skills sharp.
An avid runner and cyclist before the organ donation, he hasn’t slowed down since, and even made the news recently for completing a 100km round-island walk, a feat boasted by only seven of its 150 participants.
“Fitness is a passion for me,” he declared.
Donating alleviates patients’ suffering
As of June this year, the waiting list for a kidney from a deceased organ donor is 291 patients, and there are 52 patients awaiting a liver, meaning that Eileen and Sesshe might have waited for years if they hadn’t received living donations.
Deceased organ donors are scarce since the donor must pass on while on life support – and have the organs recovered immediately by surgeons – the organs of those who die outside of an intensive care ward cannot be used in transplants.
Kidney transplants have “shown to provide better quality of life and survival outcomes”, according to a report in The Straits Times. A full 95 per cent of donated kidneys continue to function well five years after being transplanted, too, according to LiveOn, a website run by the Ministry of Health.
While dialysis is an option for patients waiting for a donor, it cannot completely replace the function of a healthy kidney, and can lead to further complications due to the incomplete removal of toxins from the bloodstream.
It can also be an uncomfortable experience for many.
Eileen underwent dialysis thrice weekly for 10 weeks prior to her transplant, and each visit to the NUH Dialysis Centre took about four hours.
“It was troublesome and painful,” she said. “I had some very serious leg cramps during that time.”
Kumaran also noted that the liver transplant benefited his father greatly.
“Before the transplant, he was quite forgetful, he had fainting spells, and he got tired easily. After the transplant, his life has transformed tremendously,” said Kumaran. “Now he loves picking up his grandchildren from school. It’s probably given him another five or ten years to live.”
Words of wisdom
Both men specifically reassured me that the procedure was safe.
“We are among the best in the world when it comes to the medical team, equipment and facilities,” said Kumaran. “Trust in your surgeons. They’ve had years of experience and years of success. These operations are like a daily routine for them now.”
For potential donors who remain hesitant, Kumaran said: “Just do what you feel is right. If it’s for your loved ones, go all out.”
Quah, meanwhile, said it was love that made him donate a kidney.
“And it can overcome fear,” he added.