Soaring EAGLES


GLENEAGLES Hospital, Singapore, has soared to new heights with its organ transplantation services for sufferers of end-stage organ failure, blood disorders and blood cancers.

TOP CLASS: The facade of Gleneagles Hospital in Singapore.

Given the easy access to Singapore as a medical hub in the region and its reputation of high standard treatment and care, ParkwayHealth, which owns Gleneagles, had seen over 1,800 admissions and more than 2,100 outpaitents from Malaysia in 2011.

Johor made up most of the admissions at 40 per cent followed by Sarawak (20 per cent) and Sabah (10 per cent).

Most Malaysians, seeking treatment at Gleneagles, suffered from major illnesses such as cancer, heart and vascular ailments, liver and kidney diseases, and neuro and eye problems.

Recently, Parkway Health organised a media familiarisation trip for journalists from Malaysia, Myanmar, India, Sri Lanka, Cambodia and Indonesia. The group learned about the serious issues of organ transplantation, worldwide reality on shortage of cadeveric organs and a long waiting list of people with end-stage organ failure. However, with technological advancement and available specialists at Gleneagles, more living donor transplants are being carried out there.

As Singapore is one of the countries in the East Asian region that allow “emotionally-related” organ donation, a holistic procedure is adopted through the transplant ethnics committee (TEC) to provide transparency and ensure donors are not subjected to any financial motive or pressure to donate.

Such a strict protocol is important to protect the interests of both donor and recipient alike.

Getting a transplant in Singapore requires at least a two-week grace period from the TEC. Unlike living donor transplant where donor and recipient are blood relatives, “emotionally related” organ donation can be from a friend, colleague or employer. After the paperwork, donor and recipient are given a week-long “cooling off” period to do some soul-searching ahead of the operation.

Gleneagles has assured its surgeons are gazetted by the Singapore government and certified annually after meeting the required number of ‘continuing medical education’ points to maintain and develop their skills.

Apart from living donor transplants for liver and kidney, Gleneagles also performs corneal and stem cell transplants which are carried out by a multi-disciplinary team, including specially-trained surgeons, anaesthetists and nurses. Transplant coordinators are also on hand to help and guide patients and their families through the operation as seamlessly as possible.

Corneal transplant

For corneal transplant at Gleneagles, the patient can either be a Singaporean or a non-citizen, and will be subjected by the doctor as a candidate for transplantation, after which, the patient will be put on the waiting list at the Singapore Eye Bank to receive a suitable cornea.

According to Dr Lee Hung Ming, director and ophthalmologist of Parkway Eye Centre at Gleneagles, the corneas are harvested from local donors and internationally accredited eye banks from the US, the Philippines and Sri Lanka.

“The waiting time can be as soon as within a week or up to a few months,” Dr Lee expained during a briefing at the hospital.

He said for overseas patients, the eye bank would inform the surgeon in charge when a donor’s cornea became available, adding that the patient would be contacted immediatly for travelling and transplant arrangements.”

He also said the preferred countries for surgeons to obtain corneas were the Philippines and Sri Lanka as it would only be a couple of week before the cornea arrived.

“This will ensure the corneas are still ‘fresh’ for transplant.”

According to him, the transplant takes about an hour and costs up to S$20,000, depending on the severity of the case, and surgery is highly recommended when a patient’s vision is impaired from a damaged cornea and cannot be corrected with glasses or contact lenses. Immediate action should be taken when medications are unable to relieve the painful corneal swelling.

Dr Lee said there are several eye conditions that may need a corneal transplant and the most common ones are advanced keratoconus, a condition where the cornea stretches abnormally and results in an irregular shape, and Fuchs’dystrophy which causes swelling, distortion of vision and pain in the eye.

He added that scarred corneas due to severe eye infection (common in contact lens-related ulceration and herpes keratitis) and scarred corneas, stemming from a complicated cataract surgery, retinal operation or rejected graft, could lead to a possible corneal transplant.

“Corneal transplants are highly successful with over 90 per cent of the operations achieving restoration of sight. However, as with any surgery, there are always some risks involved,” Dr Lee said.

Among the complications that can occur are infection, cataract formation, glaucoma and graft rejection.

Kidney transplant

Gleneagles also offers a wide range of medical and surgical treatments for kidney deseases – from acute, chronic and end-stage failure to a living donor transplant.

“Only one kidney is needed to replace the two damaged kidneys, making living donor kidney transplant (LDKT) an option for sufferers of end-stage kidney failure,” said Dr Roger Tan, a nephrologist (specialising in kidney diseases), at Gleneagles.

He explained LDKT transformed the lives of people with kidney failure, freeing them from dialysis and enabling them to live an active life.

Kidney transplant, he said, should be considered even before starting dialysis with its accompanying potential complications.

The advantages of having this transplant, according to Dr Tan, are the freedom from the strict regime of dialysis, absence of fluid restriction, normal, healthy diet gainful employment, better health and restored fertility.

“With these advantages, transplant is the best treatment option for people with end-stage kidney failure. In fact, we recommend pre-emptive transplant even before the kidneys totally fail and before the start of dialysis. This is because pre-emptive transplants have a higher chance of success.”

The less complicated transplant costs between S$80,000 and S$85,000 while a complicated one up to S$110,000.

With the advances in medications and quality care, the transplant team at Gleneagles is able to handle complicated cases where recipient-donor blood groups are not compatible.

Dr Tan said complicated cases occurred when recipients had had previous transplants or multiple blood transfusions, making it difficult for them to have a transplant as their bodies were likely to reject the transplanted kidney.

“There is no age limit for a transplant but the recipient must be medically fit to undergo the surgery. The donor will be discharged after three to five days whereas the recipient needs to stay in hospital at least 10 days for full observation,” he added.

Liver transplant

Gleaneagels, the first hospital in Asia to perform a liver transplant in 2002, has been home to the Asian Centre for Liver Diseases and Transplatation (ACLDT) since 1994.

ACLDT is one of Asia’s foremost liver centres with a dedicated liver ward and an intensive care unit (ICU) to complement its highly succesfully living donor liver tranplantation programme.

The liver ICU has advanced equipment, including liver dialysis machines, monitoring devices and ventilators to provide high quality treatment for specific liver conditions, including transplant.

In adults, the most common cause for liver failure is cirrhosis which can be caused by viruses such as hepatitis B and C, excessive consumption of alcohol, autoimmune liver diseases, build-up of fat in the liver or hereditary liver diseases. Liver failure could also be the result of liver cancer – benign and malignant.

In children, the most common reason for liver transplantation is biliary atresia, a condition in which the bile ducts are missing, blocked or damaged. This causes bile to be retained, leading to liver damage and cirrhosis.

ACLDT respiratory physician Dr Lee Kang Hoe said liver transplantation is a surgical procedure whereby a diseased or failing liver is removed and replaced by a whole new liver from a deceased donor (cadaveric) or part of a healthy liver from a living donor.

Specialising in critical care management of all acute liver failures as well as pre and post transplant patients at Gleneagles’ Parkway Asian Liver Ward, Dr Lee said for the living donor liver transplantation (LDLT), the diseased liver is removed and replaced with a part of the liver from a healthy donor.

“LDLT is an important and effective life-saving option, especially for those suffering from liver failure and hepatocellular carcinoma (HCC), compared to cadaveric liver transplantation as the shortage of cadaveric organs is a universal problem.”

Dr Lee said LDLT’s main advantage was the timeliness because it decreased the risk of complications and death while waiting for a match from deceased donors.

He added that this would allow the transplant surgery to be scheduled in such a way that the patient’s decompensated liver function could be optimised before surgery.

“The surgeon working on the donor will remove a portion of the liver (between 40 to 60 per cent), depending on whether the recipient is an adult or a child, and then the portion is flushed with preservative solution and cooled on ice.

“The surgical procedure for the donor – from when the incision is made to the removal of the liver and then closing it up – takes six to eight hours while the recipient’s surgery is between eight and 12 hours.”

Dr Lee said most liver donors were able to return to a normal quality of life within three months and the recipients within six months.

To provide the best possible care and treatment for liver transplant patients, Gleneagles has a dedicated ward. Complementing ACLDT’s highly successful LDLT programme is the Parkway Asian Liver Ward comprising seven liver ICUs and 10 patient rooms.

It’s an integrated facility co-managed by ACLDT and Gleneagles.

“This dedicated facility allows patient care to be seamless between the ICU and the general ward,” Dr Lee said.

Stem cell transplant

Gleneagles also provides stem cell transplant for infants and adults at a cost of S$80,000 to S$180,000. This treatment may be performed on its own or in combination with other therapies for conditions like leukaemia, solid tumours, thalassaemia, sickle cell anemia, metabolic diseases, immune deficiencies and autoimmune diseases.

According to Dr Teo Cheng Peng, haematologist at the Parkway Cancer Centre, it’s highly recommendable for people to store bone marrow or cells at the autologus stem cell bank in Singapore.

He said the key advantage was that this would ease the need to find a suitable donor, especially when the cells must come from siblings, and preferably, the same blood type.

“That’s why it’s also important for parents to have more than one child.”

Dr Teo also said harvesting bone marrow was not as painful as perceived but rather similar to having one’s teeth pulled.

After the transplant, patients will be warded for at least three to four weeks, depending on recovery rate and need for observation.

“Bone marrow transplant will be harder on older patients – the younger ones will normally just breeze through the whole surgery,” he explained.

Dr Teo said most times, the donor was a family member, usually a sibling, adding that if the patient was unable to find a good match within the family, the doctor would turn to a national registry, and usually, a match could be found.

A newer stem cell source is from cord blood but the amount of stem cells from this source is often insufficient for adults. Hence, it’s mostly for children.

According to Dr Teo, there are two main types of stem cell transplant – allogenic (cells donated by parents, siblings or an unrelated person) and autologous (patient receiving his or her own stem cells). The third type is syngeneic transplant where stem cells are taken from the patient’s identical twin.

Dr Teo said autologous transplant patients recovered faster than allogenic transplant patients.

“Usually, it takes about one year for the patient’s blood cells and immune system to restore to normal levels following a stem cell transplant. For some people, a stem cell transplant can cure their disease. For others, the transplant may put their disease into remission.”

Depending on the individuals, some stem cell transplant patients do not suffer any side effects or complications. Others may experience mild to severe side effects. As with most treatments, the success of stem cell transplant differs from person to person.

“The good news is many stem cell transplant patients have gone on to live a normal active life,”
Dr Teo said.