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Dr Lim Boon Leng Kieron
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If you are a patient with severe and chronic liver conditions such as liver cirrhosis or liver cancer, a liver transplant can give you a chance to regain your health and offer you a new lease of life.
A working liver has many important functions, such as controlling your metabolism, synthesising protein, storing vitamins and iron, and removing toxins from your body.
Patients who undergo a liver transplant have a 70% chance to live up to 10 years, and a 90% chance of surviving after a year due to better surgical techniques, intensive care and medications.
In contrast, without a liver transplant, advanced liver cirrhosis or liver cancer patients have a high chance of succumbing to their liver disease within 1 – 2 years.
At Mount Elizabeth, our experienced and compassionate liver transplant care team combines modern surgical techniques with effective medication plans to bring about the best possible outcomes for our living liver donor transplant patients in Singapore and around the world.
Learn more about liver transplants and how you can begin your journey with us.
What are the types of liver transplants?
In Singapore, both cadaveric liver transplants and living donor liver transplants (LDLT) are available as treatment options for patients diagnosed with end-stage liver conditions.
Due to the shortage of deceased donors, however, LDLT has increasingly become a feasible option for patients who require liver transplantation.
Cadaveric liver transplants
This is also known as deceased donor liver transplantation. The livers that are transplanted come from brain-dead organ donors where consent is given. The donor’s whole liver will be transplanted to the patient.Living donor liver transplants
The donor's healthy liver will be partially removed and transplanted to the patient. This can be done because the liver has a remarkable ability to regenerate itself. Both the transplanted liver and the portion left behind in the donor are able to regrow rapidly. Even with 70% of its mass removed, the remaining 30% of the liver will function adequately to support life for the donor, and the liver will regenerate to 100% functionality within 4 – 6 weeks.
Why is a living donor liver transplant (LDLT) important?
In Singapore and many Asian countries such as Korea, Japan and Taiwan, transplant centres are unable to meet the demands of the growing number of patients on the waiting list for cadaveric liver transplants.
To help address this ongoing shortage, Mount Elizabeth developed a robust living donor liver transplant programme and has been successfully treating patients with our transplant services since 2014.
Benefits of a living liver donor transplant
A long waiting period for cadaveric donor liver means that some patients may progress to develop fatal complications.
On the other hand, a living donor liver transplant can decrease a person’s wait time on the wait-list. This saves vital time and could potentially save lives. Additionally, a liver from a living donor can start functioning immediately, leading to better results post-surgery.
This surgery can be performed on patients with end-stage liver disease regardless of the original cause of the disease. Potential recipients are carefully selected and must meet stringent criteria.
Learn more about living donor liver transplant (LDLT) and how it works.
Who should consider a living donor liver transplant (LDLT)?
A living donor liver transplant may be recommended to patients with:
- End-stage liver disease
- Liver cancer, or hepatocellular carcinoma (HCC)
- Liver scarring. Known as decompensated liver cirrhosis, this has several causes in adults, most commonly hepatitis B or C, excessive chronic alcohol consumption, autoimmune liver disease, or a build-up of fat in the liver.
- Liver tumours
- Hereditary liver diseases
- Blocked bile ducts, or biliary atresia (in children). When the tubes that carry bile out of the liver to the gallbladder are blocked, the accumulated bile can damage liver tissue, leading to cirrhosis.
- Medical complications such as jaundice, ascites (accumulation of abdominal fluids), encephalopathy (confusion or coma), enlarged veins in the oesophagus (varices) or bleeding from blood vessels.
Am I eligible for a living donor liver transplant (LDLT)?
The selection process to receive a liver transplant is stringent. The key factors of consideration are:
- Severity of the liver disease. A liver transplant is only recommended when the risk of death from the disease is more than the overall risk from the transplant.
- Cause of the liver disease
- Benefits and risks to both recipient and donor
Your medical team may also consider factors such as:
- Any history of tuberculosis or chronic infections such as HIV
- Your overall physical condition
- Your mental well-being
Who can be a living liver donor?
People who wish to donate their liver have to undergo a thorough medical exam to ensure their liver is healthy and that it is safe for them to donate. Safety is critical for both the donor and the recipient. Speak to your doctor about the risks.
You may be eligible to donate your liver if you:
- Are a willing adult aged between 18 – 60
- Have a compatible blood type with the patient
- Have a healthy BMI and is psychologically sound
- Do not have liver-related diseases
- Have a healthy, functioning liver
- Willing and prepared to go through the entire living donor liver transplant process including pre-donation evaluation, surgery and recovery.
Learn more about donor eligibility and becoming a donor.
What can I expect as an LDLT patient?
At Mount Elizabeth, our dedicated transplant care team will provide you with personalised care throughout the entire journey. We will work closely with you to guide you before, during and after the surgery, and offer you and your family support and resources to keep you informed at every stage.
A living liver transplant process involves:
Finding a compatible and healthy living liver donor. The first step in this journey begins with finding a suitable candidate, and this person could be a next of kin, relative or close friend. Matching of donors with recipients is based on blood group, body size, general medical condition and other factors.
Going through a thorough pre-transplant assessment to determine you and your donor's eligibility. Both you and your donor will have to undergo a rigorous medical examination and psychosocial evaluation. The assessment will be done by our clinical team, followed by an independent doctor as an additional step.
Meeting the donor with your family members for a family conference.
Preparing for the surgery by taking appropriate medications or diet according to the transplant team’s medical advice to ensure you are in optimal health.
Seeking approval and authorisation from the Transplant Ethics Committee, as required under the Singapore Ministry of Health's Human Organ Transplant Act (HOTA).
Undergoing the transplant surgery. During the transplant, the surgeon will make an incision over your upper abdomen to remove your liver and replace it with the donor liver graft. The specific part of the liver donated depends on the size of the donor liver and your needs. Then, the surgeon will connect the blood vessels and bile ducts to the new liver to restore blood flow. The incision will be closed once the vital structures are anastomosed (joined) and working well. Learn more about what to expect during and after the surgery.
Post-transplant surgery and care. After transplant, you will need to adopt a healthy lifestyle, take medications on a daily basis, and go for follow-up medical appointments regularly to protect your new organ. Your transplant coordinators, dietitians and allied healthcare team will educate and guide you on your post-transplant care.
If you have any questions regarding the transplant journey, always raise them with your surgeon and transplant care team. Your commitment and ongoing motivation are crucial for the transplant process to be a success.
Our liver transplant care team
At Mount Elizabeth Hospitals, you will be in the good hands of a skilled and conscientious team throughout your entire liver transplant journey.
Headed by Dr Kieron Lim, our experienced liver transplant team comprises a multidisciplinary group of medical specialists from various specialities including general surgery, gastroenterology, infectious disease, respiratory disease, cardiology and anaesthesiology.
In addition, you will also be supported by our:
- Clinical transplant coordinators who play the important role of working closely with patients and donors to facilitate all aspects of the transplant process
- Social workers who can provide patients with emotional support and practical advice to help address any psychosocial or financial needs
Our team members all share a common mission – to provide comprehensive, compassionate and customised care to our liver transplant patients.
Learn more about our liver transplant programme at Mount Elizabeth Hospitals.
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More information for LDLT recipients
Here are answers to some commonly asked questions from LDLT patients.
Liver transplant surgery carries a risk of complications including:
- Bile duct complications
- Bleeding
- Blood clots
- Failure of donated liver
- Rejection of donated liver
- Infection
Long-term complications may also include recurrence of liver disease in the transplanted liver.
For Singaporean patients, you can reach out to our Transplant and Cellular Therapy (TACT) executive office at sg.tact.executiveoffice@ihhhealthcare.com for more information.
For international patients, please contact our international offices where our representatives will be able to advise you on all transplant-related enquiries.
You will need to undergo robust testing to give yourself the best chance of a successful transplant. Some of these tests include:
- Blood type and cross-match to ensure compatibility with the donor
- Blood and urine tests
- Scans of the liver and abdomen using CT and/or MRI
- A comprehensive physical examination to check for underlying or previously undetected medical conditions.
- Gastroscopy and/or colonoscopy
- Electrocardiography (ECG) and other heart scans
- A mental health assessment
A liver transplant can take between 6 – 12 hours. During this time, the surgeon will remove and replace your liver through an incision in your upper abdomen. Blood vessels and bile ducts will need to be connected to the new liver to restore circulation. Once these are joined and working well, the incision will be closed.
Learn more about what to expect during an LDLT surgery.
After the surgery, you can expect to:
- Be in the intensive care unit (ICU) for 3 – 5 days, under close monitoring until your condition is stable.
- Stay another 5 – 10 days in the hospital, to continue receiving care from your transplant team.
- Have frequent outpatient consultations as you continue recovering at home. You may undergo blood tests once or twice each week, which should lessen over time.
- Take immunosuppressant medications for the rest of your life (to prevent your body rejecting the new liver).
You can enjoy a productive life upon recovery, and are able to work and play as a healthy person. As you get a handle on your new life, do take the opportunity to adopt a healthy lifestyle. You will need to take your immunosuppressant medications faithfully, and you should also have regular exercise and follow a wholesome diet to help keep your condition stable.
More information for LDLT donors
As a potential liver donor, you will have your own concerns. At Mount Elizabeth, we ensure you are well taken care of until complete post-surgery recovery. You may be confident of having the support of an experienced and conscientious transplant team along the way.
Here are answers to commonly asked questions by donors.
Severe complications are rare for donors. Your surgeon will discuss your risks and complications in detail with you before the surgery.
Some mild complications may include:
- Hernia at the incision site, where tissue protrudes through the abdominal scar
- Prolonged numbness
- Wound infection
Your liver is able to regenerate after the surgery. Even with 70% of its mass removed, it will be fully regrown and functional within 4 – 6 weeks.
A liver transplant is a complicated and long process. You must be confident you are committed and ready to see the whole process through – from the pre-transplant evaluation to the surgery, to recovery and follow-ups. You may also need to take medication to ensure you are in optimal health for the transplant.
Do schedule plenty of time for the multiple pre-procedure tests and psychosocial assessments. There will be a down-time in hospital of about a week after the surgery, followed by a few weeks of recovery time.
Your health checks, laboratory tests, donation operation and follow-up medical visits can be reimbursed under the Human Organ Transplant Act (HOTA). If you are self-employed or a daily-wage worker, you are also eligible for limited compensation for your loss of earnings.
Once a compatible recipient has been identified, you will both undergo a rigorous assessment of your psychosocial and physical suitability. You may need to take medication to ensure optimal health for the transplant. You may also want to meet the recipient with your families to discuss the process.
A liver transplant can take between 6 – 12 hours. During this time, the surgeon will remove part of your liver through an incision in your upper abdomen. For an adult-to-adult transplant, the larger right lobe of your liver will be used. If you are donating your liver to a child, the smaller left lobe will be taken.
In the early recovery period you may experience some pain and discomfort, which can be controlled with pain medications. In the 2 months after discharge you should not lift heavy items (10kg or more), or engage in strenuous activity. You will need to return for regular check-ups during this period as part of the post-surgical monitoring.
Your liver will grow back to its normal size, and should be working well within 8 weeks. You may resume work and your usual activities after this. No long-term medication is needed.
This page has been reviewed by our medical content reviewers.
