Surgeon plans more live-donor liver transplants in Asia

SINGAPORE, April 29, 2010 (AFP) - From ailing Middle East royalty
arriving in private jets to desperate charity cases, Dr Tan Kai Chah
has seen them all in his liver disease centre in Singapore.

But the Malaysian doctor, one of Asia's top liver surgeons, has a more
lofty mission: make transplants and treatment more accessible to
patients now that the organs can be sourced from living donors, not
just cadavers.

Liver disease is common in Asia due to poor hygiene practices and
dietary habits and many patients end up dying because of sky-high
medical costs, inadequate facilities and a small donor pool, experts

In Southeast Asia, about six to eight percent of the population suffer
from hepatitis B, said Tan, lead surgeon and executive chairman of the
Asian Centre for Liver Diseases and Transplantation.

"In some parts of Asia such as China's Pearl River Delta (and) north
Vietnam... it can affect up to about 12 percent of the population,"
Tan, 57, said in an interview with AFP.

Hepatitis C is "very common" in South Korea, Japan, Mongolia and
Russia where it affects about three to four percent of the population.

"There are many people suffering from hepatitis infection. Many of
them go on to develop liver cirrhosis, which is hardening of the
liver, going into liver failure and a substantial number of them
develop liver cancer," said Tan.

Despite its prevalence, liver disease treatment is a neglected field,
Tan said, noting that while heart centres can be found in several big
Asian cities, specialised liver facilities are rare.

"Why? Because heart and brain disease is a rich man's disease," said
the British-trained surgeon, who has performed 500 to 600 liver
transplants so far.

"Who's got the liver disease? It's the poor, so it's very, very much neglected."

Before medical science made it possible for a portion of the liver to
be taken from a living donor, patients had to wait in a queue for
someone else to die before they could undergo a transplant.

China's clampdown on the extraction of organs from executed prisoners
ahead of its hosting of the 2008 Beijing Olympics cut off a major
source for cadaveric transplants, Tan said.

Moreover, superstition and opposition from relatives prevent many
individuals from pledging to donate their organs when they die.

But living donors are growing in number due to reduced risks, and
rejection in liver cases is the lowest among all major organ
transplants, Tan said.

Unlike other organs of the body, the liver can regenerate itself so
only a part of it needs to be taken from a healthy donor and
transplanted into a patient.

For transplants involving a living donor, many Asian countries like
Singapore allow only blood relatives and those who are legally
related, such as by marriage or adoption, to donate, the surgeon said.

With fewer people going to China for their transplants, liver
operations in the Singapore centre have increased "substantially" over
the past two years, he said.

Surgeons at the facility, Asia's first private centre dedicated to the
treatment of liver disease, perform 35-40 transplants a year.

About 95 percent of the patients come from outside the city-state,
among them super-rich Middle East clients who find it harder to get
visas to the US and Europe after the September 11, 2001 terror
attacks, Tan said.

"We have poor patients who come to us from Indonesia, from Vietnam,
from Sri Lanka," said Tan.

"We also have very, very rich patients who fly in in their private
jets for their liver transplant and who wouldn't bat an eyelid if they
spend half a million to one million Singapore dollars (357,000-714,000

A typical liver transplant in Singapore can cost between 250,000 and
300,000 dollars but can reach as high as one million dollars if the
hospital stay and other expenses are included.

Tan said treatment has to be made more accessible and affordable in
Asia by spreading the expertise.

"If you look at all the regional capital cities, like Manila, Cebu,
Jakarta, Surabaya and Kuala Lumpur, you've got heart centres, brain
centres but you don't have liver centres, so we feel that there is a
niche for us to fill," he said.

Initially, he expects to open satellite liver clinics in Vietnam's Ho
Chi Minh City and Seremban in Malaysia in July or August.

Negotiations for similar facilities in Manila and Malaysia's Penang as
well as for a liver centre in China are also underway.

The clinics will be doing consultations at first, with the more
serious cases referred to Singapore.

But eventually the clinics should progress to handling transplants
with the support of local hospitals, and then ultimately on their own,
Tan said.

The Singapore centre will provide expertise on starting and managing a
liver ward, and help train local doctors and nurses.

To finance the centre's expansion plans, Tan had the company listed on
the Australian Stock Exchange in September 2009.

Tan earned his spurs in Britain, where he performed liver transplants
from living donors as a consultant at King's College Hospital in

Tan, who returned to Asia in the mid-1990s and now races horses as a
hobby, said the main challenge is raising public awareness that
end-stage liver patients can still cling to some hope.

"As long as the cancer has not spread out (to the other organs), you
can look at liver transplant because the success rate is very good."