Liver transplant: Hope after despair - a breakthrough

LAHORE:

In 2007, Amir Raza, an expatriate worker from Sialkot who was employed as a supervisor by a German company in Dubai, was diagnosed with Hepatitis C. For two years he sought and tried various treatments, but as his condition worsened, he left his job and he and his family returned to Pakistan in 2009.

Raza now sought treatment at the Shaikh Zayed Hospital in Lahore. Some months later that year, doctors treating him told his family he was not responding to the treatment and that they should consider a transplant. They said Raza would not recover without a transplant.

The inauguration of a Liver Transplant Centre at Shaikh Zayed Hospital in 2010 gave the family some hope. However, finding a suitable donor proved hard and they started exploring transplant options in India and China. The family’s research of transplant facilities abroad showed that they were out of their financial reach.

In 2011, Raza’s elder brother, Syed Arif Raza, agreed to donate a part of his liver. The surgery was finally scheduled for September 6.

On August 11, the family received a call from the hospital and were informed that a donor was available.

Masooma, Raza’s wife, said, “We could not believe that we had finally found a donor. We didn’t know who it was or from where...The doctor said that the transplant had to be carried out the same day.”

On August 11, a team of surgeons worked for 12 hours to plant the liver harvested from a 16-year-old victim of a road accident.

Cautiously optimistic, doctors are calling it Pakistan’s first successful liver transplant - a breakthrough.

The donor

Arsalan, a Cathedral School student, was driving a motorcycle on August 9 when it hit a pickup truck on Wahdat Road during the heavy rain. His mother was accompanying him at that time. They were both taken to Shaikh Zayed Hospital, where Arsalan was soon shifted to the intensive care unit.

The next day, he was put on a respirator. Two days later, doctors informed the family that his brain had stopped working. His organs, however, were still healthy. After the family gave their consent, Raza, who had been looking for a donor was called in for the transplant surgery.

Arsalan’s body was handed over to the family on Friday. His mother said that her entire family was at peace with their decision.

Muhammad Abdur Rauf, Arsalan’s grandfather, said that Dr Shah had called and informed them about the success of the transplant. “Our young boy’s liver has not been wasted. Hopefully his example will motivate more people thinking about what they can do for the society,” he said.

Arsalan’s mother remembers that her son had once expressed his desire to donate his organs. “We had no idea it would actually happen. But we have no regrets,” she says.

Arsalan was an only child, born ten years after his parents’ marriage. Known as a brilliant student, he was expecting his class 9 exam results by the end of August.

The reaction

The same evening, Masooma met Muhammad Arsalan’s family. She learnt that Arsalan, 16, had passed away the same day from injuries sustained in a road accident two days ago. Later, she visited the morgue to pay her respects.

Masooma said the doctors and hospital staff had been very helpful. She said the family had not been charged the cost of surgery. She said Dr Waqar Shah, who had been taking care of arranging a donor for Raza, had already informed them that the surgery will be free-of charge. Raza, reported to be recovering well after the surgery, is being monitored round the clock by a team of experts at Shaikh Zayed Hopsital, including head surgeon Dr Tariq Bangash. Dr Bangash said he is hopeful about Raza’s recovery. He said the patient will be kept at the ICU for a week before he is shifted to a room. “If Raza tries, he can stand up and walk on his own feet today (Tuesday),” he said.

The experts’ say

Talking to The Express Tribune, Dr Izharul Haq, a cancer specialist, said that there were some 2.5 million cases of compromised liver in Pakistan. He stressed a need for better health education, provision of preventive vaccination for Hepatitis C and early diagnosis. He said that the cost of such transplants varied between Rs4 million and Rs20 million. “In light of recent progress, people should be made aware of the possibility of organ donation and doubts and taboos associated with it removed. That might save hundreds of lives,” he added.

Dr Mahmood Shaukat of King Edward Medical College urged hospitals to follow international ethical conventions requiring among other things that patients be supervised by the same doctor for at least two years following surgery.

Previous attempts

The first liver transplant surgery in Pakistan was performed in 2004 by Dr Shaukat, then working at the Children’s Hospital. Unfortunately, the patient did not survive for more than 24 hours. Dr Shaukat said another attempt at the life-saving surgery at the Sindh Institute of Urology and Transplantation in Karachi, was unsuccessful. World’s first successful liver transplant was performed in the US in 1967.

How they work

Cadaver transplants involve organ harvesting within 24 hours of the donor’s death. Organs can also be taken from patients declared brain dead for more than 24 hours. Transplantable organs so far are kidneys, liver, pancreas, heart, eyes and lungs.



Published in The Express Tribune, August 17^th, 2011.