A growing crisis looms over Singapore’s healthcare system as the number of patients on the liver transplant waiting list has surged to 57 this year, surpassing the figure for all of 2023. The daunting wait time for a liver from a deceased donor now averages over 22 months, leaving patients with dire conditions reliant on living donors for any chance of survival. Professor Brian Go from the Singapore General Hospital underscores that while a liver from a deceased donor remains the ideal option to avoid subjecting healthy individuals to major surgery, the scarcity has imposed severe consequences.
Cases such as a recent transplant involving a patient with advanced primary biliary cholangitis highlight the grim reality. This patient rapidly declined due to acute on chronic liver failure, necessitating an urgent transplant. Her 32-year-old son emerged as a living donor, allowing the transplant to proceed within an expedited timeline of three days instead of the customary eight weeks. However, this surgery is not without challenges, as extracting only a portion of the liver from a living donor increases the complexity and frequency of potential complications due to reduced organ size.
Singapore’s liver transplant scene is increasingly shaped by liver cancers and chronic liver diseases, including the rising incidence of fatty liver disease akin to trends seen in Western countries. With liver transplantations becoming a growing necessity, the dismal liver donation rates exacerbate the crisis. Singapore records only 3.89 donations per million population, significantly lagging behind the global average of six per million.
The low rates of donation are not without explanation. Singapore’s safety record results in fewer incidents suitable for organ donation. Furthermore, while a presumptive consent system is in place, having an opt-out option, the donation rate remains stunted partially because the nation currently does not employ donations after cardiac death. The call for increased societal awareness and proactive encouragement remains Professor Go’s challenge to improve donor participation amidst this increasingly urgent healthcare landscape.
