Liver Transplant

2024/05/30

Liver transplant programme

Liver transplantation is now the accepted standard of care for patients with end-stage liver diseases, acute liver failure, and selected cases of hepatocellular carcinoma (primary liver cancer). The development of effective immunosuppressive drugs and the refinement of surgical techniques have led to remarkable improvements in the long-term success of liver transplantation.

With new surgical techniques and effective medications, the success rate of liver transplantation is quite high. National University Centre for Organ Transplantation (NUCOT) is the pioneer in Singapore’s liver transplant services whereby more than 90% of our patients continue to do well one year post-transplant1, 2.

Transplanting only a part of the liver is possible because of the liver's unique ability to regenerate itself within a few weeks. When surgeons remove a piece of the donor's liver, the part that remains grows back quickly to its original size.

In an adult-to-child liver transplant, a smaller part of the liver (the left lobe) is typically used. In an adult-to-adult liver transplant, the larger right lobe of the liver from the living donor is used.

In Singapore, a living donor liver donation can be from relatives (e.g., spouses, siblings, parents, uncles, aunties, cousins), friends, or even a stranger (altruistic donation). In deceased donor liver donation, the organ is retrieved from deceased donors under Human Organ Transplant Act (HOTA).

Our Programmes

Find out more about our programmes here:

1NUCOT Adult Liver Transplantation Programme, 2NUCOT Paediatric Liver Transplantation Programme

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Liver Failure

The liver plays a critical role in digestion, immunity, metabolism, and nutrient storage. It is also the body's 'chemical factory', producing important proteins and blood cells while breaking down toxins.

Another amazing function of the liver is that it can restore itself when damaged. Thus, it is important to go for regular health check-ups so that any potential issues can be detected early and well-managed. We recommend informing your doctor about your family’s health history, who will determine if you are at risk of any hereditary liver disease, and send you for relevant screenings.

Serious diseases can irreversibly destroy liver tissue and cause liver failure, also known as end-stage liver disease (ESLD). It can be acute or chronic.

Acute liver failure occurs rapidly and often in people who do not have a pre-existing liver condition. Common causes of acute liver failure include viral infections, metabolic conditions, autoimmune diseases, or reactions to certain prescription or herbal medications.

Chronic liver failure is when the damage to the liver occurs slowly over time. There are four stages: inflammation, fibrosis/scarring, cirrhosis, and then finally ESLD. Common causes of chronic liver failure include cirrhosis, chronic hepatitis B or C infection, alcohol-related liver disease, or nonalcoholic fatty liver disease.

When the liver fails, it can result in a range of serious conditions like jaundice, internal bleeding, muscle wasting, and a build-up of toxins in the body. It can be a life-threatening emergency. A liver transplant can help patients suffering from these conditions regain their health and lead productive and fulfilling lives.

Signs and symptoms of liver failure

Acute Liver Failure

Symptoms of acute liver failure include:

Feeling unwell, where the exact cause is difficult to identify
Nausea or vomiting
Feeling tired or fatigued
Abdominal pain or swelling
Jaundice
Feeling confused or disoriented

If you experience these symptoms, it is a medical emergency and you should go to the nearest Emergency immediately.

Chronic Liver Failure

Symptoms of chronic liver failure can be broken down into early or advanced symptoms:

Early symptoms include:

Feeling tired or fatigued
Loss of appetite
Nausea or vomiting
Abdominal pain or discomfort

Advanced symptoms include:

Jaundice
Easily bruised or bleed
Feeling confused or disoriented
Fluid retention in the abdomen, arms, or legs
Dark urine
Severe skin itching

Early diagnosis of the liver disease combined with a well-managed treatment plan can often help to reverse the damage and prevent liver failure.

Tips on preventing liver failure

Be vaccinated against Hepatitis A and B
Drink alcohol in moderation
Never mix medications with alcohol
Take medications in the prescribed dosage, and only when needed
Consult a doctor before taking any medications
Maintain a healthy BMI as obesity may lead to fatty liver disease
Go for regular health check-ups and examinations every year

Liver Transplant

A liver transplant can take place in three ways, where the donated liver can come from either a deceased or living donor.

Transplanting the entire liver from a deceased donor
Transplanting a part of the liver from a deceased donor (split liver transplantation)
Transplanting a part of the liver from a living donor

Transplantation is currently the only cure for liver failure.

Acute Liver Failure

Treatment includes:

Intravenous (IV) fluids to maintain your blood pressure
Taking medications such as laxatives to help your body flush the toxins out
Monitoring your blood sugar level

Chronic Liver Failure

Treatment for chronic liver failure includes not only medications but also changes to your lifestyle and diet such as:

A weight loss management plan and control of metabolic risk factors
Reducing salt and the consumption of certain foods such as red meat and cheese in the diet
Avoiding medications that can harm the liver
Cutting out alcohol

With the liver's regenerative ability, sometimes it may recover with medications. Your doctor may recommend you to go for a liver transplant if your liver no longer works. You will need to undergo screening and tests at the transplant centre to determine if you are suitable for a liver transplant.

To kick start the process of getting a liver transplant, you can approach our NUCOT Specialist Outpatient Center here.

Getting A Transplant

1. I want to see a doctor at NUCOT. How can I refer myself?

You can contact our clinic directly here to make an appointment with us.

2. What do I need to prepare for my first visit?

You will need to bring:

Your medical records, test results and medical reports from your current healthcare provider.
Your list of medications, including traditional/herbal supplements.

Think about any question(s) concerning organ transplantation that you would like our doctors to address. If your family member(s) are involved in your decision making and would to find out more, you may ask them to join you for the first consultation.

3. Who is eligible for a liver transplant?

The transplant team will assess your suitability for a liver transplant based on:

Your medical history: Not everyone is suitable for a liver transplant. You must not have conditions such as:
- Medical conditions that will shorten your life expectancy
- Severe pulmonary hypertension
- Drug or alcohol abuse
- Cancer not involving the liver
Your health: Your body needs to be healthy enough to undergo surgery and tolerate post-transplant medications.
Your discipline: Recommendations from the transplant team must be followed strictly and you will need to take the medications for life. You should have the discipline not to engage in any activities that will damage your new liver, such as drinking alcohol.

4. Who can I get a donor liver from?

A donor liver can come from a deceased donor or a living donor.

Living Donor

A living donor liver donation can be from relatives (e.g. spouses, siblings, parents, uncles, aunties, cousins), friends, or even a stranger (altruistic donation). For an adult recipient, approximately 60% of the right lobe will be grafted from the donor. For a paediatric recipient, approximately 30% of the left lobe will be grafted from the donor. The partial livers in both donor and recipient will grow in size and eventually function as a normal liver after a few weeks.

The living donor will need to undergo tests and screenings to determine if he/she is suitable to donate his/her liver to you.

Deceased Donor

In deceased donor liver donation, the organ is retrieved from deceased donors who are certified brain dead and have not opted out of Human Organ Transplant Act (HOTA) or have opted in to Medical (Therapy, Education and Research) Act (MTERA).

A brain dead patient does not have any brain function and will never regain consciousness again, although the other organs such as the liver may still function normally. It is different from being in a coma, where a person is unarousable but tests confirm that some brain functions are still present. A comatose person may still recover or regain consciousness. Organs are never taken from a person in a coma. To be certified brain dead, two independent doctors will perform thorough clinical tests and they must not have been involved in the care or treatment of the patient being certified, or belong to the transplant team.

Once a patient is diagnosed brain dead, it is recognised both medically and legally as death of the person in Singapore, and organ donation can then proceed. In cases where the patient had not pledged his/her organs before passing away, family members can decide to donate his/her organs under MTERA. Assessments will be done to determine if the organs are suitable for donation.

The deceased donor liver may be transplanted as a whole for one recipient or split into two for two recipients. In a split liver transplant, approximately 60% of the liver on the right will be transplanted onto an adult recipient and 40% of the liver on the left will be transplanted onto a paediatric recipient.

For more information on HOTA and MTERA, visit LiveOn.

5. What are the criteria for me to be added to the national waiting list?

You must be:

A Singaporean or Permanent Resident
Deemed medically suitable
Less than 70 years old

Once you have decided to go ahead with a transplant, you will be placed on the national waiting list, where you wait for a suitable organ from a deceased donor to be available. You will still be eligible for a deceased donor transplant if you have a living donor and the living donor evaluation is ongoing.

For those who are not medically suitable or more than 70 years old, you will only be eligible for a living donor transplant.

Both you and the potential living donor will be required to go through a series of tests to ensure the transplant can proceed, and an operation date will then be scheduled.

6. What are the types of liver transplants?

Living donor liver transplant

The diseased liver from the recipient is removed and a small portion of the donor’s liver will be transplanted into the recipient.

Deceased donor liver transplant

Whole liver transplant
The diseased liver from the recipient is removed and replaced with a whole, healthy liver from a deceased donor.
Split liver transplant
Improvements in liver reduction techniques have enabled us to split the whole deceased donor liver between an adult and a child patient, or between two adults, thus saving two lives.

7. How long is the wait time for a deceased donor liver transplant?

As of 2020, the average waiting time for a deceased donor liver transplant is 1 year in Singapore1.

The wait time depends on your blood group, Model for End-stage Liver Disease (MELD) score, and other factors. MELD is a scoring system that predicts the risk of death due to chronic liver disease, which ranges from 6 to 40. The higher your MELD score, the higher position you will be on the national waiting list.

The wait can be a difficult and long one. It is normal to feel worried and uncertain. There may be some false alarms, for instance, if the donor organ is not ideal for transplant or if you happen to be ill that day. Our transplant team will be there to offer support in this challenging time.

Be sure to keep your contact details updated so that you can be readily contacted when an organ becomes available.

1Source: NOTU Annual Report 2020

8. How does the evaluation process work?

In the time leading up to a transplant, our team will work to ensure that you are in the best of health, both physically and emotionally.

You will also need to undergo a range of tests and screenings. These will help doctors ensure a better match and also identify any risks.

Living Donor Liver Transplant

Step 1

You will need to undergo several tests and screenings such as:

Blood type: Your blood type should be compatible, even if it is not the same as the donor.
Recipient blood group Compatible donor blood group Incompatible donor blood group
O O A, B, AB
A A, O B, AB
B B, O A, AB
AB A, B, AB, O NIL
Liver blood test: This assesses the protein and enzymes level that can be an indicator of your liver function.
Imaging tests: Using imaging techniques such as CT or MRI scans to create pictures showing your liver.
Full medical evaluation: This will include a full physical examination as well as other tests to ensure you have no underlying medical conditions such as heart conditions, infection, or cancer that have previously been undetected.
A mental health assessment: While waiting for a suitable organ transplant, you will routinely need to be assessed for any psychological issues to be eligible for a living donor liver transplant.

Recipient blood group	Compatible donor blood group	Incompatible donor blood group
O	O	A, B, AB
A	A, O	B, AB
B	B, O	A, AB
AB	A, B, AB, O	NIL

Step 2

The liver transplant doctor will discuss the results with you approximately one week after the tests are done. You will then need to undergo a chest x-ray, electrocardiography (ECG), and more detailed heart scans, as well as other investigations as necessitated by your medical conditions.

Step 3

Appointments will be made for you to see various specialty doctors as required by your medical condition(s). For example, if you have a heart problem, you will need to see a cardiologist. You will also undergo the final step of tests as needed.

You will be seen by:

A surgeon who will inform you the risks of the operation and discuss the details of the operation.
A psychiatrist to certify that you are psychologically prepared and mentally fit to give voluntary consent for liver transplant.
Other specialists as recommended by our transplant doctors.

Step 4

Once all the tests and appointments are cleared, the application will be reviewed by the Transplant Ethics Committee (TEC) to ensure that there is no commercial transaction taking place before and after the transplant. There is a compulsory one-week cooling-off period after the review.

The transplant surgery can go ahead after the TEC has cleared the evaluation. Typically, it will take at least four to six weeks for the surgery to go ahead after your first appointment unless it is an urgent transplant.

Deceased Donor Liver Transplant

You will also undergo the same step 1 to 3 as those going for a living donor liver transplant. Once you have cleared the evaluation, you will be added to the national waiting list.

While you are on the national waiting list, you must turn up for your appointments at NUCOT so that our medical team can help ensure that you are healthy and suitable for a transplant. A match from a deceased donor is likely to be from a person with your blood type.

9. What is the Transplant Ethics Committee (TEC)?

TEC is a panel of three people, including at least one doctor and one layperson (non-medical), who have been appointed by the Ministry of Health. They will determine whether there has been coercion or financial promises made to the potential live donor.

Both coercion and payment for organs are illegal and punishable under Singapore law.

10. What do I need to prepare before the surgery?

To ensure that you are fit for a transplant, the liver transplant coordinator will contact you regularly to arrange for health checkups. Some ways to increase your chances of a successful transplant include:

Taking your prescribed medications on time
Turning up for all your medical appointments
Keeping to a healthy diet and exercise regularly to maintain a healthy weight
No smoking or consumption of alcohol

For living donor liver transplantation, you should fast eight hours before your surgery.

For those on the national waiting list, it is important to remain contactable as a deceased donor liver may be available any time. You must come down to NUCOT at NUH for the transplant immediately as the surgery must happen within a few hours after the organs are removed from the deceased donor. Do not eat or drink once contacted.

You can prepare a standby bag with necessities for your hospitalisation needs.

11. What are the risks involved during surgery?

Some of the risks include:

Blood clots or bleeding
Infection on surgery site
Biliary leak or stricture

Your surgeon will explain the risks in detail to you during your appointment.

12. What happens during the surgery?

The surgeon will make an incision just under your ribs to remove your liver and replace it with the donor’s liver. After the blood vessels are connected, blood flow will be restored and the surgical team will control any bleeding before the incision is closed.

Several tubes need to be inserted into your body during the operation and they will be removed between a few days and a week after your operation:

A tube that is attached to a ventilator will be placed into your trachea through your mouth to help you breathe.
A catheter placed at your bladder will be used to drain your urine.
A nasogastric tube inserted through your nose to your stomach will drain your gastric secretion until your bowel movement returns to normal.
Tubes will be placed in your abdomen to drain blood and fluid around the liver.

The surgery will take about six to 12 hours.

After The Transplant

1. How long will it take for me to recover after the surgery?

After the surgery, you will be monitored in the intensive care unit for several days, where the tubes attached to your body will also be removed once the respective bodily functions return. Once your condition stabilises, you will be transferred to a general ward. You can be discharged within two weeks after the surgery if no complication arises.

Complete recovery may take several weeks. The quality of life usually improves dramatically and most patients lead a healthy, normal life.

2. What happens after discharge?

You will need to take lifelong medications to ensure that your body does not reject the new liver. Do not self-medicate or consume any traditional medicines. If you miss a dose, inform your transplant coordinator immediately. Do not take a double dose.

You will also need to do lifelong follow-ups with your liver doctor to ensure that you are in good health and to prevent any new complications. The frequency of your appointments depends on your condition. In general, it will be:

Once a week after discharge for two to three months, then
Once every three months, then
Once every six months

If you are experiencing any side effects, inform your liver doctor.

3. What do I need to take note of after the surgery?

Taking care of your transplanted organ requires utmost care and living a healthy lifestyle: exercise regularly, eat a balanced diet, manage stress and get adequate sleep.

Physical Health

Take more precautions against falling ill. Your weakened immune system (to prevent rejection) will mean you may be more susceptible to infections. Practice good hygiene at all times and stay away from people who are ill with an infectious disease (cold, flu, fever, etc.).

It is also important to monitor your health. Be aware of how you feel and do self-monitoring if required. This includes checking your weight, temperature, blood pressure and pulse daily.

Mental Health

It is normal to have a mix of emotions as liver transplant is a major life change. There could be several reasons, such as mood changes due to the immunosuppressants or feeling stressed about your new lifestyle. You are not alone.

Let your transplant team know how you are feeling so that they can help to support you and adjust your medicine if needed. They may also refer you to a psychologist.

Dental Health

Practice good dental hygiene and make regular appointments to see your dentist.

Diet and nutrition

Maintaining a healthy diet and exercising regularly can help to prevent some common post-transplant complications such as heart attacks. It will also help to keep your liver healthy.

Your transplant team will refer you to a dietitian who will work around your nutrition and diet needs and recommend foods for your nutrition plan. Generally, your diet will have to be low in salt, sugar, fat, and cholesterol. It is important to avoid alcohol consumption to protect your liver. You can also discuss with the dietitian if you have any questions.

Exercise

You can explore walking, jogging, cycling, swimming, and other low-impact physical activities. Check-in with your transplant team if you want to start or change your post-transplant exercise routine.

Traveling

It is important to have recovered fully before you travel overseas. Your transplant team may recommend that you wait between two and twelve months after your surgery before you travel. You will need to have enough immunosuppressants for your overseas trip . Let your transplant team know your travel plans as you may need to take vaccines or avoid certain foods depending on your destination.

Driving

It is recommended to wait for at least two weeks after your discharge before you start driving. Some of the medications you need to take right after the surgery may cause tremors and vision changes. It will be safer to have a company in your ride when you start driving again.

Sex Life and Pregnancy Plans

Avoid having sex for four to six weeks after your transplant until your surgery site has healed to prevent the wound from opening again.

4. What are the side effects of the anti-rejection medication?

The side effects may include:

High cholesterol
High blood pressure
Headaches
Osteoporosis
Diabetes
Diarrhoea

5. What are the signs and symptoms of liver rejection?

There are typically no symptoms when your body is rejecting your new liver. You will not feel or notice anything. Some people may experience symptoms such as:

Fever of more than 38oC
Nausea
Abdominal pain
Yellowing of skin
Vomiting or diarrhoea
Extreme tiredness
Dark-coloured urine
Pain or tenderness at your surgery site

Inform your transplant team immediately if you experience any of these symptoms.

Liver rejection is usually only detected when your laboratory test results show an increase in the blood levels of a liver enzyme. Your doctor will then send you for a liver biopsy to confirm if there is liver rejection. Therefore, it is important to take good care of your body, follow your prescription dutifully and turn up for all your clinic appointments to ensure that the transplanted liver will not be fully rejected.

6. What if my body rejects my new liver?

There are two types of liver rejection that may happen after your surgery:

Acute Rejection
This can happen in up to 50% of transplant patients within the first year of the transplantation. The highest risk period is the first four to six weeks after transplantation.

Your doctor will adjust the amount of immunosuppressants you need to take to combat the rejection and prevent further rejections. Additional treatment may be required but it will not affect the chances of your graft survival.
Chronic Rejection
Chronic rejection of the liver is not a common occurrence and it could be due to repeated episodes of acute rejection. The rejection happens slowly over the years but is often reversible with treatment.

It is extremely important to follow your prescription to prevent liver rejection or any related complications.

Donating Your Liver

With the increased incidence of chronic disease leading to organ failure, there is a gap between organ demand and supply of donor organs.

As of 2020, more than 50 people are on the liver transplant waiting list. The average wait time for a suitable organ donor is one year.

Living liver donation is key in easing the ever-present problem of organ shortage. Compared to deceased donor liver transplantation, living liver transplantation has significantly better graft and patient survival in the long term. Other than improved viability of the donated organ, recipients can undergo the operation earlier in a better state of health.

The success rate for living donor liver transplantation is over 99%, although over 20 years or so, some liver transplants are lost to rejection or other causes.

Living donation is a sacrifice and anyone can be a potential organ donor. It is the noblest gift an individual can give. The criteria to determine if an organ is suitable for donation is based on a set of medical standards and not dependent on age* or gender. All that is required is a willing and suitable donor.

*If you are below the age of 21 and are interested to donate your organ, parental consent will be required.

Frequently Asked Questions

Living Donor Liver Transplant

Deceased Donor Liver Transplant

Frequently Asked Questions on Living Donor Liver Transplant

1. Who is eligible for living liver donor donation?

If you are interested to donate your liver to your family member, friend, or even stranger, there are some criteria you have to fulfill. You must be:

At least 21 years of age; donors older than 65 years can be considered on a case by case basis.
Free from the following conditions:

Cancer
Heart disease
Liver disease
Diabetes
Hepatitis B or C
HIV infection

2. What are the assessments that I will need to undergo?

You will need to undergo a range of tests and screenings to ensure that you are a good match with the recipient and also to identify any risks.

Step 1

You will need to undergo several tests and screenings such as:

Blood type: Your blood type should be compatible, even if it is not the same as the recipient.
Recipient blood group Compatible donor blood group Incompatible donor blood group
O O A, B, AB
A A, O B, AB
B B, O A, AB
AB A, B, AB, O NIL

A blood group-incompatible live donor liver transplant may still be done, but there is a slightly higher risk of rejection.
Imaging tests: Using imaging techniques such as CT or MRI scans to create pictures showing your liver. It will help the doctor to determine whether it is safe for you to donate while saving the recipient.
A mental health assessment: You will need to undergo a counselling session and be assessed for any psychological issues.

Recipient blood group	Compatible donor blood group	Incompatible donor blood group
O	O	A, B, AB
A	A, O	B, AB
B	B, O	A, AB
AB	A, B, AB, O	NIL

Step 2

Step 3

You will be seen by:

A surgeon who will inform you the risks of the operation and discuss the details of the operation.
A psychiatrist to certify that you are psychologically prepared and mentally fit to give voluntary consent for liver transplant.
Other specialists as recommended by our transplant doctors.

Step 4

3. Can I change my mind about donating my organ during the evaluation process?

Yes, the decision to donate is 100% voluntary. You can withdraw from organ donation any time, up till the day of surgery. Inform your primary doctor about the withdrawal and your decision will be kept confidential.

4. Can I decide who I want to donate my liver to?

You can choose who you want to donate your liver to, as long as the assessments have deemed that you are healthy and a match to the recipient, and you have made a completely voluntary decision. You may also choose to be an altruistic donor.

5. What if I am not a good match with my intended recipient?

If your blood group is incompatible with your intended recipient, the transplant team may suggest a paired liver exchange if there is another donor who is also incompatible with his/her recipient but both of you are a good match for the other’s recipient. This results in two new compatible pairs and allows others on the national waiting list to move up.

6. What is the Transplant Ethics Committee (TEC)?

Both coercion and payment for organs are illegal and punishable under Singapore law.

7. What are the risks involved in donating a liver?

Donating your liver will not affect your general health, life span, or energy level. Your liver will regenerate, grow back to its normal size, and function normally after a few weeks.

There could be minimal risks such as wound infection at your surgical site. Your surgeon will explain the risks in detail to you during your appointment.

8. What does the operation involve?

There are two types of surgery, traditional open surgery, and laparoscopic surgery. Not everyone is suitable to undergo laparoscopic surgery, especially overweight donors or those with limited space in their upper abdomen. The surgeon will choose the method most suitable for you. You will be administered general anaesthesia before the surgery and will be asleep throughout as this is a major operation.

For traditional open surgery, a 20cm to 25cm J-shaped incision is made on the side of your chest and upper abdomen to remove the liver. The operation is about six to eight hours long.

Laparoscopic surgery, also known as keyhole surgery, is a new, minimally invasive approach for liver transplantation. Laparoscopic surgery involves having two small incisions around 0.5cm to 1cm on the abdomen, where the surgeons will insert a camera and tiny instruments. These are used to separate the part of the liver and its attachments after which the liver is removed through a second incision of around five cm at the lower abdomen. As the second incision does not involve cutting muscle, this method results in faster recovery for the donor than traditional open surgery. The operation is about four to five hours long.

9. How long will I need to be hospitalised?

After the surgery, you will be monitored in a High Dependency Unit for about one to two days before moving to the General Ward for another one to two days. You can be discharged within one week after the surgery if no complication arises.

10. What happens after discharge?

You will not need to consume any long-term medication but will need to come back to NUCOT for your follow up appointment to ensure that you are well:

Two weeks after surgery, then
Once every quarter for half a year, then
Once yearly

Your liver doctor will give you specific advice on taking care of yourself to reduce any risk of complications during your recovery.

Exercise

Maintaining a healthy lifestyle is important. You should be able to return to normal daily activities two to four weeks after your discharge. Please seek advice from your doctor if you are looking to resume any contact sports or strenuous activities.

If you would like to donate a liver to save a life today, you can contact us at our NUCOT Specialist Outpatient Clinic here.

Frequently Asked Questions on Deceased Donor Liver Transplant

1. Will my medical care be compromised if I am a potential organ donor?

Medicine is an ethical profession. No doctor will risk one life to save another. As a potential organ donor, organ donation will only be considered after every effort to save your life has been exhausted by the medical team. There are seven strict criteria that must be confirmed by two independent doctors, who were not involved in your medical care, before brain death can be certified and organ donation is considered.

2. Can I donate my liver after I pass away?

In Singapore, Singapore Citizens and Permanent Residents above the age of 21 and above, and are not mentally disordered, are included under the Human Organ Transplant Act (HOTA) unless they have opted out. HOTA allows for organs (kidney, liver, heart and cornea) to be donated in the event of death for the purpose of transplantation.

Over the years, HOTA has been widened in scope so as to grow the organ donor pool. This has meant more people waiting on the transplant list have successfully gotten a life-saving organ. Despite the widening of HOTA, hundreds of people are still waiting for an organ to become available. This is where living organ donation comes in, an area also under the regulation of HOTA. Living organ donation further increases the chance that a suitable kidney can be found.

Those who are under HOTA will not only have a chance to help others, but also have a higher priority on the waiting lists should they need an organ transplant. For those who had opted out of HOTA, you will receive a lower priority for receiving an organ on the national waiting list should you require an organ transplant in the future. This will apply specifically to the organs which you have opted out from.

If you have opted out before and would like to opt back in, you will need to complete the Withdrawal of Objection Form and send it to the National Organ Transplant Unit.

For deceased donor organ donation, bodies of those with chronic illnesses or cancer may still be used for education or research purposes under the Medical (Therapy, Education and Research) Act (MTERA).

To find out more about HOTA and MTERA, visit LiveOn.

3. Can I donate more than just the organs listed under Human Organ Transplant Act (HOTA)?

Yes, anyone above 18 years old can opt into Medical (Therapy, Education and Research) Act (MTERA) to donate their organs and/or tissues for the purposes of transplant, education, or research after they pass on.

Fill in the Organ Donation Pledge Form and send it in to the National Organ Transplant Unit. You are encouraged to discuss your decision to pledge your organs and/or tissues with your family members so that they are aware of your decision and can advocate for your wishes in the event of your death.

4. What is the Medical (Therapy, Education and Research) Act (MTERA)?

MTERA is an opt-in scheme, whereby anyone aged 18 years old and above can pledge your organs or any body parts for the purposes of transplant, education or research, after you pass away. You can choose to donate all your organs and tissues or specify those you wish to donate.

In cases where you have not pledged your organs before passing away, your family members can also decide to donate your tissues and/or organs under MTERA on your behalf, if they wish to do so.

For more details on MTERA, visit LiveOn.

5. Can I decide who I want to donate my liver to?

You will not be able to choose who you donate your liver to. Your liver will be matched to the blood group, weight and urgency from the pool of patients on the national liver transplant waiting list.

6. Will I or my family have to pay the costs for organ donation/recovery?

The hospital bills for any organ removal-related procedures and tests will not be charged to the donor’s family.

7. If I choose to donate my organs after I pass away, will my body be disfigured after organ donation?

All bodies are cared for with utmost respect. Any incisions made during the removal of organs are carefully repaired during the procedure and you will still be able to have an open casket funeral.

Liver Transplant Care Team

Directors

Adult Liver Transplant Programme

Dr Mark Muthiah
Medical Director and Consultant

Associate Professor Shridhar Iyer
Surgical Director and Senior Consultant

Paediatric Liver Transplant Programme

Professor Yap Hui Kim
Medical Director and Emeritus Consultant

Dr Vidyadhar Mali
Surgical Director and Senior Consultant

Clinicians Paediatric Specialty Nurses Transplant Coordinators

Clinicians

Adult Liver Transplant Programme

Professor Lim Seng Gee
Senior Consultant

Professor Krishnakumar Madhavan
Senior Consultant

Associate Professor Glenn Kunnath Bonney
Senior Consultant

Associate Professor Dan Yock Young
Senior Consultant

Associate Professor Shridhar Iyer
Senior Consultant

Associate Professor Alfred Kow
Senior Consultant

Dr Lee Guan Huei
Senior Consultant

Dr Lee Yin Mei
Senior Consultant

Dr Low How Cheng
Senior Consultant

Dr Prem H Thurairajah
Senior Consultant

Dr Gao Yujia
Consultant

Dr Daniel Huang
Consultant

Dr Mark Dhinesh Muthiah
Consultant

Dr Pang Ning Qi
Consultant

Dr Eunice Tan
Consultant

Paediatric Specialty Nurses

Professor Quak Seng Hock
Emeritus Consultant

Associate Professor Marion Aw
Senior Consultant

Dr S Venkatesh Karthik
Senior Consultant

Dr Dale Lincoln Loh
Senior Consultant

Dr Vidyadhar Mali
Senior Consultant

Dr Nyo Yoke Lin
Senior Consultant

Dr Michelle Tan
Senior Consultant

Dr James Huang
Consultant

Dr Lee Yang Yang
Associate Consultant

Specialty Nurses

Nurse Clinician Junaidah Binte Abu Bakar
Nurse Clinician Pamela Tan

Transplant Coordinators

Priscilla Wee
Principal Transplant Coordinator

Aye Su Mon
Transplant Coordinator

Brenda Kok
Transplant Coordinator

Chloe Tan
Transplant Coordinator

Diana Teh
Transplant Coordinator

National University Centre for Organ Transplantation (NUCOT) provides pre and post-transplant patients with comprehensive, dedicated and individualised care. We also welcome potential living organ donors to get in touch with us.

Referrals to NUCOT

NUCOT takes in self-referrals and referrals from healthcare practitioners. Patients can do a self-referral by contacting our NUCOT clinic directly or have your primary physician refer you to us.

Click here for our NUCOT clinic’s location, contact details and operating hours or to make an appointment with us.