Transplanting Life for Patients with Liver Disease in the Philippines

Transplanting Life for Patients with Liver Disease in the Philippines
By Ramon Rivera, MD, MBA

For so long, liver transplantation in the Philippines had not produced survival outcomes that could rally confidence among Filipinos, necessitating having the procedure done in reputable centers abroad, with much economic and emotional burden on the patients' family members. Unlike kidney transplantation, liver transplantation requires a bigger team of experts from different fields of specialization because preparing the patients for surgery and following through their care post-operatively require just as much expertise as performing the long and complex surgical procedure itself. Moreover, organ donation and the procurement of the liver for transplantation, itself, have not been easy - both in the aspects of the Filipino culture and the tedious processes and procedures imposed by government bureaucracy. It is our aim and our hope to not only elevate the science and the skills in organ transplantation in the country but also to address the economic, cultural and political issues surrounding it. – Dr. Eugenio F. Ramos, TMC President & CEO.

There has been a steady rise in the prevalence of liver diseases the past few years attributing to better diagnostic screening procedures and the increasingly sedentary lifestyles we have become accustomed to.

The most common cause of end-stage liver disease in children is biliary atresia. It is a debilitating liver disease occurring in 1 of every 16,000 newborns. Bile, a substance secreted by the liver to help metabolize fat, is unable to pass down to the intestines due to anatomic deficiencies or inflammation of the passageways (bile ducts). As bile builds up, the liver deteriorates necessitating a liver transplant within the first few years of life.

Chronic hepatitis infection, alcoholic liver disease, and non-alcoholic fatty liver disease account for the most common causes of liver disorders of adult Filipinos. Approximately 20% of this disease population will develop liver cirrhosis, liver failure, and liver cancer. Hepatocellular Carcinoma, a type of liver cancer, is the seventh most common cause of cancer in women, it is second only to lung cancer among Filipino men, and the fourth leading cause of cancer death in the Philippines overall. For most of these patients with severe complications of liver disease, the only option is liver transplantation.

The alternative? Death.

Around 16,500 Filipinos die because of liver disease and their complications based on the World Health Organization 2017 data. That comprises 2.65% of the total deaths in 2017 making it the fourth leading cause of death in our country.

The Compounding Problem of Donor Scarcity

It was on August 6, 1988 when the first liver transplant (LT) was performed locally. This puts our country’s pioneering prowess at par with most of our East Asian neighbors performing liver transplant surgery. Initial outcomes were not good as the patients did not survive. But, while the technology and expertise have developed swiftly, our society’s cynicism towards organ donation has bottlenecked the advancements to a crawl.

One of the main reasons for the scarcity of transplantable organs is that relatives of people who died simply were not asked. The healthcare team is generally reluctant to bring up the subject of organ donation to a grieving family. And, for the times that the deceased showed pre-morbid intent to donate his or her organs, hospitals often have to call off the organ procurement, as next of kin want to bury their deceased “whole.” Evidently, it matters little whether the deceased has a donor card or not, or that he had agreed to have his organs donated prior to passing. Hospital policy invariably concedes to the requests of the living, who in this case, are the bereaved family.

Republic Act No. 7170, also known as the Organ Donation Act of 1991 was passed to legalize donation of the deceased human body in its entirety or its parts for specified purposes. Additionally, the Philippine Government has proposed an administrative declaration designating September as National Organ and Tissue Donation Awareness Month. The campaign runs with the motto: “Dugtong Buhay: Ako, Kabahagi Mo!” exemplifying the Filipino spirit of generosity and selflessness.

But despite these efforts, organ donation rates have remained abysmal, compelling Filipinos to seek liver transplant services overseas where they would have to rack up millions of pesos for healthcare alone.

The Medical City’s Response

It was in 2008 when The Medical City (TMC) established the Center for Liver Disease Management and Transplantation (CLDMT) – composed of a collaborative, multi-specialty group of healthcare professionals catering to advanced liver diseases of both the adult and pediatric age groups.

TMC has its own in-house organ donation program called Lifeshare with a hospital transplant coordinator in the person of Dr. Rica San Diego. Overall operations of the CLDMT are overseen by Dr. Vanessa de Villa, a surgeon and a pioneering liver transplant specialist in her own right, who has performed numerous liver transplant surgeries in several of the leading transplant centers worldwide. She captained the first successful pediatric liver transplantation surgery in 2011 revitalizing interest in liver transplantation in the country. The child’s (living) liver donor was her uncle. The five children before her, transplanted in other hospitals in the country, all died early.

Facts and Numbers

There have been a total of 59 liver transplantations performed in the Philippines since 1988. Twenty-one of those patients are alive and well today. That accounts for a 56% overall survival rate. Out of the thirty-four, fifteen were done in The Medical City and eleven (11) of these patients (or 73.3%) are alive and well to this day. These rates are competitive with survival rates from the leading transplant centers worldwide (at 75%).

With benchmarked services competitive with the leading transplant centers in the world, The Medical City’s CLDMT provides a more economical and family-centric alternative. Now, people don’t have to go abroad, having to spend upwards of six million pesos for healthcare expenditures including travel and accommodation fees.

Success Stories At The Medical City

Marilda Agcaoile Guzman is TMC’s second pediatric liver transplant recipient. She had been suffering from end-stage liver disease due to biliary atresia with a rare congenital condition called Situs Inversus Totalis (SIT). People with SIT are said to have all their internal organs “flipped” to the opposite side of the body, and because of the unusual position of the organs, transplantation in these patients becomes a lot more complicated making Marilda only one in a handful with the disease to have undergone a successful liver transplant.

Marilda is now finishing fourth grade studies in Riyadh, Saudi Arabia where they are currently based. She is a top student in her class and a member of their dance troupe. She is the poster child for the success of the living donor liver transplant program at The Medical City.

--

One of TMC’s adult liver transplant recipients is Baltazar "Vhal" Lucas, a software developer in a publishing company who lost all his three brothers to liver cancer from chronic hepatitis B infection.

Vhal, who was diagnosed with the same dreaded disease as his brothers back in 2014, found out that he could conquer the disease through life-saving liver transplantation. He underwent living donor liver transplant (LDLT) at TMC in September 2015. “He is a living testament of how transplantation can transform the lives of those with the end stages of liver diseases and even those with liver cancer,” affirms Dr. Janus Ong, a renowned doctor-researcher and the lead hepatologist of CLDMT.

--

A Child Named Tibay

Stevie Arghie Garcia, fondly called “Tibay” underwent a liver transplant at The Medical City (TMC) on June 29, 2017 at a very young age of two.

His father, Ghieboy, says Tibay got his nickname from being a pillar of strength despite his young age.

"Marami na siyang pinagdaanan, marami ng tusok at iba pang tests, pero matibay talaga, mabait at palangiti," (“Despite being through a battery of diagnostic procedures, he continues to be valiant and cooperative with ever a positive outlook.") says Ghieboy.

Tibay is the 14th to undergo liver transplantation at The Medical City. He was first seen by a pediatrician in a hospital in Pampanga where he was diagnosed with biliary atresia when he was only four months old.

Ghieboy was determined to learn more about the disease, its complications and the options for treatment. His vigilance led him to an online video hosted by anchor Karen Davila featuring Dr. Vanessa de Villa. It was an interview about the first successful pediatric liver transplant case in the country. Ghieboy wasted no time in going to The Medical City to seek Dr. De Villa’s help.

"Kinausap ko si Dr. De Villa tungkol sa condition ng anak ko. Dala ko lahat ng test results. Sabi ko, Doc tulungan nyo po anak ko (I talked to Dr. De Villa about my son's condition. I had all his test results with me. I said, Doc please help my son)," recalls Ghieboy.

A liver transplant procedure for Tibay was an impossible dream, Ghieboy says, but they remained undaunted. Tibay and his mom Ruby, who was to be his live liver donor, underwent all the necessary preparations for the transplant. With the help of family and friends, they were able to raise the funds to proceed with the surgery. The rest, as Ghieboy recalls, is history.

Tibay, now four, is a gleaming ball of happiness with an undeniable zeal for life and learning. He especially enjoys singing the alphabet and Bahay Kubo and jotting down letters.

Ghieboy says the family is happy and satisfied with their decision to have Tibay’s surgery in the Philippines, at The Medical City. They did not see the need to go abroad for the procedure because according to them, the technology and expertise are already here.

Dr. De Villa gives most of the credit to the patients and their families for helping the country move forward with liver transplantation. “The true heroes are the people who believe in what we do.”

---

The Center for Liver Disease Management and Transplantation is a specialty unit of The Medical City that offers a comprehensive array of diagnostic and therapeutic options for patients with liver diseases and liver tumors through an integrated and highly skilled multidisciplinary, patient-partnership approach.

For any inquiries or clarifications, you may call 9887000 local 6506 or visit the website at https://www.themedicalcity.com.