What Is a Liver Transplant? A Singaporean Patient’s Guide

A liver transplant can be a critical treatment option for individuals with severe or end-stage liver disease. In Singapore, this procedure is offered by both public and private institutions and includes liver transplants from deceased donors and living donors.

This guide helps patients understand when and why a liver transplant is necessary, how the procedure is carried out and what to expect before and after surgery.

What Is a Liver Transplant?

A liver transplant is a surgical procedure to remove a diseased or failing liver and replace it with a healthy one. The donor liver may come from a recently deceased individual or a living donor who provides a portion of their liver.

The liver is the only organ in the body that can regenerate, which means both the recipient and a living donor can regain full liver function after surgery. This regenerative property makes living donor liver transplantation (LDLT) possible.

Who Needs a Liver Transplant?

A transplant may be considered when the liver becomes so damaged that it cannot sustain life. This is often due to:

• Liver cirrhosis, particularly it leads to fluid retention (ascites), confusion (encephalopathy), jaundice or bleeding from varices.
• Acute liver failure , sometimes triggered by medication overdose (e.g. paracetamol) or viral infections.
• Liver cancer (early-stage hepatocellular carcinoma) that cannot be safely removed with surgery.
• Chronic viral hepatitis (B or C) when long-term infection results in liver failure.
• Inherited metabolic diseases such as Wilson’s disease or haemochromatosis, which can damage the liver over time.

Types of Liver Transplant in Singapore

1. Deceased Donor Liver Transplant (DDLT)

Under Singapore’s Human Organ Transplant Act (HOTA), livers from recently deceased donors may be used. However, due to limited availability, patients may wait months or years for a suitable match.

2. Living Donor Liver Transplant (LDLT)

In LDLT, a healthy person donates a portion of their liver to the patient. This is more common in Singapore due to the organ shortage and allows for planned surgeries. The donor’s liver typically regenerates within 6–8 weeks.

3. Split Liver Transplant

A liver from a deceased donor is divided into two parts and transplanted into two different recipients. This is often done for one adult and one child, maximising the benefit of a single donated organ.

The Liver Transplant Process

Before the Procedure

Candidates undergo a series of medical tests and evaluations to determine suitability. This includes imaging, liver function testing, cardiopulmonary assessments and psychological screening.

Living donors are also carefully evaluated to ensure physical and emotional readiness for donation.

Surgery

During transplant surgery:

• The recipient’s diseased liver is removed.
• The donor liver or liver segment is implanted.
• Blood vessels and bile ducts are connected.

The transplanted liver will gradually regenerate and adapt to the recipient’s body, reaching full functional capacity within a few months.

The procedure involves close coordination among surgeons, anaesthetists, hepatologists and nurses. In private practice, Dr Kieron Lim, who is the Medical Director of the Liver Transplant Programme at Mount Elizabeth Hospital, leads such multidisciplinary efforts. He has trained at The Royal Free Hospital (UK) and Mount Sinai Hospital in New York, and focuses on managing transplant-related liver conditions.

Recovery

After surgery, patients are first monitored in the intensive care unit (ICU). They typically stay in the hospital for about 5–10 days for close observation and recovery. During this time, they will:

• Take immunosuppressants to prevent the body from rejecting the transplanted liver
• Undergo regular blood tests to monitor liver function and detect any complications early
• Receive ongoing follow-up care from the transplant team to adjust medication and support long-term recovery

Most patients require about six months or more to fully recover. Depending on their overall health and condition before surgery, some may be able to return to normal activities or work within a few months.

Risks and Complications

As with all major surgeries, liver transplants come with potential risks:

• Organ rejection: The immune system may attack the new liver.
• Infection: Increased susceptibility due to immunosuppressants.
• Bleeding or bile leakage: Surgical risks immediately post-op.
• Long-term side effects: From anti-rejection medications.

Patients are closely followed for early detection of complications.

Living After a Liver Transplant

Most patients experience improved quality of life, can return to work and family responsibilities and maintain normal activity levels. Key components of long-term success include:

• Strict adherence to prescribed medications.
• Avoiding alcohol and smoking.
• Regular follow-up with a hepatologist or transplant team.

Final Thoughts

In Singapore, liver transplantation offers a potential lifeline for patients with severe liver disease. Whether through the national transplant system or private specialist-led centres, early referral and multidisciplinary care are critical for best outcomes.

Dr Kieron Lim, who also oversees the Liver Transplant Programme at Mount Elizabeth Hospital, provides comprehensive evaluation and post-transplant care for patients requiring advanced liver support.