Sunday Star (Used by permission)
by Lee Yuk Peng
• Hui Yi the miracle girl
• Seah relives his brave battle
A 14–year–old girl was dying and hooked onto a mechanical heart which at most could give her another year of life. Overnight, her life undergoes a dramatic change – thanks to two donors, a superb team of medical specialists and the unwavering commitment of the police and air force.
THE race against time began with a donor call from Ipoh hospital to the National Transplant Resource Centre (NTRC) at 1pm on Oct 3, notifying the centre of a potential organ donor, diagnosed as brain dead.
After the first brain dead test was conducted and confirmed, the difficult task of approaching family members to consider organ donation had to be undertaken.
Transplant co–ordinators swung into action after family members signed the
consent papers, starting to plan for a mission – informing the respective
hospitals based on the types of organs donated, planning for the transportation
for surgeons, seeking traffic police's assistance to clear traffic, laboratory
to prepare for tests and a host of other details.
Dr Lela Yasmin Mansor, 48, chief national transplant co–ordinator with the NTRC, who co–ordinated the procurement of organs from Ipoh and Johor Baru, said: “You need a highly co–ordinated team with multiple discipline to work on it. You can't afford any hiccup,” she said.
This is especially so when it involved heart and lung donation, when the ischaemic time for a heart (heart without blood flow) and lung is four to six hours. Liver could last for eight to 12 hours while kidneys 24 hours, she said.
“The faster the organs are transplanted onto a patient, the better it is and the higher the success rate,” she added.
As NTRC staff were busy making calls to sort out travelling arrangements, doctors and nurses were busy maintaining the condition of the brain dead donor so it remained stable.
At the same time, potential organ recipients, including 14–year–old Tee Hui Yi recently at National Heart Institute (IJN), were called up by the respective transplant co–ordinators to show up for a final selection and lab tests to cross match receipients with donor.
While surgeons left with their medical kits and solutions meant to preserve organs, another team of doctors would be deciding on the recipients.
Hui Yi was given priority as she had been on a mechanical heart for a year and had yet to get a matching donor. The last heart transplant performed by IJN was in December 2005 and there was no heart donation for year 2006.
To cut short the time spent on the journey, NTRC staff requested a mercy flight from the Royal Malaysian Air Force with traffic police clearing the road for surgeons from different hospitals to reach the airbase.
Drivers were at the airport to pick up the medical team and headed straight to the operating theatre to procure the organs.
As procurement went on, medical staff kept in touch with the medical team in Klang Valley where organ recipients were based to plan the schedule for them to be wheeled into the operating theatre.
As the surgeons flew back with the organs, the recipients would be ready for the transplants.
With great respect, the donor would be stitched back as if after an operation before the family claimed the body in the mortuary, said Dr Lela.
“Without the co–ordination from paramedics, drivers, police, blood bank, Institute of Medical Research (IMR), operating theatre staff, the pilots, the labs, the telephonists, staff from Ipoh Hospital, Johor Baru hospital, the whole mission would not been accomplished,” said Dr Lela.
On many occasions, Dr Lela said, the police and air force were given very short notice.
“They were very helpful.” she said, adding that the police and air force personnel did not even get to break their fast on time on Oct 3 and 4 when they were involved in the two transplants.
Dr Mohamed Ezani Mohd Md Taib, director of heart and lung transplant services at IJN, who procured the hearts in Ipoh and Johor Baru, said the IMR and blood bank gave tremendous support to provide blood supply and lab tests even at odd hours as both transplants for Hui Yi were around 1am on Oct 4 and 5 respectively.
In Hui Yi's case, just when surgeons completed her heart transplant in a 10–hour operation on Oct 4, they faced another complication when the new heart did not contract well in Hui Yi's body.
“This is the last thing you want to see after working so hard,”said Dr Ezani.
Just when the doctors met to discuss Tee’s condition eight hours after the transplant surgery – and the whole team had yet to gain enough rest – another donor call came at 5.15pm on Oct 4.
The entire transplant co–ordination scheme started again after surgeons decided on the choice of candidates and they were in the air again at 8.54pm.
Dr Ezani, who had been sleeping at IJN, said it was adrenalin that kept him going.
The Ipoh boy was the first heart donor this year but the transplant team had never thought of getting another heart donor from Johor Baru in less than 24 hours.
As for heart transplant co–ordinator Noorsalina Othman, who left her three–year–old girl with a clerk at 2pm on Oct 3, she only went home in the afternoon of Oct 5.
For all the effort made to save the lives of Hui Yi and other recipients' Nooorsalina said: “It is worth it.''
Hui Yi the miracle girl
KUALA LUMPUR: Tee Hui Yi is indeed a miracle girl. The teenager, who is making steady progress after a second heart transplant on Friday, had no luck with six potential donors in the past nine months.
Yet, in a space of 24 hours, she had two suitable donors. The first failed and the doctors are now “cautiously optimistic” about the second heart transplant.
Since January this year, there had been six possible donors.
On June 15, the heart of a donor was rejected for being incompatible.
The following month, the heart of a man who weighed more than 100kg was rejected. Days later, there was another heart available but the donor was too young, just five.
On July 31, the heart of an accident victim was offered to Hui Yi but unfortunately, the organ was found to be damaged.
The fifth chance for Hui Yi came in September but the donor was suffering from hypertension and diabetes.
Then just into Ramadan, a private hospital in Alor Star offered her the organ but that donor was found to be a hepatitis carrier.
On Thursday, finally, her luck turned. Hui Yi received a heart from a 15–year–old boy diagnosed to be brain dead but soon after the operation her body started rejecting it.
The next day, Hui Yi got the heart of a 20–year–old mechanic who was declared brain dead after a road accident in Johor.
National Heart Institute heart and lung transplant unit clinical director Dr Mohamed Ezani Md Taib said Hui Yi was making good progress after her second transplant.
He said she was responding to calls, was moving and obeying commands through signals.
“When the doctors asked her which areas she felt pain, she was able to point and was able to move her feet and hands.
“This is good progress and doctors are cautiously happy. We hope for the best in the days to come,” he told a press conference yesterday.
Despite her stable condition, Dr Mohamed Ezani said Hui Yi was still in critical condition and not out of danger yet.
He said an echocardiogram was conducted yesterday morning and the test showed the heart was functioning normally.
The doctor said she had no breathing problems but was put on a ventilator as a precaution.
He added that her wounds were cleaned yesterday at the operating theatre, explaining that it was safer to do it there rather than the Intensive Care Unit.
“She had to be given doses of immunosuppressant and the intra–aortic balloon pump that had been inserted into the vessel was removed in the morning,” he said, adding that Hui Yi’s progress would be closely monitored over the next 72 hours.
He said if everything went well, she would be moved to the normal ward in about five days and fed through a tube.
Once she is moved to the ward, he said doctors would continue to conduct biopsies with a tube placed in her heart to check for any infection.
Seah relives his brave battle
Words of cheer from South–East Asia’s first transplant patient and Star columnist, Seah Chiang Nee, who has survived for 22 years.
I SAW Hui Yi’s story over Singapore state TV last night and was moved to write this article with the hope that it can bring hope and encouragement to her and her family.
First, I’d like to congratulate Hui Yi and her parents, her doctors and the hospital team for pulling it off. The two operations in two days were no mean feat, a great day for Malaysia.
I pray she will recover to lead a normal, healthy life.
More than anyone else, I can understand how the 14–year–old will be feeling when she regains consciousness and gets rehabilitated.
I had travelled the same road in 1985, when I received a donor heart in Sydney in 1985, so my experience here can hopefully help every one to prepare for her return to normalcy.
As in my own case, her first reaction when she opens her eyes will be an overwhelming sense of relief and gratitude.
Since my operation 22 years ago, heart transplant has crossed the Rubicon, skills and medicine having significantly improved. The year 1985 was pioneering time, so Hui Yi may feel much less discomfort than I did.
For a couple of days, her mind may be hazy – as mine was – as a result of the anaesthetic. I could not recognise my wife or son when they visited me.
Even worse, I went through a brief period of life–like dreams and fantasy. For example, I dreamt my throat was caught by a fishhook and unseen hands were tugging at it, causing me intense pain.
I would sit and watch TV, smiling and laughing at a programme, when the set was not switched on. One day, I got up in panic to search for my heart, saying someone had taken it.
Thinking that I had lost my marbles, my wife rushed for the doctors to be assured that it was normal.
It was probably a mixture of the steroids and effect of the anaesthetics playing tricks on my mind. Everyone reacts differently. She may be spared the same intensity, but parents and hospital staff should prepare for it.
Be prepared for the patient’s emotional highs and lows, especially unprovoked angry outbursts. Don’t worry if they happen; it’s the medicine talking and will blow over. It can be stressful for the unprepared family and hospital, who should never respond in kind.
At St Vincent’s Hospital, Sydney, a medical psychiatrist had to counsel us – family, relatives and me – on how to manage it.
One example: One morning a male nurse put the breakfast tray on the table behind me as I was watching TV and told me one time too many to eat.
For no reason, I screamed invectives at him. Quietly he left. When the impact of what I had done struck me, I scoured the wards looking for him to apologise for my misbehaviour.
He had gone home. For two days it bothered me until I eventually said “sorry” to him. His reply: “No worry mate. It’s a normal thing around here.”
Several things the hospital staff and parents may have to deal with early on: –
> Mental rehabilitation. Instil a sense of self–reliance in the patient who may cocoon himself in his bed or room, too lazy to use his brain or body to do even the slightest chore.
From card games, I eventually graduated to harder memory tests.
>Physical recovery. This lethargy has to be broken very early. As a routine, the visiting doctor would ask me questions that forced me to think. I had to remember my medicine, and take them by myself. Self–reliance!
Enforced exercise, it’s very crucial. After a month of lying in bed, my thigh and buttocks had shrunk. I could hardly walk. The therapist would pull me out of bed under protest to work on the exercise bicycle. I hated it and called it “my torture chamber”. It had to be done.
>Diet. A strict diet has to be in place at all times to keep one’s weight constant. Weight gain would put stress on the new heart. Low cholesterol, low salt have to be maintained. For 22 years, I have not tasted my favourite kambing soup or most of the fried dishes.
How well Hui Yi will live will not only depend on good medicine, but her own will power to live and sense of discipline. Parental support is very important because of her tender age.
However at 14, she would have a strong constitution to withstand the tribulations of life.
The greatest danger, especially for the first month or two, is rejection. It is not necessarily due to organ incompatibility or medical capability.
It’s this: When you introduce a “foreign” object into the body, it tends to react like “Hey, you’re not one of us” and reject it! So anti–rejection (Cyclosporine/Neoral or Cellcept) drugs are needed to fight the rejection.
The dosage will be high at the beginning and decline with the passage of time as it gets used to the new organ.
Another risk is infection. Patients like us have a lower level of immunity. For a while I had to wear a facemask, and still avoid smokers, fumes and very crowded places in the event of flu or any epidemic. I refuse to sit on the floor.
A fever, cough and cold or a body cyst, a common occurrence to a normal person, could develop into something more serious.
With the hope of the nation and a high standard of medical and family care, I am very sure, Hui Yi will soon be able to resume her studies and live a normal life, get married and have children.