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A fresh chance at liver transplants

The NKTI was the first in Asia to perform a simultaneous kidney-pancreas transplant in the same year, and a liver-kidney double transplant in 1990.

Trina Ibarle Orquiza

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Once one of Asia’s leading hospitals in the field of conducting organ transplants, the National Kidney and Transplant Institute (NKTI) was poised to be the channel to which the government would be able to offer Filipinos an accessible means for liver transplant surgery.

The NKTI, a government-owned and controlled corporate tertiary specialty center attached to the Department of Health (DoH), was a forerunner in the field of organ transplants as it was able to conduct several complex operations through the years.

Having successfully conducted its first adult liver transplant in 1988, the NKTI was the first in Asia to perform a simultaneous kidney-pancreas transplant in the same year, and a liver-kidney double transplant in 1990.

However, recent reports showed that there has been an increasing number of cases of biliary atresia in the country — a condition among infants in which bile ducts inside and outside the liver are scarred and blocked, causing bile build-up resulting to liver damage as bile is unable to flow into the intestines.

With cases of biliary atresia on the rise, the demand for pediatric liver transplants has also gone up. But with prohibitive rates and only a handful of Filipino medical practitioners available to perform the procedure, options have shifted elsewhere in locations such as Taiwan, Hong Kong and India where pediatric liver transplant surgery is said to be more accessible and affordable.

The NKTI admitted that while its adult liver transplant program is still ongoing, it was not able to sustain their pediatric program due to lack of government support to equip doctors in the field of pediatric specializations, as well as the problem of a low retrieval rate of the liver organ itself for pediatric recipients.

“Unfortunately, we did not have the opportunity to sustain our pediatric liver transplant program due to lack of government support, financial reasons, refusal of family members to become living donors and lack of brain-dead or cadaver donors,” NKTI Executive Director Rose Marie Rosete-Liquete said.

Recognizing this need, she added, “We want to reinvigorate the liver transplant and revive the pediatric liver transplant program.”

This also prompted President Rodrigo Duterte and Sen. Christopher Lawrence “Bong” Go to redirect their focus on the NKTI’s need to strengthen its capabilities in performing pediatric liver transplants as well as making the procedure less prohibitive so that Filipino patients need not go abroad for such medical operations.

Earning trust back
The President expressed his concern on this matter when he met with Ronald Naval and Kendy Aguilo, whose daughter Sophie is suffering from biliary atresia and was about to undergo liver transplant in India because it was cheaper than having the operation done locally. He encouraged Sophie’s parents to have the operation done locally.

“Let us try doing it here. I believe we can do it. Money is not an issue — I will help,” President Duterte said.

The President and Go also preferred the procedure to be done in the Philippines so that the patient can receive better pre-operative and post-operative care, along with easier access to financial assistance from relevant government agencies.

Go also expressed his intent to bring the public’s trust back to local medical practitioners as he met with key government officials and private health care professionals in August to discuss the rising cases of biliary atresia in the country.

“We want our patients to trust in the capabilities of our doctors. We want them to know that they don’t need to go abroad for a liver transplant. They should trust our local doctors,” Go said.

It was not always a guarantee that procedures done abroad would be successful as Go cited the unfortunate case of Eren Arabella Crisologo, the daughter of a Philippine Army soldier from Butuan City.

The President and Go first met the baby, who had biliary atresia, when they visited the wounded-in-action soldiers in a hospital in Cagayan de Oro City in March 2019. They sent the 11-month-old baby and her parents to India in June 2019, but the operation did not succeed.

“Unfortunately, there were complications and baby Eren was not able to survive the operation,” Go said.

Finding solutions
Upon consultation with health officials and practitioners, Go came up with short- term and long-term solutions to the problem that were presented to the President.

The short-term solution is to form a consortium among the Office of the President, the DoH, Philippine Children’s Medical Center (PCMC) and The Medical City (TMC), wherein the estimated budget for each beneficiary is P3.6 million.

Under the consortium, P2.9 million will be spent on the operation at TMC while the rest will be spent for pre-operation and post-operation care at the PCMC.

Considered to be the most feasible immediate solution to the problem, the consortium also takes advantage of an existing partnership between the PCMC and TMC that will last until NKTI is capable of solely performing pediatric and adult living donor liver transplantation.

Based on Go’s suggestions, to make the procedure less prohibitive, the PCMC will work out a possible assistance arrangement with the DoH through the agency’s Medical Assistance for Indigent Patients Program.

“There are a lot of people asking for help for their children’s operation. They beg so that they could raise funds for the operation,” Go observed.

The Presidential Management Staff will also map out other sources of assistance and arrange a meeting with the Philippine Health Insurance Corporation (PhilHealth), Department of Social Welfare and Development (DSWD) and Philippine Charity Sweepstakes Office (PCSO) as well as with private partners.

Go added that patients can avail themselves of the services of Malasakit Centers, one-stop shops that streamline medical and financial assistance from the DoH, DSWD, PCSO, PhilHealth and PAGCOR.

On the other hand, the long-term solution involves acquiring equipment for and developing the facilities of NKTI and sending its specialist staff for training to the Kaohsiung Chang-Gung Memorial Hospital (KCGMH) in Taiwan, known as Asia’s liver transplant center.

The government will also be spending P58.1 million for the equipment that NKTI needs, as well as P1.3 million for a batch of 12 specialists who will be trained for one to two months in Taiwan. In exchange for the training, each specialist will have to serve at NKTI.

“If we had the necessary equipment, more well-trained specialists and cheaper costs for the operation, these patients don’t need to be treated abroad,” Go said.

The long-term solution, expected to raise the standards of health care and elevate the morale of Filipino medical practitioners, also takes advantage of an established relationship between NKTI and KCGMH.

“That is our objective, that as soon as possible, we be at par with other countries,” Go added.

As a result of these proposed solutions, the cost for a liver transplant is expected to go down once NKTI has the sufficient number of specialists and the necessary equipment and facilities.

In a position paper, Liquete affirmed that the NKTI, “being the lead government agency for organ transplantation, is now ready, with the help of the Office of the President, to provide accessible liver transplantation to the Filipino people.”

For the past years, Filipino pediatric patients have been traveling abroad for liver transplants, mostly in Taiwan, Hongkong and most recently to India, but Liquete said that NKTI provides many of their post-operative follow-up and care.

“As of the present, we have more than 30 pediatric patients who were transplanted abroad and have their post-operative laboratories done at NKTI,” Liquete said.

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