First-ever transplant for acute liver failure in Sri Lanka
Doctors crossed line between human and divine, says joyous family 25-year-old Maleena saved from the grip of death
It was meant to be – with even the tiniest detail falling into place promptly, paving the way for the first-ever liver transplant for acute liver failure in Sri Lanka. A humble family from Bandiruppuwa in Lunuwila, close to Wennappuwa, believes that for a brief moment in time all the members of the Colombo North ( Ragama) Hepatobiliary and Liver Transplant Unit crossed the line between human and divine, to snatch from the grip of death their one-and-only 25-yearold daughter and sister.
“Devivaru,” murmurs the tearful father, as mother, elder son and daughter, Maleena Madushani -- with a brand-new liver that wonder organ, working to perfection within her -- sigh and cry at the sudden turn of events which so easily could have brought about death and tragedy. They also smile at the final outcome as we meet them on Wednesday at the Colombo North Hepatobiliary and Liver Transplant Clinic.
“My first birth was from my mother and this is my second birth, due to the efforts of the doctors and their teams and the liver donor,” says emotional Maleena about her new lease of life, while pleading with people to consider organ donation from kith and kin to save lives.
We relive the trauma of the family of W.L.D. Stephen Merinas and W. Dulma Priyanthi Kurera before we get into the medical wonders of the miracle that is this transplantation, with a liver from a cadaver (a person who had been declared brain-dead) for Maleena with acute liver failure.
There was absolutely nothing wrong with her, both her Thaththa and Amma tell us emphatically, while Maleena wearing a mask to prevent catching an infection describes how she is a Physical Training Instructress at Jennings International College at Nainamadama.
It was while she was at mass on a Sunday morning in May that she felt faint and collapsed in church. Tests including an EEG (an electroencephalogram tracks and records brain wave patterns) followed, with a diagnosis that she had had a fit (seizure). Some pills were prescribed to be taken daily.
Always physically fit, she took her school team for an athletics meet in Polonnaruwa soon after, returned to school and worked for another week and then once again took the team for another athletics meet in Wennappuwa which was close to home, all the while popping the pills diligently.
“The vomiting after a meal, at least once a day, started around that time,” recalls Maleena, while Thaththa says that her whole body including her eyes turned yellow and Amma says that she just could not eat, “bohoma chuttai kewe” (she ate very little).
With advice to eat a lot of sweet stuff, it was a blood test that indicated that something was wrong with her liver and she was re f e r re d to Consultant Gastroenterologist and Hepatologist, Dr. Madunil Niriella.
The day is seared into the memories of Maleena’s family….. it was July 17. Maleena was in a wheelchair and when Dr. Niriella asked her to stretch her arms out they were gehenava (trembling).
Dr. Niriella’s advice was urgent and clear – Don’t wait until tomorrow, admit her right now and that is how she went into the Colombo North Teaching Hospital’s Intensive Care Unit (ICU).
“Bohoma kadinaming, ” the Hepatobiliary and Liver Transplant Unit’s members got activated, says Thaththa, describing how they began “cleaning” her blood. By that time, however, Maleena was not fully conscious. She was confused and in a daze and by July 19 when she developed severe breathing difficulties the team immediately put her on the ventilator.
It was to Maleena’s Aiya, Malik, that Consultant Gastroenterological and Hepatobiliary Surgeon, Dr. Rohan Siriwardena explained the critical condition in which his sister was. She need- ed an immediate transplant as her liver cells were dying.
“We had never heard of such a thing before,” says Malik, who then pleaded for just one hour, as Thaththa was on the way, before making a decision. A small family meeting followed and both brothers, Aiya Malik and Malli Manoj, without hesitation offered a part of their liver to their beloved sister.
However, the Hepatobiliary and Liver Transplant Team had also spread the word around among colleagues that they were in want of a donor liver, while keeping the distraught family updated with all the information at every step telling them they would require certain items which may not be available at the hospital.
“On July 20, we got the list of requirements and by 6.30 in the evening everything was bought, while we kept a vehicle and three motorcycles on the ready to rush off if anything else was needed,” says Malik, recalling those hours fraught with tension.
Maleena was wheeled into the Operating Theatre at around 8.30 on the night of July 20 and the family kept in a room close-by, with a team member keeping them posted about what was happening. They also kept the younger brother who was a ‘match’, fasting just in case they needed him to donate part of his liver.
The rest is now only a very worrying memory for the family. With a cadaveric liver being sent from the Sri Jayewardenepura General Hospital at the crack of dawn around 12.40 on July 21, the transplant was concluded by 5.30 a. m. Thereafter, Maleena was transferred to the ICU of a private hospital nearby and in three days all tubes were removed. This was necessitated as the Colombo North Hospital has only a general ICU which could lead to infections being acquired by the organ- recipient.
A week after the transplant, Maleena was back at the Colombo North Hospital, kept in a special room until she was discharged on August 4.
Many are the people who supported this family, both in cash and kind, in their hour of need. The students of Jennings College had donated their tills and also cancelled their class trips to channel the funds to buy the items not available at the hospital; and her alma mater, Ave Maria Convent; the family’s neighbours and friends, three Catholic priests; the monks at the temple; and even strangers who responded to a Facebook appeal by her brother.
With Maleena’s Thaththa and Amma being Roman Catholic and Buddhist respectively, for the Colombo North Hepatobiliary and Liver Transplant Team and the donor’s family there are double blessings – masses in church and Bodhi poojas in the temple.