It began in 2005 with a bout of diarrhoea, which lasted six months. But after his right leg started to go numb as well, retired pastor Lau Chin Kwee, 58, consulted a neurologist. 
He was diagnosed with familial amyloid polyneuropathy - a rare genetic disorder which results in the liver producing an abnormal protein that affects the nerves and also attacks the major organs like the heart and liver. 
Without a transplant, Mr Lau would have died within two years. 
The genetic disorder affects one in about 100,000 Caucasians, but there is no available data on how frequently it occurs among Asians. 
His only option - a double transplant. 
Two weeks ago, Mr Lau made medical history when he became Asia's first heart-liver transplant recipient. The operation at the Singapore General Hospital (SGH), bought him another 10 years of life. 
'One of the things God gave me in my old age is a son. He is already six and it is a great responsibility bringing him up. I want to be there,' the father of three said yesterday on his decision to go ahead with the operation. His two other children - a daughter and a son - are already in their 20s, but he wanted to be around for his youngest son, he explained. 
According to a US-based registry for patients with the same disorder, 55 multiple organ transplants were carried out up until June last year, 17 of which were heart-liver transplants. 
It was reported that Dr K. C. Tan from Gleaneagles Medical Centre carried out the world's first such double transplant in the early 1990s in a British hospital. 
Yesterday, doctors who were part of the team of 50 medical staff from SGH and the National Heart Centre Singapore gave details of the operation that lasted 12 hours and 20 minutes. 
The team started with the heart transplant, which was completed within 3 1/2 hours, before moving on to the liver, which took another five hours. 
Both teams were up against several challenges both before and during the operation. 
For one thing, Mr Lau had lost much body mass and was 'terribly malnourished,' said the surgical director of the liver transplant service at SGH, Dr Tan Yu Meng. 
'We had to ensure that he was healthy enough to go through the operation, and also that the donor was of the same size and blood type,' Associate Professor Tan Chee Kiat, the director of the liver transplant service, added. 
The Straits Times understands that both organs came from the same donor, in an operation carried out at the National University Hospital. 
Dr Tan said that when the heart transplant started, Mr Lau was hooked up to a heart-lung machine to keep him alive. 
He was also on medication to prevent his blood from clotting. 
'So we had to carry out liver transplant in this dangerous setting,' said Dr Tan. 
Yesterday, 16 days after he pulled through, Mr Lau said that he was grateful to be able to wake up. 
'I had known that going for the transplant was my only option. I had, through the Internet, been in touch with an American woman with the same condition. She went through a triple transplant - liver, heart and kidney,' he said. 
His doctors say he could be discharged as early as next week. Mr Lau will now be on drugs to prevent organ rejection, which is standard treatment after transplants. 
Both the doctors and Mr Lau did not want to discuss the bill, but each organ transplant costs between $180,000 and $250,000, with a government subsidy of about 50 per cent. 
As for his plans, Mr Lau said that he hoped to return to his ministry as soon as he can as he believed it was what 'God had meant for me to do'. 
He added: 'I will never forget the one who gave me my life back and I am very thankful to the loved ones of the donor .' 

Half a day later, a new heart and liver

APRIL 7, 2009 

10.30pm: The donor's heart and liver is inspected at the National University Hospital (NUH) to make sure that they are suitable for transplant. 

11.50pm: Over at Singapore General Hospital (SGH), Mr Lau Chin Kwee, 57, is anaesthesised and prepared for the transplant operation. During surgery, a machine will take over the functions of his heart and lungs. But before this happens, surgeons prepare the damaged liver before administering anti-clotting drugs. The surgical director for the Liver Transplant Service at SGH, Dr Tan Yu Meng, said: 'Part of the liver was prepared for removal at this point and this takes between three and six hours.' 

APRIL 8, 2009 

2.50am: The donor heart arrives at the SGH operating theatre. Said Dr Tan: 'In transplantation, we work against the clock to ensure the donor organ is functioning well. Ideally, the heart should be implanted within four hours and the liver, 12.' 

3.00am: The donor's liver is removed at NUH, while in SGH, surgeons complete preparations to remove Mr Lau's diseased liver. 

3.10am: The heart transplant surgery starts and the heart-lung machine takes over the functions of Mr Lau's organs. The diseased heart is removed and the donor heart put in. 

4.00am: The donor liver arrives at the SGH operating theatre. 

5.00am: The heart transplant is done. The director of the heart-lung transplant programme at the National Heart Centre Singapore, Dr Lim Chong Hee, said the heart is restarted with electric jolts and clamps removed to allow blood to flow again. 'The heart-lung machine and electrical wires continued to be connected to Mr Lau as a precaution while the second part of the transplant commenced,' he said. 

6.40am: The liver transplant surgery begins. The damaged liver is removed and the blood vessels are attached to the donor organ. Blood flow is restored to the new liver, which had been preserved in ice for the last five hours. 'This is the most dangerous time as toxins that had built-up would be released into the system, causing the blood pressure to plunge and in turn, the new heart to stop beating,' Dr Tan said. It goes smoothly and the new heart 'tolerated the stress', said Dr Lim. 

11.20am: The finer blood vessels and bile duct are connected and the liver transplant is completed. 

1.00pm: Mr Lau is wheeled out of surgery to the intensive care unit.

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