Ms Tan, who had a transplant operation in 1991, is the longest living female heart transplant patient here. -- ST PHOTO: MUGILAN RAJASEGERAN

If Ms Tan Chwee Suan ever needs reminding of the fragile link between life and death, she opens her wallet and looks at the picture of a young man she keeps there.

The picture, laminated to keep it safe, was part of an obituary published by a newspaper 19 years ago, yet it still resonates strongly for her.

She has never had official confirmation, but she is sure that it is that young man's heart that beats in her chest.

He had died just hours before her heart transplant operation in August 1991, gifting her the miracle of a new lease of life.

At 18, she contracted bone cancer and had her right leg amputated. But it did not go away and chemotherapy drugs caused her heart to fail. At 26, she was put on the heart transplant list.

She waited three years before a heart became available. The doctors never told her who the donor was but when she was recuperating, she searched newspaper obituary pages and found one of a young man who died on the same day she received a new heart.

A few months later, a newspaper report on the coroner's inquiry into his death provided further confirmation, when it mentioned that his organs, including the heart, had been donated.

Nineteen years later, she still has his obituary picture tucked away in her wallet. A copy of the newspaper report on the coroner's inquiry is pinned on the wall at her neat workstation at the Society for the Physically Disabled in Tiong Bahru, where she works as a book binder.

Ms Tan, now 49, lives a simple life, managing on her $700 a month salary in a one-room rental flat in Bukit Merah she shares with her brother.

She says she is lucky to have the gift of life: 'Every day, I wake up, I think I am so lucky to be alive.'

And it has been quite a gift. Ms Tan is the longest living female heart transplant patient in Singapore.

Her male counterpart is veteran journalist Seah Chiang Nee, 66, who underwent a transplant in Australia 25 years ago after suffering the rare viral infection cardiac myocarditis.

Doctors at the National Heart Centre Singapore say advances in treating heart patients mean more patients can expect to live as long as Ms Tan.

Just over half the 48 patients so far who have undergone heart transplant operations here have survived for at least 10 years after surgery. One in four lived for at least 15 years.

Ten years ago, survival rates were lower, with only about 46 per cent of patients living at least 10 years.

Dr Lim Chong Hee, 45, who heads the heart and lung transplant programme at the Heart Centre, attributes the improved survival rates to medical advances that have helped doctors better deal with the rejection problems with transplanted organs.

He says: 'Anti-rejection drugs, which keep a person's immune system from attacking the new heart, have improved such that patients now routinely leave the hospital a few weeks after surgery.'

Dr Lim adds that with the experience gained from 48 heart transplants since 1990, doctors at the centre are also more able to anticipate, spot and arrest possible problems in heart transplant patients.

'Chronic rejection can set in after a year, even six months in some cases, but we look out for the signs and try and treat it before it sets in.'

Dr C. Sivathasan, who heads the Mechanical Heart Devices programme at the centre, says artificial heart devices have helped keep more patients alive while they wait for a transplant and also enabled them to recover faster after the operation.

Previously, three in 10 heart failure patients died while waiting for a transplant. But artificial heart devices, which take over the function of the heart in circulating oxygenated blood in the body, now buy time for patients awaiting a transplant.

Three of the eight patients on the heart transplant list have been fitted with the latest artificial heart device, Heart Mate II, which is small enough to be implanted in people with a smaller build, including Asians and women.

Dr Sivathasan believes that with devices such as Heart Mate II, far fewer patients are likely to die while awaiting a transplant.

He adds that patients who have been on the mechanical heart system also tend to recover faster than those who were not.

'The mechanical heart system helps with blood circulation, and this in turn helps keep the other organs in good condition while the patient is waiting for a transplant,' he says.

Dr Lim points out that the importance of the heart transplant programme goes hand in hand with the increasing incidence of heart failure here.

About 5,000 people are admitted to hospital for heart failure every year in Singapore.

The Heart Centre gets 30 patients with end-stage heart failure each year and about six to eight progress to its waiting list for a new heart.

'As we are an ageing population, the numbers are likely to go up,' says Dr Lim.

He is optimistic that Ms Tan and other transplant patients will live many more years.

'With the advances made in treating heart patients, I am sure when we celebrate the 30th anniversary of the first heart transplant in 2020, many more of our patients would have passed the 10-, 15-, even 20-year, mark.'

Source: The Straits Times © Singapore Press Holdings Limited. Permission required for reproduction.