Friday, April 2, 2010

Aussie dies after transplant

Apr 2, 2010

Blood clotting gene also caused first transplant to fail: S'pore doctor
By Salma Khalik

AN AUSTRALIAN woman who flew to Singapore for a second liver transplant has died. Ms Claire Murray, 25, underwent a successful transplant last month. But two weeks after she received a part of her aunt's liver, blood clots started to form in her veins.

On Wednesday, she underwent further surgery at Mount Elizabeth Hospital to remove the clots. But even as the surgeon, Dr J. Prema Raj, was removing the clots, others were forming.

Ms Murray, an unwed mother of two with a history of heroin addiction, became a lightning rod for controversy after her first liver transplant in Australia last September, using an organ from a dead donor, failed.

A blockage in a grafted artery which supplies blood to the liver caused the transplant to fail.

But detractors in Australia blamed her drug addiction for it, and because of that, she was ruled ineligible for a second liver from a dead donor. Her family rallied around her and were unwilling to give up the fight, however.

Her father, Mr Michael Murray, 55, could not help as he has a heart problem. But both her mother, Valerie, and her aunt Carolynn Jackson stepped forward. Her aunt, who has four children of her own, was found to be the better match.

However, Australian doctors do not have expertise in living-donor liver transplants, and the family arranged for a trip to Singapore, where dozens of such procedures are carried out each year.

But more controversy erupted when the Western Australian government gave the family a A$250,000 (S$321,000) interest-free loan for treatment here.

Many Australians were angered by the gesture, and said a drug addict did not deserve a second chance at life.

Some doctors there also claimed that her first transplanted liver failed because she had gone back on drugs. They blamed the arterial blockage on heroin.

However, Dr Prema Raj said this was not true. Tests here showed that she had a gene that made her prone to blood clots, he said. It is clear now that this gene caused the blockage in her artery that destroyed her first transplanted liver, he added. It also led to her death.

Ms Murray had been recovering well and was due to be discharged soon, but a clot showed up during a test on Wednesday morning.

The doctors first tried to dissolve it with medication. When that did not work, they operated to remove the clot.

But while operating, the surgical team discovered that new clots were forming as fast as they were clearing the older ones.

Yesterday morning, Dr Prema Raj told Ms Murray's family that her chances of survival were very slim.

Shortly after, she was declared brain-dead, but was kept on life support until a Catholic priest arrived to administer last rites at her bedside.

Her parents, siblings and other relatives, who had flown in from Australia to support her, were present.

Several nurses at Mount Elizabeth Hospital joined in a prayer session as well.

Ms Murray was taken off life support around noon.

When asked about his daughter's drug addiction yesterday, Mr Murray blamed the amphetamines doctors administered to her when she was 12.

He claimed the doctors used the drugs to treat her attention deficit disorder.

Neither of his two other children drinks or smokes, he said, but Claire dabbled in marijuana, Ecstasy, Ice and finally heroin.

When she was pregnant with her first child, at the age of 18, she tried to kick the addiction. Her doctor then gave her naltrexone to help beat her addiction.

When she moved to a different district, she had another doctor who said naltrexone was too expensive and put her on a cheaper drug, methadone.

However, she eventually returned to drugs, and also contracted Hepatitis B, which destroyed her liver.

Mr Kim Hames, Western Australia's Health Minister, said on hearing of her death yesterday: 'She was an example of what can happen when the scourge of illicit drugs enters the life of a young person.'

He added that she 'deserved every chance to watch her two young boys grow up. I can honestly say we did everything we could to give her that chance'.

[So much happening with one story.

First off, Singapore doctors has more experience with live donor liver transplant than Australian doctors? Hooray for Singapore.

Second, do addicts deserve a second chance and a second chance worth A$250,000?

Third, behind every story there is humanity. Or excuses, if one is cynical.

Fourth, are we always so quick to judge, to jump to conclusions? Sure it is pretty probable that the addiction could've contributed to the transplant failure. Or that she returned to her addiction causing the liver to fail.

Still, whatever the reasons or circumstances, whether the bad decisions were of her own making, or poor choices were offered to her, this was a life cut short. ]

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