A man's decision to donate a part of his liver without hesitation has given a new lease of life to a baby girl.
All Mr Sakthibalan Balathandautham was concerned about was that "a life was at stake".
The 28-year-old, a project manager at an international trade organisation, watched a few videos of how liver transplants are done and decided overnight that he had to respond positively to the baby's parents' plea for a liver donor.
"My biggest concern was probably the pain that I would have to endure and my recovery period," Mr Sakthibalan told tabla!. "But in the end it didn't quite matter."
Baby Rheya, who is turning two in July, is faring well after the liver transplant at the National University Hospital (NUH), thanks to Mr Sakthibalan's generosity.
Seeing her smile and looking cheerful has also lit up the lives of her parents J. Sunil and S. Ruthra, who were in misery soon after her birth.
The first-time parents were in high spirits when their daughter was born in July 2019. However, a few days later their joy took a hit when she developed jaundice.
The couple initially dismissed the occurrence as something most newborns suffer from.
But they became concerned when, even after three weeks of consultations at the local polyclinic, her condition did not improve.
She was then referred to the National University Hospital (NUH) for further examination. The doctors at NUH examined Rheya and broke the grim news to the young parents - the baby had biliary atresia.
It is a rare disease in infants where the bile ducts in the liver are inflamed, blocking bile flow to the gallbladder and eventually leading to liver failure.
They suggested that she undergo a surgical procedure called Kasai porto-enterostomy, which would restore bile flow from the liver into the intestines.
"The procedure involves excision of the malformed or blocked bile ducts that are characteristic of biliary atresia and creating a loop of intestine that is attached directly to the liver to achieve bile flow," explained Dr S. Venkatesh Karthik, senior consultant, Khoo Teck Puat-National University Children's Medical Institute, NUH.
Forty days after her birth, Rheya went through the procedure.
"Seeing surgical tubes attached all over her body for a 10-hour surgery broke our hearts," said Mrs Ruthra, 30, a civil servant.
"Why us? How is she going to deal with the surgery? What is life going to be like for her post-surgery? These were some of the thoughts that were running in our minds."
The couple thought their worst nightmares were over with the completion of the surgery. But they were in for another rude shock: The post-surgery test results revealed that there was some bile flow but it would not be sufficient in the long run.
"In Rheya's case, the bile flow was insufficient because biliary atresia is also associated with chronic inflammation and scarring in the tiny bile ducts within the liver," explained Dr Karthik. "These later may worsen despite the Kasai procedure."
Since there was the possibility of Rheya developing chronic progressive liver disease and liver failure, the doctors recommended a liver transplant when her condition stabilised. But Rheya's parents were told finding a suitable donor would not be simple.
"The donor should be healthy, with no medical problems, at least 21 years of age and ideally less than 55," said Assoc Prof Shridhar Iyer, senior consultant, National University Centre for Organ Transplantation, NUH.
"We go through the medical history, conduct a physical examination, followed by a panel of blood tests, ECG and chest X-ray. This is followed by a detailed evaluation of liver quality, anatomy and volumetry with CT scan and MRI scan.
"Then there are reviews by an independent physician, an anaesthesiologist and a psycho-social assessment. It is a multi-step process and, if the donor is found suitable, we will seek approval from the ethics committee."
In January last year, Mr Sunil, 31, a lab executive, decided to be the donor as he and Rheya belonged to the same blood group. He was advised to lose weight and attain an ideal Body Mass Index range.
"I was pretty sure that I would be a suitable donor for my daughter," he said. "With a strict diet plan and regular exercise, I managed to reduce my weight from 93kg to 81kg."
But matters again turned topsy-turvy when Mr Sunil failed the donor suitability test in June last year and was asked to find another donor.
The couple were in despair but did not pause to reflect on their woes. Mr Sunil posted a plea for a suitable liver donor on social media.
A few Vasantham TV celebrities helped by doing an interview with the couple and sharing their plea on social media. Within three weeks, 99 people expressed interest in donating a part of their liver.
Mr Sunil did the initial shortlisting by checking their health records and lifestyle habits. Ten suitable ones were then referred to the transplant coordinating team at NUH for testing.
It costs about $2,500 to do a donor suitability test. The couple bore the expenses. Mr Sakthibalan was finally found to be the most suitable.
"The donor's identity was kept confidential before the transplant," said Mrs Ruthra. "We were praying for both the donor and our daughter to complete the transplant successfully as there is risk involved."
On Sept 30 last year, the transplant was successfully done at NUH, which is the only hospital in the public sector in Singapore that performs liver transplantation for children. Twenty-three per cent of Mr Sakthibalan's liver was excised and transplanted.
Having utilised the bulk of their Medisave accounts for their daughter's medical treatment, Rheya's parents approached the GIVE.asia platform and managed to raise about $55,000 in two weeks for the surgery.
Mr Sakthibalan was discharged from the hospital four days after the transplant and has since resumed his usual sporting activities of yoga, running and volleyball.
Rheya is recovering well.
Her parents have forged a strong bond with Mr Sakthibalan, and invited him over to their home on New Year's Eve.
The couple have pledged their organs for donation after their death and hope others will follow suit.
"If someone tells you that they would like to donate their organs, please encourage them because there are many others like Rheya who are dependent on it," said Mr Sunil.
"My biggest concern was probably the pain that I would have to endure and my recovery period. But in the end it didn't quite matter because a life was at stake."
- Mr Sakthibalan Balathandautham