Health Minister Manto Tshabalala-Msimang is ”doing very well” after her liver transplant, her doctors said on Friday.
”She’s a strong lady and has recovered very well after surgery,” said Dr John Tilley of Wednesday’s operation.
Infection will remain a concern over the next five days and 66-year-old Tshabalala-Msimang will be placed on immuno-suppressant medication for the rest of her life.
Her physician for the past four years, Professor Jeff Wing, said: ”There’s been no rejection [of the organ]. Technically, it was a great transplant.”
She is expected to stay in the Wits Donald Gordon Medical Centre’s (WDGMC) intensive-care unit for about 10 days. This will be followed by a month-long recuperation in hospital. It will then take about five to six months before she can return to work.
”So far all our transplants have been able to return to work,” said Dr Russell Britz, chief of transplantation at Johannesburg Hospital and Wits University.
The minister was readmitted to Johannesburg hospital’s intensive-care unit on February 20 following hospitalisation for a lung ailment last year.
Professor Ernie Song said she suffered from cirrhosis, or extensive scarring and damage to the liver. This had forced her blood to find alternative channels back to the heart, leading to veins in her oesophagus and gullet dilating.
Wing said there are ”perhaps 10 000 causes” of cirrhosis, of which hepatitis B is the most common.
On waking up after Wednesday’s operation the minister had expressed gratitude that her family was around her, and that the operation had been successful, said Wing.
Several factors contributed to her being chosen for the operation.
”Her tissue type rendered her a universal recipient. She could have been the recipient of any potential donor.”
Because of her condition she scored the highest points on a Meld (Model for End-Sage Liver Disease) scale that determines how urgently a liver transplant is needed. This rates a patient on a scale of between 10 (less ill) to 40 (gravely ill).
Britz said it is not possible to compare heart, liver and kidney transplants. Patients needing a kidney could be kept alive with a dialysis machine. This means that the longer they have been on a waiting list, the greater their chances of getting an available organ.
”With a liver we don’t have a machine that can keep you alive. There’s a big wait-list death rate, so we take the sickest people on the list first, according to the Meld system.”
The body size of the donor and recipient is also a factor in determining compatibility.
Britz said the WDGMC, which performed the operation, currently has a list of about 20 to 25 patients waiting for a liver. About 20 livers are transplanted annually, meaning the waiting list is turned over once a year.
Wing said there are more liver donors than there are effective recipients as time, suitability and the size of the patients plays a role.
”About four in 10 potential donor livers are lost because of these reasons.”
Sharing livers with Groote Schuur hospital in Cape Town — the only other liver transplant centre in the country — is also a problem because South African Airways has cancelled its 8am flights.
This means recipients have to wait until the following day for the organ. ”We have lost some livers because of that.”
Dr Belinda Rossi, transplant coordinator for the WDGMC, said the Human Tissue Act prevents any information about the donor being made public without the written permission of his or her relatives.
Wing said four other patients benefited from Tshabalala-Msimang’s donor.
Johannesburg hospital CEO Sagie Pillay appealed to the public to become organ donors.
”In South African society there seem to be all kinds of taboos [associated with organ donations].”
Speaking on behalf of the public sector, he said that as a liver transplant is a ”very expensive intervention”, doctors are circumspect in deciding who should receive a new liver.
”We have to be absolutely certain that the investment we make will have a return … The surgery is only one component. The immuno-suppression [medication] is for a lifetime and hugely expensive.”
Speaking on behalf of the private sector, Dr Sue Tager, academic and medical director of the WDGMC, said the centre is ”not only an elitist programme” available to those with money. The decision to transplant is based on need, not money, she said.
Health Department spokesperson Sibani Mngadi stressed that Tshabalala-Msimang is still the country’s health minister.
”We will be guided by the experts to tell us how she’s progressing and how much time she needs to recuperate.” — Sapa