Press Release
January 24, 2020

PRRD and Bong Go: NKTI will soon offer affordable liver transplants; Filipino patients need not go abroad

Based on recommendations by Senator Christopher Lawrence "Bong" Go, President Rodrigo Duterte stressed the need to capacitate the National Kidney and Transplant Institute (NKTI) to perform liver transplants so that Filipino patients need not go abroad for such medical operations.

The President expressed this when he met with the parents of a child with biliary atresia on Wednesday, January 15. He encouraged Ronald Naval and Kendy Aguilo to have their daughter Sophie undergo liver transplant in the country instead in India, which they prefer due to the lower cost of the operation there.

"Subukan natin dito. Ako, naniniwala ako. Hindi ako nambabarat--may pera at tutulong ako," the President said.

A liver transplant in the Philippines is at least three times more expensive than the P1.2 million needed in India, but the cost is expected to go down once NKTI has the sufficient number of specialists and the necessary equipment and facilities.

The President and Go also prefer the procedure to be done in the Philippines so that the patient can receive better pre-operative and post-operative care and has easier access to financial assistance from relevant government agencies.

Go cited the unfortunate case of Eren Arabella Crisologo, the daughter of a Philippine Army soldier from Butuan City. The President and the senator first met the baby, who had biliary atresia, when they visited the wounded-in-action soldiers in a hospital in Cagayan de Oro City in March 2019. They sent the 11-month-old baby and her parents to India in June 2019, but the operation did not succeed.

"Sa kasamaang palad, nagkaroon ng komplikasyon si baby Eren kaya hindi na-survive ang operasyon," Go said during a meeting in August 2019 with key government officials and private health care professionals to discuss the growing cases of biliary atresia in the country and the high cost of liver transplant.

Short-term and long-term solutions

It was during the meeting that the senator, upon consultation with health officials and practitioners, came up with short-term and long-term solutions to the problem that were presented to the President.

The short-term solution is forming a consortium among the Office of the President (OP), Department of Health (DOH), Philippine Children's Medical Center (PCMC) and The Medical City (TMC), a private hospital.

The long-term solution involves acquiring equipment for and developing the facilities of NKTI and sending its specialist staff to Kaohsiung Chang-Gung Memorial Hospital (KCGMH) in Taiwan for training.

Under the consortium, the estimated budget for each beneficiary is P3.6 million, P2.9 million of which will be spent on the operation at TMC and the rest will be for pre-operation and post-operation care at the PCMC.

Considered to be the most feasible immediate solution to the problem, the consortium takes advantage of an existing partnership between the PCMC and TMC and will last until NKTI is capable of solely performing pediatric and adult living donor liver transplantation.

The government will spend P58.1 million for the equipment that NKTI needs and P1.3 million for a batch of twelve specialists who will be trained for one to two months in Taiwan. Each specialist will have to serve at NKTI for two years in exchange for the training.

The long-term solution, expected to raise the standards of health care and elevate the morale of Filipino medical practitioners, also takes advantage of an established relationship between NKTI and KCGMH.

"Nais natin na ang mga pasyente ay magtiwala po sa kakayahan ng ating mga doktor. Gusto natin sabihin sa kanila na hindi na nila kailangan pumunta ng ibang bansa para sa liver transplant. Magtiwala sila sa ating local doctors," the Senator said.

"'Yun po ang objective natin dito, as soon as possible sana. Sana ay maging at par tayo sa ibang bansa," he added.

Based on Go's suggestions, the PCMC will work out a possible assistance arrangement with the DOH through the agency's Medical Assistance for Indigent Patients (MAIP) Program. The Presidential Management Staff (PMS) will also map out other sources of assistance and arrange a meeting with the Department of Social Welfare and Development (DSWD), Philippine Charity Sweepstakes Office (PCSO), Philippine Health Insurance Corporation (PhilHealth), Philippine Amusement and Gaming Corporation (PAGCOR) and private partners.

Go also said that the patients can avail themselves of the services of Malasakit Centers, one-stop shops that streamline medical and financial assistance from PhilHealth, DOH, DSWD and PCSO.

NKTI's commitment

In a position paper, NKTI Executive Director Rose Marie O. Rosete- Liquete affirms that the hospital, "being the lead government agency for organ transplantation, is now ready, with the help of the Office of the President, to provide accessible liver transplantation to the Filipino people."

She also said that NKTI used to have a liver transplant program but was not sustained, and she supports its revival. "It is our thrust to gain back the trust and confidence of the patients who are now traveling abroad for liver transplant," she added.

The first adult liver transplant at NKTI was performed in 1988. The hospital was also the first in Asia to perform a simultaneous kidney-pancreas transplant in 1988 and liver-kidney double transplant in 1990.

The first pediatric liver transplant at the hospital, wherein a mother donated a segment of her liver to her child, was performed in 1996 with the help of specialists from KCGMH.

"Unfortunately, we did not have the opportunity to sustain our liver transplant program due to lack of government support, financial reasons, refusal of family members to become living donors and lack of cadaver donors," Liquete explained.

For the past years, Filipino pediatric patients have been traveling abroad for liver transplants, mostly in Taiwan, Hongkong and, recently India, but Liquete said that NKTI provides many of their post-operative follow-up and care.

"As of the present, we have more than 30 pediatric patients who were transplanted abroad and have their post-operative laboratories done at NKTI," she said.

"We want to reinvigorate the liver transplant and revive the Pediatric Liver Transplant Program," she added.

Patients sent to India

With their affordable medical services, hospitals in India have been a primary option for Filipinos who need to undergo liver transplant, especially children with biliary atresia.

As of January 2020, Senator Go helped 46 such children receive assistance from the Office of the President for their families' round-trip tickets and accommodation in New Delhi in India. Go also provided the families allowance for their food and basic necessities.

The Senator has kept close contact with at least two of the patients. He met Dionifer Zephaniah Itao when he visited the victims of a fire in Cebu. She was sent to India with baby Eren, but unlike baby Eren's, the operation of 10-month-old Dionifer was successful.

In October 2018, Go met Xia Kazumi Ngo at a gathering in Taguig City, and he helped her undergo the needed operation in India. Baby Xia has been in good health since, and Go took her to Malacañan for a meet-and-greet with the President on June 2019.

When Indian President Ram Nath Kovind visited the Philippines for five days in October 2019, he spent some of his time with at least 40 Filipino children who had successfully undergone liver transplant in his country.

Biliary atresia is a condition in infants in which the bile ducts outside and inside the liver are scarred and blocked. Bile cannot flow into the intestine, so bile builds up in the liver and damages it.

Recent scientific literature indicates that biliary atresia occurs in approximately 1 for every 18,000 live births in Western Europe. In the world, the reported incidence varies from 5 to 32 for every 100,000 live births and is highest in Asia and the Pacific region. The cases in the Philippines cannot be determined because the country has yet to start its own registry.

"Maraming lumalapit, humihingi ng tulong para maoperahan ang mga bata. Namamalimos sila para maka-raise ng funding for the operation," Go observed.

"Kung mayroon tayo dito sa Pilipinas ng mga kailangang equipment, mas maraming well-trained specialists at mas murang operasyon, hindi na kailangang magpagamot pa sa ibang bansa ang mga pasyenteng ito," he added.

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