Pioneering step in little girl’s battle between life and death
Dr. S.P.A. Liyanage Ranaweera
A little girl would have been dead……..but for the timely intervention, a first-ever in Sri Lanka at short notice, excellent coordination between a base hospital and a teaching hospital and a state medical system which does not discriminate between the poor and the rich.
The first successful paediatric liver transplantation for acute liver failure is another sparkling gem in the crown of the Colombo North Centre for Liver Diseases (Ragama) of the Faculty of Medicine, University of Kelaniya.
The little queen, of course, talking nineteen to the dozen is Diluni Ahinsa who giggles for the photographs and tells her parents that she “is going to be on TV” and directs our attention to a few works of art that are displayed prominently in a special room of Ward 23 of the Colombo North Teaching Hospital, Ragama.
The tale begins in September, just last month, at the height of the lockdown due to COVID-19, with a child on the brink of death, then hope and a fresh lease of life. Diluni celebrates her 7th birthday in a month (November 10th).
With Diluni’s Thaththa, A. Dinesh Gunaratne (37) being a three-wheel driver, mostly taking children to school, the family living in Kirindiwela, Gampaha, was hard-hit economically, but Amma, M.P. Gayani Dilrukshi (37), managed to put tasty meals on the table. There were constant squabbles between Diluni and aiyya Dilum (13), with so much time spent together under lockdown.
“It was around a month ago that Diluni complained of a tummy-ache and threw up,” recalls Dilrukshi. Earlier, they had noticed that her urine was yellow.
That night she ate little and unusually went to bed early. Next morning, she murmured “angata amarui” (she was feeling unwell). Her skin had also taken a yellowish tinge.
The distraught parents “tak gala” (immediately) took her to the Wathupitiwala Base Hospital where a battery of tests were performed under the guidance of Consultant Paediatrician Dr. Maheshaka Wijayawardena.
All smiles: Diluni Ahinsa. Pic by Akila Jayawardana
While the little one had also been taken to Colombo for an echocardiogram of the heart which was normal, Dr. Wijayawardena was in touch with the Colombo North Centre for Liver Diseases because he had diagnosed that something was wrong with Diluni’s liver. Her eyes had turned yellow and blood tests had found that her liver was dysfunctional.
The Colombo North Centre for Liver Diseases evolved with a name-change in May this year from the North Colombo Hepato-Pancreato-Biliary and Liver Transplant Unit established in May 2012, contributing pioneering work to saving numerous lives, while also taking on referrals from across the country.
Transferred to the Colombo North Centre for Liver Diseases from Wathupitiwala on September 20, listless Diluni had been evaluated by the full team the same day, with the conclusion that she was in acute liver failure possibly due to Wilson disease. This is a rare inherited disorder that causes the excessive deposition of copper in the liver.
Diluni needed a very urgent liver transplant, as otherwise she would die in a few days.
A team member of the Colombo North Centre for Liver Diseases says that usually it would take about two months to prepare a child who was suffering from cirrhosis and needed a transplant. But Diluni just did not have that time.
Why not medication and close monitoring without a transplant? Diluni needed a transplant soon because she not only had acute liver failure but also cerebral oedema and encephalopathy (a decline in brain function).
The challenges such as finding a donor and getting the staff (human resources) prepped and the operating theatres (infrastructure) ready, with the added burden of the troubles posed by COVID-19 can only be imagined.
“When we explained the dire situation the child was in, the parents were understandably in shock. The response to finding a donor was quick and without hesitancy,” says the team member.
Father and mother had been assessed to get part of the donor liver for Diluni. Both were found to be suitable, with the mother more so and ever willing.
All systems were “ready to go” by the morning of Thursday, September 23, with the team deciding to have a restful previous night. But it was not to be, as by Wednesday, Diluni’s condition plummeted and it was “now or never”. Time was of essence.
Wheeled into the side-by-side operating theatres, Dilrukshi had been opened up at 12 midnight on September 22, with Diluni’s procedure beginning at 4 early the next morn, the marathon going on till 4 p.m. the next day.
And so, history was made that night even in these difficult times of the pandemic – with a live donation for acute liver failure in a child in Sri Lanka, with optimized care before and after transplantation.
For this feat by the skilled University Surgical, Anaesthetic and Paediatric Units and Operating Theatre and Surgical ICU staff, there has been unstinting support from the Director General of Health Services Dr. Asela Gunawardena, the Colombo North Teaching Hospital Director Dr. S.P.A. Liyanage Ranaweera and staff.
It is on Day 15 (Thursday) after the transplant that we chat with Diluni. Issallama yoghurt saha jelly kewa, she smiles, adding that she has also had rice and string-hoppers with maalu hodi.
While Thaththa fusses over Diluni and she cheekily confirms that she loves him more than she does Amma, the message that reverberates is – from the word “Go”, the state health system cares for all and has worked smoothly to save the life of a humble little girl.