Father Overcomes Hepatitis C and Fatty Liver Disease to Become Living Donor for Son with Alagille Syndrome
Key Insights
A 36-year-old father in Singapore reversed his hepatitis C (search) and fatty liver disease (search) through medication, diet, and exercise to become a viable living liver donor for his three-year-old son with Alagille syndrome (search).
Alagille syndrome (search), affecting approximately one in 70,000 people, is a rare genetic disorder where abnormal bile ducts cause liver damage, with liver transplantation being the only effective long-term treatment.
The complex 12-hour living donor liver transplant was performed on March 26 at National University Hospital, involving coordinated surgical teams from both adult and paediatric liver transplantation programmes.
A Singaporean father's determination to save his son's life led him to completely overhaul his health, reversing two disqualifying liver conditions to become a living liver donor. Noel Joshua Selvanathan, 36, was initially ruled out as a donor for his son Isaiah, now three, who was born with the rare genetic disorder Alagille syndrome (search) and faced worsening liver failure.
Isaiah's condition was first diagnosed at KK Women's and Children's Hospital, after which he was referred to the National University Hospital (NUH) — the only public hospital in Singapore authorised to perform paediatric liver transplants. These complex procedures for children up to 18 years old are managed by the National University Centre for Organ Transplantation (search) (NUCOT) and the Khoo Teck Puat – National University Children's Medical Institute (search) (KTP-NUCMI).
A rare disease with limited options
Alagille syndrome (search) is a rare genetic disorder characterised by abnormal bile ducts that cause bile to accumulate inside the liver, impairing the organ's ability to eliminate waste from the blood and progressively damaging the liver. The condition is estimated to affect about one in 70,000 people and is usually discovered either when patients are still infants or during early childhood. Liver transplantation remains the only effective long-term treatment.
When S. Venkatesh Karthik, a senior consultant with the Division of Paediatric Gastroenterology, Nutrition, Hepatology and Liver Transplantation at KTP-NUCMI, first saw Isaiah at two years old, the clinical picture was stark. "What struck me when I first saw him was how jaundiced he was. Also, his appetite was very bad and his energy was very low. He was unable to play as a child of his age should be playing," Karthik said. He added, "Even when his (older) sister, Alexandria, was trying to stimulate him to play, he just did not have the energy to do so. He used to lie down and smile."
The medical team immediately brought a nutritionist on board to optimise Isaiah's dietary plan, recognising that the child needed to be at optimal nutritional health before undertaking a major transplant procedure. Isaiah underwent a battery of tests and scans before being listed for a transplant.
The donor pathway narrows
In Singapore, the average waiting time on the national list for a deceased donor liver is approximately 12 to 22 months. However, because donor organs are scarce, waiting periods can extend significantly depending on blood type, medical urgency, and the severity of the patient's condition. Many families opt for a living donor liver transplant, where a healthy family member or compatible living person donates a portion of his or her liver, reducing the wait time to about two months.
Noel, who had been incarcerated and struggled with substance and alcohol abuse, initially believed he could not help. "I was incarcerated then and having struggled with substance and alcohol abuse in the past, I was just not the right fit. I also suffered from hepatitis C (search) and fatty liver disease (search), so all I could do was pray," he said.
His wife, Melissa Orchard, 39, volunteered to donate. However, during pre-donation scans, she was found to have lesions and a growth in her spleen. "The doctors had to eventually remove my spleen and because of that, I could no longer give part of my liver to Isaiah. The only way for Isaiah was to wait for a cadaveric (deceased) donor," she said.
A father's transformation
With his wife's donation no longer possible and Isaiah's condition deteriorating, Noel embarked on what he described as the most important mission of his life. "I had to totally change my lifestyle and give up bad habits and alcohol to become a viable organ donor for Isaiah," he said. At the time, he had been having supper and drinking almost every day, usually with friends after work.
The medical team informed Noel that while hepatitis C (search) and fatty liver disease (search) disqualified him automatically, both conditions were highly treatable. Once the hepatitis C virus was eradicated with medication and his fatty liver disease reversed through weight loss, diet adjustments, and regular exercise, he could become a donor — provided he also abstained from alcohol.
Noel began going to the gym regularly and adopted a healthy diet. "I even managed to reduce my fatty liver by eating healthily. That surprised even myself," he said. After a few months, the doctors gave him the green light to donate part of his liver to his son.
The 12-hour transplant
On March 26, father and son underwent a complex 12-hour liver transplant at NUH. The procedure was led by Vidyadhar Mali, surgical director of the Paediatric Kidney and Liver Transplantation Programmes at NUCOT. Transplant surgeon Pang Ning Qi from the Adult Liver Transplantation Programme operated on Noel to remove part of his liver, while paediatric transplant surgeons Dale Loh and Vidyadhar carried out the transplant in Isaiah.
The two operating theatres were connected by a common corridor, enabling the surgical teams to communicate and coordinate their progress throughout the procedure. The surgery was a success. "The eureka moment for the teams was when Isaiah's liver turned a nice reddish brown and it was soft," Loh said, indicating that the organ was beginning to function. The team used Doppler ultrasound to confirm blood flow, listening for the pulsation of the portal vein. "That was when we knew it was good," Loh added.
A transformed life
Today, Isaiah — once frail, jaundiced, and devoid of energy — is an active toddler who loves life and displays the curiosity typical of any child his age. Because the first year after transplant is the most challenging period, when rejection typically occurs, Isaiah continues to be closely monitored by the NUH team. His mother noted, "He is so active, I have to focus my attention on him all the time."
The journey has also permanently transformed Noel. He now exercises regularly, has cut red meat from his diet, and no longer drinks alcohol. "I remain healthy for not only myself but for my family. We are forever deeply grateful to the NUH team, who took us through one of the most difficult periods of our lives," he said.