Just days before 2008 ended, Gwen’s young life was cut short by a congenital disease. But a belief that the 16-year-old would have wanted to help others even as death faced her led her parents to donate her organs. To the eight people who received them, Gwen was the angel who touched their lives – and gave them the gift of hope as a new year was beginning.

“MUST learn French.”

“Must study in Australia and Europe.”

“Must learn to ski in Korea.”

“Must go holiday in Antarctica and learn to build igloos and snowmen.”

“Then settle down in Canada.”

The wonders of the world reached out to Gwen Tan. But the young girl, poised on the cusp of teenhood, would not have known that in just another few years, those dreams would quickly slip away from her grasp.

On a hot December day last year, the vivacious 16-year-old, a triple Science student of a top school, would find herself suddenly collapsed in a train station, slipped into a coma, and days later, was pronounced brain dead.

The cause: Cerebral Arteriovenous Malformation (AVM), a congenital disorder that interrupts blood flow in the brain due to abnormal connections between arteries and veins. In Gwen’s case, the disorder sent a massive blood clot to her brain.

Yet the promise of a young life cut short would not end at death - but has led to a new beginning for many others.

The belief that Gwen would have wanted to help others led her parents to off er her heart, liver, kidneys, lungs and corneas for donation, giving a new life to eight people.

The recipients - five men, two women and a little girl - came from diverse backgrounds. One was as old as 61 and the youngest was three. Several were single, a few were married with children. Some had waited for years. The two men who received her kidney seach waited over seven years, while the child – born with a rare life-threatening condition – waited one-and-a-half years.

The lung recipient was able to sit upright, a day after his operation, smiling and waving to visitors. Th e split liver transplant was successful, a feat not repeated since more than eight years ago.

“I told myself that everyone has a mission in life. For Gwen, it is probably to save that little girl,” said mother Mrs Tan.

“I believe she would be happy to know that the act has transformed the lives of so many people. It was her nature to do so. She lived her life to the fullest and that was our consolation.”

AVM silently waiting Brain AVM often shows no symptoms until the tangle of dilated blood vessels rupture to cause a haemorrhage.

On the morning of Dec 20, mother and daughter were on a bus. Mrs Tan showed Gwen a news article, to which she replied “You know I can’t read on the bus. I get a headache.” Little did Mrs Tan know that the complaint was to be her daughter’s last words.

Later on a train, Gwen began to show signs of discomfort, and developed a headache. Th e pain seemed quite severe. “I tried to massage her head but she stopped me,” said Mrs Tan.

Other than mild childhood asthma and occasional nosebleeds due to a thin nose membrane, Gwen had always seemed healthy. Mrs Tan didn’t feel too worried at that point, and decided to take her daughter to a clinic. She was given an injection and medicine for giddiness and vomiting.

By the time her husband, an engineer, arrived at the clinic to take them home, Gwen was no longer able to see things clearly.

Her elder sister Jane opened the gate for her and she bumped against it. “You can’t see properly ah?’ Gwen just smiled and went to bed,” said Mrs Tan.

Late that night, Gwen vomited again. Her parents decided to send her to the hospital.

A computer tomography (CT) scan showed a massive blood clot in the left lower back of her head. Th e doctors suspected AVM and transferred her to the intensive care unit at around 1am. She was hooked up to machines to induce coma, so as to minimise her brain activities.

Th e next morning, Gwen had a probe inserted into her forehead to monitor intracranial pressure. Doctors said her condition had stabilised.

But the respite did not last. Overnight, the pressure shot up. An emergency procedure was done to remove part of her skull to relieve pressure on her brain.

Farewell to a well-loved friend


Th e neurosurgeon told Mrs Tan that part of her left brain was damaged – the part that controls speech, vision and psychomotor skills.

Th at afternoon, a senior neurosurgeon showed them a scan of another abnormal artery vein at the top of her head. Th e bed of capillaries connecting the artery to the vein was not formed.

“According to him, she was like a walking time bomb. As the high-pressure blood acts on the vein, the thin wall of the vein is being stretched. It’s only a matter of time before it burst,” said Mrs Tan.

Another consultant told them that Gwen would “be gone” the moment she was taken off the life support machine.

On Dec 24, Mrs Tan informed Gwen’s classmates of her critical condition.

An outgoing and sporty student, Gwen was well-loved by friends. She played the clarinet for the school band and trained with the badminton as well as soccer teams at her secondary schools. She would sometimes stay up till 1am to complete her schoolwork, waking up for school at 6.30am the next day. To top it off , she occasionally volunteered to tutor under-privileged kids and for charity organisations.

“She was a lively, cheerful and thoughtful person, always remembering friends’ birthdays, taking care to buy and wrap gifts, adding a drawing or note,” her mum said.

Dozens of Gwen’s schoolmates visited, along with their parents and teachers, fi lling her hospital room with cards, presents and a softboard with drawings and get-well messages. They prayed hard. They prayed for a speedy and complete recovery. They prayed for a miracle to happen.

“Question is not why we donated…” On Dec 25, the doctors told the Tans that they had done their best. Her hormones had become imbalanced – a sign the brain had lost its function. The following night, Gwen was certifi ed brain dead.

As Gwen was under 18 years of age, she did not fall under either the Human Organ Transplant Act (HOTA) nor the Medical Therapy, Education and Research Act (MTERA), which allows for organs to be recovered in the event of death.

It was up to her family to donate her organs.

But the thought of removing Gwen’s organs distressed the family. Th e family consulted a shifu – a Buddhist nun – and she explained the nobility of the deed.

“We initially felt that it was too cruel to remove the organs. A long cut has to be made from the chest all the way to the abdomen,” said Mrs Tan.

“But the question is not why we donated. Rather, it is how we would feel if we didn’t donate, knowing that many are suffering from organ failure. We felt it was something good that we could do on Gwen’s behalf.”

The Tans signed the donation papers on Dec 26 – coincidentally, a day rooted in the Christian tradition of giving gifts to the less fortunate.

“As she was wheeled into the operating theatre, we told her that we were donating her organs and not to fear the operation.”

It was only after the procedure that the family knew that Gwen’s donation would benefit eight people.

Cremation was held on a weekday. Many family members, her classmates, temple volunteers and well-wishers crowded into Bright Hill Crematorium to see her for the last time.

Today, the Tans continue to grieve their loss. In particular, Mr Tan, who used to drive Gwen to and from school every day, misses her greatly. Friends and neighbours share their grief. “Call me if you need to talk. I will stop whatever I’m doing and give you my time,” said June, a close friend of Mrs Tan.

During the Lunar New Year, the family went to watch a fi lm, a yearly routine. “There happened to be a vacant seat next to my husband. Filled with emotion, he said the seat was supposed to be for Gwen,” said Mrs Tan.

The family is starting to come to terms with their beloved daughter’s departure. Mrs Tan who used to have vivid dreams about Gwen said she is getting fewer such dreams in recent months. The family has donated much of Gwen’s clothes, shoes and accessories to the Salvation Army but is reluctant to make changes to her room. Jane wants to keep her younger sister’s soft toy piglet and doggie a little longer.

The family has also grown closer. Buddhists, they go for chanting sessions together every Tuesday night at a nearby temple.

“She was an angel who couldn’t even kill an ant. We love her very much. We hope to meet each other again at the Western Paradise.”

“Whenever we hear that a donor’s organ is available, we get very excited for our patients who have been on waiting lists, some for years. When we’re activated (for a transplant surgery), we drop our routine work to concentrate on the case. The gift of a transplant organ is second to none for these patients - their lives are centred on this one phone call.” - Dr Tan Yu Meng, Surgical Director, Liver Translant Programme, Department of General Surgery, SGH

And she lives on…in the eight recipients Heart Recipient: 49-year-old unemployed woman, married with a child. She had waited for slightly over a year. Do you know? A heart recovered from a brain-dead or deceased donor ideally needs to be transplanted within four hours. Thus, the heart and lung are the first organs to be recovered for transplant. On average, three to five heart transplants are done a year. The first heart transplant done in Singapore was on Jul 6, 1990. At the end of 2008 4 people were on the waiting list for a heart. Lung Recipient:  47-year-old married male accountant with three children. He had waited about one and a half years. Do you know? The first lung transplant was done in SGH in November 2000. Like the heart, lungs recovered from a donor have to be transplanted quickly, within four hours ideally. Many patients can be helped by the transplantation of a single healthy lung, although some patients may require both lungs to be replaced. At the end of 2008 2 people were on the waiting list for a lung. Two kidneys Recipient:  Two men, both single - a 53-year-old who was unemployed; and a 49-year-old salesman. Each had waited about seven years. Do you know? A recovered kidney has to be transplanted within 24 hours. Last year, 46 kidney transplants from deceased donors were performed. The first kidney transplant from a deceased donor was performed in SGH on Jul 8, 1970, marking the start of organ transplant in Singapore. The then-30-year-old Chinese housewife lived with excellent kidney function for another 21 years before dying of other causes. The first living-related kidney transplant was performed on Jul 31, 1976. In a living kidney donation, the remaining kidney grows bigger to compensate for the loss of the other kidney. At the end of 2008 511 people were on the waiting list for a kidney. Two liver lobes Recipient:  Two patients - a 54-year-old housewife, married with a child; and a three-year-old girl. The woman had waited about two years, while the child, born with a congenital disease, had waited about 18 months. Do you know? Operations involving the splitting of the left and right lobes are rare and complicated, and this was the third such procedure done in Singapore - and the fi rst involving two transplant centers. A liver recovered from a donor – living or deceased - has to be transplanted within 12 hours. The number of deceased donor liver transplants has been increasing. Last year, 13 to 15 liver transplants were done, compared to seven in 2007. The first liver transplanted from a deceased donor in Singapore was performed on Sep 29, 1990 and on Feb 15, 2006 in SGH. The first liver transplanted from a living donor in Singapore was performed on Jun 8, 1996 and on May 22, 2006 in SGH. The large majority of liver transplants use the entire liver from a deceased donor for the transplant, particularly for adult recipients. In living donor transplants, a portion of the healthy person’s liver is removed for transplant. Liver transplantation for children involves the removal of about 20% of the liver. When a part of a liver is taken from a donor for transplant, the donor’s liver quickly grows back to its full volume. At the end of 2008 13 people were on the waiting list for a liver. Two corneas Recipient:  Two men – 61 and 43 years old respectively – received her corneas. Do you know? Corneas are hardy and can be stored for up to two years before they are used for transplant. In August 1964, a road accident victim became Singapore’s fi rst local eye donor, although the first corneal transplant performed here in December 1962 used a cornea from the Washington International Eye Bank. At the end of 2008 27 people were on the waiting list for a cornea.

*Names were changed at the family’s request for privacy.

This article first appeared on Outram Now, May/Jun 2009.
Click here for the printed article: Touching lives