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About “Liver Transplant”

Liver Transplant

Liver transplantation has been one of the successful innovations in the healthcare industry over the last five decades. Today, this medical treatment is in its golden era in India due to the number of surgical procedures and the latest advancements that emerged over the last few decades.

The first successful living donor liver transplant along with a deceased donor liver transplant took place in November 1998 after a few unsuccessful attempts. With progressive growth in the medical field, there were 1,200 liver transplants in 2014 itself.

Along with these statistics and Indian medical personnel keeping abreast of the latest developments in the medical industry, India has become one of the favorite medical tourism destinations for people around the globe.

 

Liver Transplant – A Gift Of Life!

A liver transplant, also known as a hepatic transplant, is the replacement of a diseased liver with a healthy one donated by another person. Being a cure to end-stage liver disease or acute liver failure, it comes with a bunch of several benefits.

 

Health Conditions That May Lead To Liver Transplantation

When you have the end-stage liver disease with no medical therapy being effective, then you may be eligible for a liver transplant. If a candidate suffers from any of the following liver disorders:

  • Hepatitis B

  • Hepatitis C

  • Alcoholic liver disease

  • Fatty liver disease or Non-alcoholic steatohepatitis

  • Autoimmune hepatitis

  • Wilson’s disease

  • Previously failed liver transplant

  • Polycystic disease

  • Alpha 1 Antitrypsin deficiency

  • Hemochromatosis

  • Liver cancers

  • Primary biliary cirrhosis

  • Acute liver disease

Then, he/she has to undergo a liver transplant.

 

Types Of Liver Transplant Procedure Options Available In India

Liver transplant improves the quality of life and adds years to your life.

More than 80 percent of live donor liver transplants take place in India as compared to the western countries where approximately 90 percent of transplants are from deceased donors. 

There are mainly two kinds of liver transplantation happen in India and they are:-

  • Deceased Donor Transplant:
    – When the patient is brain dead, then he is considered dead and his liver is ready to be transplanted.
    – After matching the deceased’s blood group and size, the liver is transplanted to the needy one who comes first on the waiting list.
    – As the liver has the ability to regenerate, therefore, sometimes it is divided into two portions and transplanted to two patients at once – a child and an adult.

A deceased donor can donate as many as eight lifesaving organs and numerous life-enhancing tissues.

  • Living Donor Transplant:
    – When a lobe of the liver is transplanted from a live donor to replace a diseased liver, then it is a living donor transplant.
    – The donor should be an immediate relative such as parents, siblings, children, spouse, grandparents.
    – The liver regenerates/regrows to its normal size and this process starts as soon as the liver is divided/transplanted.
    – It takes 2-3 months for the whole of the liver to regrow to its size.

Do you know that a patient needs a liver which is 0.8-1 percent of their body weight to recover fully from the surgery? It corresponds to the right lobe of the liver for adults, left lobe for teenagers, and left lateral segment for kids and children. 

 

Requirements And Evaluation: Live Liver Donor

As the liver donation is organ donation, therefore, the donor and the recipient should adhere to the rules and regulations by the Indian Government. For organ donation, the donor and the recipient must follow the following rules:

  • All liver transplants need prior approval from the Competent Authority/ Hospital-based Authorization Committee/ State Authorization Committee.

  • Only licensed hospitals have the authority to conduct liver transplants.

  • Cadaver transplants should be done from brain dead persons.

  • In the case of brain dead person, if tissues, organs or both are to be removed, then it requires the permission of the board of medical experts prescribed by the Act and the Rules thereunder.

  • Live donation from ‘near-relative’ should be encouraged more instead of non-near relative.

  • If the donor and the recipient are near relatives and either of them is foreign national, the approval of the State Authorization Committee or Hospital-based Authorization Committee, (constituted as per the Act and Rules) is a must.

  • A Coordination Committee is set up by the State Government to oversee all transplant-related issues that demand the presence of both parties.

  • If the donor is unrelated by blood, then there should be no commercial angle behind the donation which is cleared by the authorization committee duly appointed by the Government.

 

Documentation Process For Liver Donation In India

When you bring a donor along, you need to bring the following documents as well:

  1. Forwarding letter by the Processing Consultant

  2. Authorization Committee Approval Letter

  3. No Objection Certificate from the Embassy/District Hospital

  4. Affidavit on stamp paper along with an attested photo of the recipient signed by SDM/DM/Embassy

  5. Affidavit on stamp paper along with an attested photo of the donor signed by SDM/DM/Embassy

  6. Affidavit on stamp paper along with an attested photo of the Donor’s close relative signed by SDM/DM/Embassy

  7. HLA/DNA typing results displaying the relationship in the case of parents and siblings

  8. Donor and Recipient Performa

  9. Form-1(Related Donor) Form-2(Spousal Donor), Form-3(UN-related Donor) to be duly filled by the patient and countersigned by the Notary Public

  10. Form 4 (Psychiatric Evaluation of the donor) to be complied by the Processing Consultant and the surgeon

  11. In the case of Spousal donor, form-6 is to be filled by the competent authority

  12. Whether the donor is related/unrelated, Form-11 (Joint transplant application by donor/recipient) is to be filled and signed by the Processing Consultant along with rubber stamp

  13. Medical Visa

  14. Document proof of relationship photo identity Card/Ration Card Passport/election Card/ Income-Tax PAN Number/ Driving License/Government identity card or Certificate along with attested photographs from Superintendent of Police/ District Magistrate/ Deputy Commissioner of their area

  15. Income proof of donor and recipient

Kindly note that all papers in the file must be numbered. Falsification of any document misleading the authorization committee and violating the law carries a heavy penalty.

 

Pre-Operative Evaluation Process For Liver Transplantation

As liver transplantation is a big step, therefore, one has to adopt a positive attitude before getting treated. The evaluation is a step-by-step process that begins with the recipient’s evaluation. Once the patient is eligible for transplantation, the hunt for donors in the family begins based on their blood group.

If the donor is found, it needs clearance by the authorization committee to proceed further and the transplantation usually undergoes in about 2-3 weeks.

Step 1: Pre-transplant Recipient Evaluation
– After the patient is diagnosed with end-stage liver disease and in need of the transplant, the transplant team performs a series of evaluation tests such as blood tests, CT scans, other tests to check the functionality of the heart, lungs and other vital organs.
– These tests are conducted to identify the exact cause of cirrhosis, the severity of liver disease on other organs, liver tumors, and to check the condition of other vital organs.
– The evaluation generally takes 7-10 days which is an outpatient procedure.

Step 2: To Decide The Donor
– Deciding the donor is the most critical part of the entire process. The donor has to meet the following criteria:
– A family member related by blood as defined by the Act.
– If the donor is non-related by blood, then it needs approval from the government-appointed authorization committee along with clarifying that there is no commercial angle involved.
– Age group between 18-55 years with no overweight issues.
– The donor’s liver size should be adequate enough to donate the required amount of portion.
– Compatible blood group with the recipient

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