For your Liver Transplantation journey, the transplant process is essentially divided into four stages to guide you along the way.
1. The patient or family can contact us by e-mail or phone and send all the patient's relevant medical records by e-mail or fax or courier.
2. After reviewing the medical details, we will revert with our opinion and course of treatment including need for liver transplantation, financial details and donor requirements that are relevant to the case.
Pre-transplant evaluation (Liver Transplant Assessment)
This stage begins when the patient arrives at the hospital and begins the process of medical evaluation, orientation, informed consent, and other preliminary activities. Patient undergoes an evaluation for the cause of end-stage liver disease and for the fitness for a major surgery like liver transplantation. As end stage liver disease has adverse effects on other organs of the body, a multidisciplinary team consisting of Transplant surgeons, Anesthesiologist, Hepatologist, Cardiologist, Chest physician, Dental surgeon, Psychiatrist. Recipient evaluation is done in three phases and typically takes 5-7 days in hospital.
Phase 1: To establish the cause of liver disease, determine the severity of liver disease and assess the urgency of the transplant.
Phase 2: To determine the fitness of the patient for a transplant. Vital organs such as heart, lungs, kidneys, blood counts are tested and the presence of any infection is ruled out. Sometimes the patient is often very sick before a liver transplant or if the tests detect any abnormality in the functioning of organ system or infection then the patient’s condition needs to be medically improved to the point where a transplant can safely be done. This comprises chiefly of identifying and treating any infection and making sure that the other organs (particularly the kidneys which tend to be affected by the liver disease or the medicines used to treat it) are working well.
Phase 3: The final phase consists of psychological and mental preparation of the patient. The patient and the family are counseled about the procedure, hospital stay, the likely course after surgery, follow up and aftercare.
The further preparation is dependent on the fact whether the patent has a willing and blood group matched family donor available. If there is a willing and blood group matched family donor available, he/she is evaluated for donation and a transplant is scheduled or else the patient is placed on the waiting list for deceased organ (cadaveric) donation.
Living Related Donation: Once a willing family donor has been identified, he/she is subjected to detailed evaluation to assess the health, size and make of liver as well as general fitness of donor for surgery. Ideally, the donor must be between the ages of 18 and 60, have a blood group compatible with that of the patient and be healthy and fit for surgery. Overweight people and those who consume alcohol regularly are usually not suitable (Annexure I). Such detailed assessment helps in proper selection of the donors so that the risk to the donor is minimal. The risk to the donor from the operation is 0.1-0.5% depending on how much of the liver needs to be removed. Once the donor has been deemed suitable for donation based on the results of such evaluation, the donor would need to submit certain Documents (Annexure II & Annexure III) to facilitate the Legal Clearance from Authorization Committee. The transplant surgery may be scheduled anytime once clearance is obtained from Authorization Committee. This step normally takes about 3-5 days but in the case of an emergency clearance can be obtained within 1-2 days.
Cadaveric (Deceased) Donation: If the patient does not have a willing family donor, he/she is put on the waiting list for deceased organ (cadaveric) donation. While on such a waiting list, the patient follows up with the Transplant Team until a suitable liver becomes available. The waiting time apart from the availability of organ (shortage of donors), depends on the general medical condition of the patient. Thousands of people die each year while waiting for a cadaveric liver to be offered. Organ donation after ‘brain-death’ is still evolving in India but it is slowly and steadily making a place in the transplant program. Once the transplant team gets information regarding organ availability, the recipient on the waiting list for cadaveric liver transplant is contacted and admitted to the hospital. Simultaneously the retrieval team gets involved in the organ procurement while the patient is taken up for the surgery. Liver once retrieved is transported to the recipient hospital in a cold preservative solution and transplanted in the patient.
Operation: The operation involves removal of the diseased liver and replacing it with a healthy liver. This is a complex and highly technical operation where the new liver with the conduits (arteries, veins and bile duct) are joined to the corresponding structures in the patient. The operation typically takes around 8-10 hours in a cadaveric and 10-12 hours in a living related liver transplantation.
Post-transplant care: The patient usually stays in hospital for 2-3 weeks depending on the pre-transplant condition and his/her recovery. After surgery patient is started on medications (immunosuppressants) to prevent the patient’s own body reacting to the new liver and rejecting it. However, these medicines make the patient susceptible to infection and the patient is also given prophylactic antibiotics and anti-fungals and sometimes anti-virals as well. Over a period of time the requirement of these medicines comes down and they are gradually withdrawn. At least one immunosuppressant medicine continues lifelong in a small dose. After transplantation patients have a good quality of life and most of them lead a comfortable and healthy life. For donor, the life is otherwise normal; there are no medicines in the long term and no dietary restrictions. Like anyone undergoing abdominal surgery, the donor should avoid lifting heavy weights for 3 months.