Liver Transplant in India - A Complete Guide

What is Liver Transplantation?

Liver transplantation is a surgery(surgical procedure) to replace a diseased or ill-functioning liver with a healthy and well functioning one. This procedure has been performed for over 38 years, and many recipients go on to live completely normal lives. A healthy liver for transplantation is mostly obtained from either a deceased person or a living donor. A deceased donor is someone who is brain-dead, while a living donor is typically a family member willing to donate a portion of their liver. What makes the liver unique among organs is its ability to regenerate lost or damaged tissue, a feature crucial to the recovery of both the donor and the recipient. Read the details below to know about Liver Transplant in India more.

When does the need for Liver Transplant Arise?

Liver diseases severe enough to necessitate a transplant can arise from various causes. In adults, the primary reason for liver transplantation is cirrhosis, a condition where the liver gradually deteriorates and loses function due to long-term damage. In cirrhosis, a healthy functioning liver tissue is replaced by scar tissue, which restricts or limits blood flow through the organ.

Common causes include hepatitis B and C, excessive alcohol consumption, autoimmune liver disorders, fatty liver disease, and hereditary conditions, Chronic Hepatitis with Cirrhosis, Primary Biliary Cirrhosis, Biliary Atresia, Chronic Alcoholism, Wilson’s disease, Hemochromatosis, Metabolic disorders, Acute Liver Failure, Liver Tumors. Individuals with alcohol-induced cirrhosis often require a transplant, though many improve significantly with six months of abstinence and treatment for related complications, allowing them to avoid transplantation.

However, for those with advanced liver disease where abstinence and medical care fail to restore health, a liver transplant becomes necessary. In children, the leading cause of liver transplantation is biliary atresia, a rare condition affecting newborns where the bile ducts connecting the liver to the small intestine are blocked or missing.

This obstruction prevents bile, essential for digestion, from exiting the liver, causing cirrhosis and eventually leading to liver failure if untreated. The exact cause of biliary atresia is unknown, and effective treatment typically requires surgery or a liver transplant. Other conditions that may require transplantation include liver cancer, benign liver tumors, and genetic disorders. Primary liver cancer, which occurs more frequently in cirrhotic livers, especially those linked to hepatitis B, can sometimes be effectively treated with early transplantation, offering long-term survival. However, liver cancers originating elsewhere in the body and spreading to the liver cannot be cured through transplantation.

Also, Liver transplantation becomes an absolute necessity if the person is suffering from a life-threatening liver issue, and medical specialists carefully assess each patient’s circumstances to ascertain if the procedure is suitable. Common reasons for liver transplantation include:

End-Stage Liver Disease: This occurs when the liver is severely damaged and scarred, rendering it incapable of performing its critical functions. Patients with end-stage liver disease often experience severe symptoms, are at high risk for complications, and face a poor prognosis without a transplant.

Irreparable Liver Damage: In some cases, liver related ailments develop to a critical stage of permanent damage. Issues like portal hypertension, Abdomen fluid build up, and hepatic encephalopathy may notably decrease a patient’s life quality and increase the chances of death.

Management Failure of Treatment: When all the treatment initiatives by major interventions fail to treat liver disease complications, a liver transplant is the last resort towards prolonged life and overall health.

Types of Liver Transplant

There are different approaches for Liver Transplantation depending on the patient’s needs and the accessibility of donor organs.

Here are the 3 Major types of Liver transplant mentioned below:

Deceased Donor Liver Transplant: In this procedure, a healthy liver is acquired from a deceased person(After consent). The liver of a deceased person is primarily used for whole liver transplants.But a whole adult liver can also be split and used for two recipients

Living Donor Liver Transplant: In this method a living person is donating a portion of their liver to the recipient. The liver’s miraculous ability to regenerate makes sure that both the donor and recipient will have fully functional livers after the surgical procedure. This way of Liver Transplant is commonly chosen when a suitable deceased donor is unavailable and involves two subcategories:

Split Liver Transplant: This transplant procedure involves dividing a deceased donor’s liver into two parts. One portion is transplanted into an adult recipient, and the other is given to a paediatric recipient. Split liver transplant technique is important for helping a large number of patients who can take advantage of a single donated organ.

Tests before a Liver Transplant

A series of Liver tests is crucial before a patient undergoes a Liver transplant recommended by a Liver Specialist. These tests give vital information which shows great prominence about your health and ensure compatibility with the donor organ as well as eligibility to go for a liver transplant. Below is a list of key pre-transplant evaluations:

Blood Group Matching: Ensuring the donor and recipient have compatible blood types is essential to avoid complications during and after the transplant.

Virology Screening: Tests for viral infections such as hepatitis B, hepatitis C, and HIV are mandatory for liver transplants and many other surgeries.

Computed Tomography (CT) Scan: A Computed Tomography scan gives high definition detailed images of the liver, assisting surgeons evaluate the condition of the liver and precisely plan for the transplant.

Doppler Ultrasound: This non-invasive test checks blood flow in the vessels around the transplant site to confirm proper circulation for the new liver.

Echocardiogram: An echocardiogram assesses heart function, which is critical for the success of major surgeries, including transplants.

Lung Function Tests: For liver transplant candidates, pulmonary function tests are important to evaluate lung health and working capacity.

Blood Tests: Comprehensive blood work assesses overall health, including liver and kidney function, and helps identify any underlying issues.

Cancer Screening (for liver cancer cases): If liver cancer is present, additional tests determine the extent of the tumor and its impact on transplant eligibility.

Kidney Function Tests: For kidney transplant candidates, specific evaluations assess kidney health and detect any related diseases.

These assessments are essential to ensure the best possible outcome for a transplant procedure.

Evaluation Process Before Liver Transplant

A comprehensive evaluation process before a liver transplant is conducted to determine the patient’s eligibility and assess their overall health. The process involves multiple important steps to make sure that the patient is a suitable candidate for the Liver transplant procedure.

Pre-Transplant Assessment

A thorough pre-transplant assessment is performed by a team of doctors to review the patient’s medical history, present health, and liver disease severity. Key Components here are:

Medical History Review: The transplant team examines the patient’s medical history, including the underlying cause of liver disease, previous treatments, and any other health conditions such as diabetes or heart disease that could affect the transplant’s success.
Physical Examination: An overall physical check up is carried out to assess the patient’s health and check for signs of any critical liver diseases.
Laboratory Tests: Blood tests assess liver function, clotting ability, and the patient’s overall readiness for surgery. These tests involve liver function tests, a complete blood count, coagulation studies, blood chemistry.
Imaging Studies: Diagnostic imaging like ultrasound, CT scans, or MRIs is used to examine the liver’s size, structure, and any complications such as tumors or portal hypertension.
Psychological Assessment: A mental health evaluation ensures the patient is emotionally and psychologically prepared for the challenges of the transplant and recovery process.
Cardiac Evaluation: Heart function is evaluated using tests such as electrocardiograms (ECGs) and echocardiograms to confirm the patient’s heart can handle the stress of the surgery.
Cancer Screening: Patients are screened for cancers like hepatocellular carcinoma (HCC) using imaging studies and tumor marker tests to ensure the transplant is appropriate and safe.

MELD Score

The Model for End-Stage Liver Disease (MELD) score is extremely important in determining a patient’s urgency for a liver transplant procedure. This score is calculated using specific lab result values, including serum bilirubin, serum creatinine, and (INR)- International Normalized Ratio for blood clotting. It provides details about the severity of the liver problem and ranks patients on the transplant waiting list. A higher MELD score shows significant priority for transplantation.

This comprehensive assessment is essential to identify potential risks, improve outcomes, and ensure the patient is ready for the life-changing procedure of liver transplantation.

Finding a Donor

Liver transplantation depends on the availability of a suitable donor organ, which can come from either a deceased or living donor. Finding a compatible and healthy donor is a critical part of the process. Below is an overview of the two main sources of donor organs and the key considerations involved.

Living Donors

Living donors can donate a portion of their liver, thanks to the liver’s unique ability to regenerate. Key aspects of living donor liver transplantation include:

Eligibility Criteria: Potential donors must be in good physical and mental health, have a compatible blood type with the recipient, and pass a thorough evaluation to determine their suitability for donation.
Donor Evaluation: Donors undergo extensive medical, psychological, and social assessments to ensure their safety and readiness for the donation process.
Partial Liver Donation: A portion of the donor’s liver, usually the left or right lobe, is removed for transplantation. The liver is divided into lobes and based on the donor anatomy and recipient weight one lobe is transplanted into the recipient. Both the donor’s and recipient’s livers regenerate to near-normal size over time.
Transplant Surgery: Simultaneous surgeries are performed in separate operating rooms. The donor’s liver lobe is surgically removed and immediately transplanted into the recipient after the diseased liver is removed.
Donor Recovery: Living donors typically recover more quickly than recipients. Their remaining liver lobe regenerates, and they can resume normal activities within a few weeks.

Deceased Donors

In Western countries, most liver transplants rely on deceased donors, individuals who have experienced brain or circulatory death and whose organs are made available for transplantation. In India, however, deceased donor transplants are less common.

Organ Matching: Once a deceased donor’s liver is deemed suitable, it is matched with a recipient on the transplant waiting list. Matching considers factors such as blood type, body size, and the urgency of the transplant, often determined by the MELD score. The goal is to find the best possible match to ensure a successful outcome.
Transplant Surgery: After a match is found, the recipient undergoes a thorough medical evaluation to confirm readiness for surgery. The recipient’s diseased liver is removed, and the donor liver is carefully implanted, with connections made to blood vessels and bile ducts to ensure proper function.

In India there are government organisations (eg TRANSTAN in Tamilnadu, Jeevasarthakathe in Karnataka) which over see registraion of recipients and allotment of deceased donor organs to suitable recipients

Both living and deceased donor transplants are complex but lifesaving procedures, providing patients with a chance to regain health and quality of life.

The Liver Transplant Procedure

Liver transplantation is a complex surgical process that involves removing the diseased liver from the recipient and replacing it with a donor liver. This intricate procedure requires a highly skilled surgical team and advanced medical equipment. Below is a detailed overview of the transplant process:

Steps in the Procedure

Anaesthesia: The surgery begins with administering general anaesthesia to ensure the patient remains unconscious and pain-free throughout the procedure. Anaesthesia is given to both the living liver transplant donor and the recipient.
Incision: The surgeon starts with making an incision in the recipient’s abdomen. The placement of the incision depends on multiple factors such as the anatomy of the recipient, previous surgical records, and the fact if the transplant requires a whole or partial liver.
Diseased Liver Preparation: The surgeon will disconnect the liver of the recipient from the blood vessels (hepatic artery, portal vein, and hepatic vein) and bile ducts. The surgical team assesses the liver to ensure safe removal.
Donor Liver Implantation: The liver of the donor is inspected and made ready for transplantation. In an orthotopic transplant, the new liver is placed in the same location as the original liver.
Reconnection of Blood Vessels and Bile Ducts: The surgeon meticulously reconnects the donor liver’s blood vessels and bile ducts to the recipient’s system. This includes suturing the hepatic artery, portal vein, and hepatic vein, as well as ensuring proper bile flow.
Restoration of Blood Flow: Once the vascular connections are secure, blood flow to the new liver is gradually restored. This is a critical moment to confirm the transplanted liver begins functioning properly.
Closure: After confirming the new liver’s functionality and checking for any bleeding or leaks, the surgical team closes the incision. Surgical drains may be placed to monitor post-surgical fluid accumulation.

Postoperative Care and Recovery

After the completion of the surgery, the patient is shifted to an intensive care unit (ICU) for direct monitoring. Typically, recipients stay in the ICU for a few days to ensure the liver is functioning properly and to address any immediate complications.

In the following weeks and months, the patient’s condition is monitored closely through regular follow-ups, laboratory tests, and imaging studies. Medications, particularly immunosuppressants, are adjusted to prevent organ rejection and manage complications.

Cost of Liver Transplantation

Liver transplants are highly expensive Surgical procedures because of the complexity and the resources required. Check the cost breakdown below:

Surgery and Hospital Fees: These include the surgeon’s fees, operating room charges, anaesthesia, ICU stay, and hospitalisation. Costs can differ depending on the complexity of the procedure and discharge time.
Post-Transplant Medications: Lifelong immunosuppressive medications, such as tacrolimus and mycophenolate, are essential to prevent rejection. These medications are a significant, ongoing expense.
Diagnostic Tests: Regular blood tests, imaging studies (CT scans, ultrasounds), and other diagnostic procedures are necessary to monitor the transplanted liver.
Follow-Up Care: Patients require ongoing consultations with transplant specialists to manage medications and address any health concerns.
Additional Surgeries or Treatments: Complications post-transplant may necessitate further medical interventions, adding to the overall cost.

Complications Possibility Post-Transplant

While liver transplants can be life-saving, they come with risks. Common complications include:

Rejection: The immune system can attack the new liver in the recipient’s body. Though Immunosuppressive drugs are given for prevention for this issue, regular monitoring is important.
Infections: Immunosuppressants are known to weaken the immune system, increasing vulnerability to infections. Also, these infections can range from mild to severe.
Bile Duct Issues: Complications such as bile leaks, strictures, or blockages may arise, requiring further procedures.
Vascular Problems: Issues like blood clots or narrowing of blood vessels can affect blood flow to the liver, necessitating medical intervention.
Primary Non-Function: Rarely, the transplanted liver fails to function properly, requiring urgent re-transplantation.
Side Effects of Medications: Immunosuppressants may cause kidney problems, high blood pressure, diabetes, or increased vulnerability to infections.
Metabolic Concerns: Some patients may develop high cholesterol, weight gain, or bone density loss.
Chronic Rejection: Over time, the liver may be gradually rejected, leading to decreased function and potentially requiring re-transplantation.
Emotional and Psychological Challenges: Patients often face emotional stress and challenges adjusting to a new lifestyle. Psychotherapists and mental health experts can assist the patient in this critical phase.

Conclusion

Despite all the potential complications, liver transplantation is a highly effective treatment, significantly enhancing quality of life and survival rates for many patients. Human liver is the most vital organ of the body so it’s necessary to safeguard it at any cost. The liver transplant process can be expensive and challenging but the major benefits involving long life and better life quality, are super important. With continuous advancement in medical technology, the area of Liver transplantation is evolving at a rapid pace providing more life-saving opportunities for people in the near future.

If you are looking for the Best liver transplant in India, contact our Liver Specialist and Founder, Dr. Hemamala Ilango of The Liver World today.

Liver Transplant in India – A Complete Guide