Overview : 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:
Alcoholic liver disease
Fatty liver disease or Non-alcoholic steatohepatitis
Previously failed liver transplant
Alpha 1 Antitrypsin deficiency
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:
Forwarding letter by the Processing Consultant
Authorization Committee Approval Letter
No Objection Certificate from the Embassy/District Hospital
Affidavit on stamp paper along with an attested photo of the recipient signed by SDM/DM/Embassy
Affidavit on stamp paper along with an attested photo of the donor signed by SDM/DM/Embassy
Affidavit on stamp paper along with an attested photo of the Donor’s close relative signed by SDM/DM/Embassy
HLA/DNA typing results displaying the relationship in the case of parents and siblings
Donor and Recipient Performa
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
Form 4 (Psychiatric Evaluation of the donor) to be complied by the Processing Consultant and the surgeon
In the case of Spousal donor, form-6 is to be filled by the competent authority
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
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
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
Donor’s Blood Group
Recipient’s Blood Group
O, A, B, or AB
A or AB
B or AB
The donor’s evaluation process is done in four different phases which is as follows:
Liver function tests
Evaluation of other organs
Evaluation by specialists
Liver fat estimation
Anatomy of liver blood vessels
It also includes HLA testing and matching to be performed before the authorization committee meeting.
Along with the above-mentioned process, the patient and the family has to deal with the treatment emotionally, mentally, and financially. Therefore, they must be strong enough to deal with such a situation.
Alternatives If The Patient Does Not Find A Suitable Liver Donor
If the patient does not find a suitable donor, then he/she has to be in a waiting list to wait for a deceased donor. However, the patient may benefit from one of the following procedures:
Dual Lobe Liver Transplant
ABO Incompatible (ABOi) Transplant
It is considered when the patient’s family member is up for donation but is not a good match.
When the donor’s liver volume is inadequate enough for the recipient, then the option to hunt for another donor is on.
This transplant is rarely performed as it triggers the production of antibodies against the transplanted liver causing organ rejection.
In this process, two families exchange their donors as they are not suitable for their own patient and appropriate for another family’s patient.
It happens when two or more people are rejected for donation due to low liver volumes, however, found suitable, then their partial livers from both donors are combined.
However, immunosuppressants can be used to reduce the chances of organ rejection.
It is commonly done in case of a blood group mismatch.
It is complex and is performed at a few centers.
In kids, the antibodies levels are low and hence, this transplant can bring better results.
Both transplants are performed simultaneously.
The process involves three surgeries (one recipient and two donors) and is performed simultaneously.
Risks And Complications: Post-Liver Transplant Management
Out of all risks and complications, there are two major complications that need to be taken care of and they are:
– The immune system tries to attack the transplanted liver as it can not differentiate between the transplanted liver and unwanted bacteria and viruses. This episode is organ rejection.
– More than 30 percent of liver transplant patients experience some degree of organ rejection in the first year.
– Therefore, the doctors prescribe anti-rejection medications or immunosuppressants to avoid organ rejection if the immune system attacks the transplanted organ.
– As the anti-rejection medications suppress the immune system, liver transplant patients become prone to infections.
– Sometimes, these infections go away on their own.
– Some patients do not experience any infection at all, while in other cases, infections are treated successfully as they are diagnosed.
What Factors Influence Liver Transplant Costs?
The cost of liver transplantation in India is half of the cost in western countries. There are several reasons that convince people to choose India for their medical treatment. Other than cost difference, the quality of healthcare services is another reason.
Talking about liver transplantation in India, the following factors account for the cost of this surgical procedure:
Location and position of the healthcare institution, hospital, treatment center, etc.
Diagnostic tests, laboratory tests, etc.
Availability of donor: live or deceased
Food, accommodation, and other basic amenities
Anti-rejection medications and other drugs
Physical therapy and rehabilitation
Ethics Committee Approval
All of the above-mentioned factors make liver transplantation expensive. However, if you compare the cost of treatment in India with other western countries, then the treatment is quite cost-friendly.