The liver, the largest internal organ in the human body has an interesting facet to it. It is the only organ that can regrow even after a section of it is removed. This organ has the ability to grow to its normal size in just a couple of months. It performs multiple functions. Hence, it is impossible to live without a well-functioning liver. Therefore, in cases of a liver failure doctors recommend a liver transplant surgery.
Liver transplantation is a surgery performed to replace a diseased or damaged liver with a healthy liver. In a liver transplant surgery, the diseased liver is replaced with a healthy liver from a deceased or a living person. Very often, a liver transplant is the only option for the long-term survival of a person with liver failure. Not only adults, but children may also need a liver transplant.
Need for Liver Transplant
A liver transplant is required for people with liver failure and whose condition cannot improve further with other treatments. It is also required in selected patients with liver cancer. The most common indication of liver transplant is liver cirrhosis or the scarring of the liver. When a person is diagnosed with liver cirrhosis, scar tissue replaces his normal liver tissue. This results in the malfunctioning of the liver.
Liver Transplant in Children
The most common cause of liver transplant in infants is biliary atresia. The symptoms become evident in infants about two-eight weeks after birth. In this medical condition, the bile ducts carrying the bile from the liver to gall bladder are underdeveloped. The bile is then trapped in the liver and causes rapid damage to the liver and scarring of liver cells. This eventually leads to liver failure and thus necessitates a liver transplant. This condition can be corrected only after transplant surgery.
Liver Transplant in Adults
A liver transplant in adults is required when patients develop cirrhosis and starts having complications of cirrhosis like – ascites, oedema, blood vomiting, change in mental state etc.
The common causes of cirrhosis are –
- Hepatitis B virus – This is an infection of the liver caused by the Hepatitis B virus (HBV) that causes both acute and chronic liver disease. It is most commonly transmitted through contact with blood and other body fluids. If untreated, it can cause liver cirrhosis and even liver cancer.
- Hepatitis C virus – This is yet another viral infection afflicting damage to the liver by causing inflammation. Inflammation is a swelling of the tissues when they are injured or infected. This is also transmitted through blood or body fluid.
- Non-alcoholic Fatty Liver Disease – A medical condition that occurs when too much fat accumulates in liver cells. This is due to causes other than the consumption of alcohol. Resistance to insulin leads to too much fats in the liver.
- Primary Biliary Cirrhosis – Now known as Primary Biliary Cholangitis (PBC) is a type of chronic liver disease where there is a build-up of bile in the liver. It is an autoimmune disease of the liver resulting from slow, progressive destruction of the small bile ducts of the liver.
- Primary Sclerosing Cholangitis – This condition is a chronic inflammation of the liver which over a long period results in liver failure.
- Liver Cancer – This cancer begins in the cells of the liver. Among the various types of liver cancer, hepatocellular carcinoma is the most common.
- Autoimmune Hepatitis – In this condition, the body does not recognize the liver as its own and attacks the liver tissues. It is a chronic condition which can lead to cirrhosis and finally to liver failure.
- Metabolic Diseases related to the liver – These are genetic diseases of the liver, where the organ is unable to process fats, proteins and carbohydrates. These diseases result from disorders in children from birth. Some of the following conditions related to the liver that necessitate a liver transplant are Primary Oxaluria, Familial Amyloidosis, 1-Antitrypsin Deﬁciency and Wilson’s disease amongst others.
- Acute Liver Failure – In certain condition there can be a sudden onset liver failure due to a drug overdose such as Acetaminophen or viral infections like hepatitis A or E. If the liver does not recover spontaneously then patient may require liver transplant.
Types of Liver Transplant
- Deceased donor liver transplant – the recipient of a liver transplant receives a liver harvested from a deceased person. The donor, in this case, is a person who is declared brain dead.
- Living Donor Liver Transplant – In this surgical procedure, a living, healthy person donates a portion of her/his liver to the candidate in need of a liver transplant. The remaining section of the donor’s liver and the transplanted section then regrow to a normal-sized liver.
- Split Donation – In this case, the liver is harvested from a deceased person and is split into two pieces. Each piece is then transplanted into different candidates from where they grow into a regular size.
- Receiving Two Organs – Here, the candidate receives both, a liver and another organ in a single surgery. This is done when the patient is suffering from multiple organ failure and is in need of organs to help restore her/his quality of life.
- Auxiliary Partial Orthotopic Liver Transplantation (APOLT) – In APOLT, surgeons remove a part of the diseased native liver and attach a partial donor liver to it. This donated portion of the liver supports the patient during recovery of native liver.
Liver Transplantation Surgery in India
The Transplantation of Human Organs Act was passed in India in 1994 to regulate organ transplantation in the country. The first successful Deceased Donor Liver Transplant (DDLT) and the Living Donor Liver Transplant (LDLT) were performed in 1998. Interestingly, the Act also allows foreigners to undergo a liver transplant in India, provided there is no eligible Indian candidate for the deceased donor organ.
Over the years, India has emerged as a regional centre for liver transplants (LT) in Southeast Asia. As per a research paper published in April 2016, it is estimated that 35% of living donor liver transplants are performed on patients from Burma, Nepal, Pakistan, Maldives, Sri Lanka, Africa and the Middle East. The liver transplant success rate in India is 90%-95%, at par with some of the best centres in the World.
Given the success rate of liver transplants and the availability of best liver transplant surgeons in India, many hospitals offer liver transplant procedures. Besides, the procedure is available at a fraction of the cost charged in the US, UK and other European countries. Typically, a liver transplant procedure for foreign national takes place as follows:
- Most of the liver transplant for foreign national is done in the form of living donor liver transplant due to shortage of cadaveric organ in the country.
- The candidate identifies a donor, preferably a first or second degree relative. The hospital does not arrange for a donor. Also, no candidate should undertake the commercial purchase of an organ. She/he should not make/receive payment for the purchase/sale of the organ. For a liver transplant to take place, the donor’s blood group should be compatible with that of the candidate, she/he should be in overall good health and physical condition and be over 18 years and up to 55 years of age.
- Both the donor and recipient are evaluated in detail about their suitability for major surgery.
- They are also assessed by the ethics committee which is an independent committee and makes sure that donor is donating organ with his or her own will and there is no foul play.
- In case of an LDLT, both the donor and candidate will be in the operation theatre.
- A liver transplant will take more than 6 hours.
- After surgery, the patient is kept under observation in the ICU before being shifted to the ward.
- After an average stay of two-three weeks in the hospital, the patient is allowed to go home. She/he will be handed a discharge manual, a manual of instructions to be followed at home.
Liver transplant surgery in India is extremely affordable. To speak with our patient care expert about Liver Transplant surgery, drop an email to email@example.com or Call/IMO/WhatsApp/Viber on +91- 9769516280.
Reviewed by Dr. Rakesh Rai. MS, FRCS, MD, CCT, ASTS Fellow (USA).
Senior Consultant HPB & transplant Surgeon.