Liver Transplant India

What is the function of Liver?

Liver is the largest gland of the body and is the largest internal organ in the human body. It is the second largest organ after the Skin, usually the human skin weighs around 10 kilograms as compared to an average liver size of around 1.5 kilograms. At anytime the liver contains around 10 per cent of the blood in the body, and it pumps around 1.4 liters through every minute. It is situated in the right upper part of the abdomen, just below the right side of the diaphragm (a structure that separates the chest cavity from the abdominal cavity). Liver is one of the vital organs of the body (a “vital organ” is one whose malfunction will lead to imminent death if the function of that organ is not supported otherwise) known to keep the body clear of harmful substances and toxins. It is also responsible for metabolizing drugs and medicines and at times this function is used to activate molecules in drugs which then provide medicinal properties after their conversion in the Liver.

Apart from detoxification, the Liver is responsible for producing Bile which is required for fat digestion, stores Iron and some vitamins including Vitamin K in the body, destroys old blood cells, stores sugar glucose, converts stored sugar to functional sugar (during low blood sugar levels), breaks down hemoglobin, breaks down insulin and preforms the vital metabolic function of the body of converting ammonia to urea. Liver is such an important organ as it has multi-functional roles and performs over 500 different functions including fighting infections, neutralizing toxins and clotting of blood.

Interestingly, Liver is the only organ that regenerates or grows back thus making it possible for one person to donate part of their liver to another person (as little as 25 per cent can regrow into a whole liver, all this in 30 days), a principle behind living donor liver transplants.

What are the most common causes of Liver Diseases?

Though common causes for Liver ailments vary with geography, age and race but the most common causes can be broadly summarized as follows:

Infective: these include viruses especially Hepatitis B and Hepatitis C. Hepatitis A is also known to cause long standing liver sequelae in children, where as Hepatitis E is the most common cause of Acute Liver Failure in some endemic parts of India

Alcohol-related: Long term consumption and abuse of alcohol is one of the most common causes around the world including in India where it is the most common cause. Though the liver condition is reversible and would improve upon abstinence but once stage of cirrhosis is reached then the liver damage and scarring is irreversible.

Non-Alcoholic Fatty Liver: a condition in people who consume little or no alcohol may develop progressive accumulation of fat in the liver, eventually leading to liver failure. One of the most common causes in India, most people suffering from this condition, have no symptoms and essentially have a silent liver disease till they reach the stage of irreversible Liver Failure.

Inherited or Congenital: conditions acquired due to the genetic composition or present since birth constitute a small percentage overall but form a large group in children. Some common conditions include Hemochromatosis (a genetic condition where there is gradual build-up of iron in the body especially around the liver eventually leading to organ failure), Primary Biliary Cirrhosis (a congenital condition associated with damaged bile ducts in the liver and may require surgical correction), Budd-Chiari Syndrome and Wilson’s Disease.

What are the symptoms of Liver Disease?

Like many other diseases of the body, Liver Disease often may produce no or generalized symptoms, at least not initially making early diagnosis in these conditions difficult. The symptoms may occur slowly and worsen or emerge suddenly and be severe. A person suffering from Liver disease and Liver malfunction may experience the following early symptoms:

  • Nausea or vomiting
  • Loss of Appetite
  • Fatigue – compromised liver function can greatly reduce the level of available energy, making it extremely difficult to complete one’s day. Caffeinated drinks like coffee only worsen the symptom and having water, fruits and proteins may help.
  • Diarrhea

As liver failure progresses the symptoms worsen and routinely require medical intervention or may lead to life threatening conditions. These symptoms are as follows:

  • Jaundice (skin and eyes turn a yellow hue, eventually with severe jaundice palms and soles are also having this yellow discoloration)
  • Bleeding Gums and tendency to bruise easily – this happens due to Vitamin K deficiency and reduced platelet counts
  • Swollen and painful abdomen
  • Swelling of legs and ankles
  • Itchy and scaling skin
  • Dark urine color
  • Pale stool color or tar-colored or bloody stools
  • Blood in vomiting
  • Sleepiness
  • Frequent infections and or fever
  • Muscle wasting and weight loss
  • Mental disorientation or confusion (known as Hepatic Encephalopathy)
  • Unconsciousness or Coma (known as Hepatic Coma)

What is Liver Failure or Hepatic Insufficiency?

Liver failure, also known as hepatic failure or hepatic insufficiency, is a condition where the liver fails to function or perform its physiological functions. The liver failure may happen over days to weeks known as Acute Liver Failure or over a period of weeks to months known as Chronic Liver Failure.

A diagnosis of Cirrhosis means that the person is in the final stage of chronic liver failure and the liver is not functioning well enough to meet the needs of daily life. Cirrhosis is a slow progressing liver condition marked by repeated fibrosis and regeneration eventually replacing healthy liver tissue with scarred tissue leading to compromised liver function and eventual Liver Failure. This kind of liver failure is permanent. It cannot be reversed or cured and can only be managed by Liver Transplant.

What are the treatment options available for Liver Failure?

The mainstay of clinical management or treatment of Liver Failure, especially in the early stages is to address causative agents like alcohol dependency treatment, addressing obesity and anti-viral therapy and management of complications like portal vein hypertension and esophageal varices. There is no cure for Liver Failure unless Liver Transplant is considered and the quality of life and overall clinical outcomes are superior if it is chosen early in the disease.

Is there Liver Dialysis to manage Liver Failure like Hemodialysis is used in Kidney Failure?

Dialysis is a treatment modality for Chronic Kidney Disease or End Stage Kidney Disease but the same is used in very specific conditions when it comes to Liver Failure. Further, Hemodialysis is used to remove water soluble nephrotoxins whereas in Liver failure there is excess protein soluble toxins which require other forms of Dialysis.

Liver dialysis allows blood to be removed from the body and pumped through a set of filters to purify it. The procedure can last anywhere between 5 to 6 hours. Unlike hemodialysis which is for life (or till transplant), Liver dialysis is required to tide over the acute liver failure phase. At times, one requires only one or two sessions because the therapy aids in restarting the damaged liver.

Molecular Adsorbents Recirculating System (MARS®) is one of the types of Liver Dialysis which aims at stabilizing the patient and supporting the liver by mimicking the detoxification function of the liver until the liver regenerates, or until a liver donor is found. It is the only FDA approved treatment modality for Acute Liver Failure and clinical trials are ongoing to assess its effectiveness in Chronic Liver Failure.

What is Liver Transplant in India?

A liver transplant is a complex surgery where the patient or recipient’s liver is replaced with a healthy whole liver from a deceased donor or with part of a liver from a living donor. The living donor transplant is superior to the deceased donor transplant and the former is more commonly performed in India. The most common cause for a liver transplant is Cirrhosis and the other cause being Hepatocellular Carcinoma (HCC).

Patient for liver transplant undergo extensive testing to determine whether they are healthy enough to have a good outcome following surgery.

Additionally, some period of alcohol abstinence is required for people with alcohol-related liver disease prior to the transplant. This fact is also verified and asked during authorization committee proceedings and has a bearing on it’s outcomes.

Liver transplant is essentially of two types deceased-donor transplant (formerly known as cadaveric) or living-donor transplant depending on the source of the donor organ. In Deceased Donor Transplant, there is a huge waiting period and sometimes the patients succumb to the disease before getting the Liver. Living Donor is more complex than Deceased Donor but in India, the surgeon especially in Northern part of India have mastered this surgery and are known as the leaders in Living Donor transplants the World. There success rate of the transplants succeeds those of their US and UK counterparts. In a Living Donor transplant there is no waiting time and success rates are higher than in deceased donor transplant, especially if the donor is a first degree blood relative. The success is maximum with a sibling donor.

What are the advantages of Living Donor Liver Transplant over Deceased Donor Transplant?

Liver donor transplant can be scheduled at the convenience of both receipt and donor.

Flexible scheduling allows the transplant to occur sooner than in case of a Deceased Donor transplant. This saves valuable time that would otherwise be spent on the liver transplant waitlist and reduces the risk of fighting complications of the liver disease.

Because they are receiving a portion for a healthy donor's liver, recipients have improved long-term outcomes and quicker recovery times (as the living donor Liver kicks in to action faster than a deceased donor).

How is Liver Transplant in India different from Liver Transplant in Singapore or Liver Transplant in Thailand or Liver Transplant in Korea?

First and most importantly, India boasts of the highest number of Solid organ transplants (which includes Liver, Kidney, Heart and Pancreas) in the World. The clinical outcomes with most of these organ transplant programs in India are either at par with the World’s best outcomes or better than them.

Another important advantage that Liver Transplants in India have is the Cost Advantage. In South Korea one would spend 27.7 times more on Healthcare than in India. In a similar comparison, one would spend 39.5 times more in Singapore and 5 times more in Thailand. With at par and at times superior clinical outcomes, it is short of foolish to choose these other countries over India for Liver Transplant and Kidney Transplant.

Lastly and most importantly, India has the most skilled and most experienced transplant surgeons when it comes to Live Donor Transplant (which is far superior and more complex than Deceased Donor Transplant) and one doesn’t need to wait in queues of organ registry for Live Donor Transplant and results in a longer post-transplant life. So without doubt one should choose India as their destination for liver and kidney transplantation.

What are the advantages of getting a transplant done through MedMonks?

MedMonks helps patients choose amongst the best and most experienced Transplant Surgeons with the most cost effective transplant packages. As Transplants in India are governed by the The Transplantation of Human Organs Act, 1994 and its amendment in 2008, we help all our clients go through this process smoothly and without any surprises which are very common if one is unaware and inexperienced.

We have been part of a number of Transplant Authorization Committees and know what are the requirements as well as precautions we need to take including complete documentation which ensures our clients get timely clearance and have a comfortable experience.

Further, MedMonks gives a number of advantages to its patrons including:

  • 24x7 Support
  • Associated with only Verified & Accredited Hospitals
  • Leading & Highly Experienced Doctors on Panel
  • Transparent Process
  • Travel Desk assisting in Visa, Airline Tickets, Hotel Bookings etc.
  • Personalized Services like interpreter, forex, on-ground logistics and treatment/ intra-hospital coordination
  • Health Insurance and Medico-legal advice

What is the process of Liver Transplant in India?

The process starts in the home country itself, with choosing potential donors and if possible getting their basic screening done which includes blood profile, blood grouping, kidney function test and urine tests.

It is ideal to choose between 2-3 potential donors as last minute rejection of candidate by Transplant team should not lead to process breakdown. Further these potential donors should be blood relatives like siblings, parents or children (above 18 years of age) or the spouse.

Following this a set of documents are to be prepared which would require visits to your local governing bodies, your embassies etc. Apply for Medical Visa (Med) and your one potential donor will have to apply for Medical Attendant Visa (Med-X).

Upon arrival in India, the patient and medical attendants undergo a series of tests and diagnostics to determine donor match and pre-transplant workup. DNA HLA match is also conducted for the Authorization Committee for related cases (if spouse is the donor, then a child/ issue also needs to be brought along for this testing).

The Authorization committee generally reviews the case within one week of arrival and the results are available within 24 hours of the review. The surgery is generally planned as soon as possible. The stay within the hospital for donor is about 4-5 days and patient is around 8-10 days.

They stay in India for another 10 days for review and follow-up and can fly back after that.

We at MedMonks also ensure post treatment long-term follow-ups for patients in their home country through local clinics and tele-medicine.

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