Liver transplantation is the process of replacing the diseased liver with a healthy liver from another person (allograft). Orthotopic transplantation is the most common liver replacement technique wherein the recipient’s liver is removed and replaced with the donor liver in the same anatomical location as the original liver.

Today, liver transplantation is considered a viable treatment option for various end-stage liver diseases and acute liver failure.

Liver transplantation is considered to be a life-saving procedure as it successfully addresses some of the major life-threatening liver conditions. For example, liver cirrhosis was once considered a terminal disease; however today, timely intervention can treat it successfully.

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When is Liver Transplantation Necessary?

At HCG, each patient is assessed before the specialists devise personalised treatment plans to restore the liver functions. The transplant assessment is necessary for the specialists to determine if the patient requires a transplant. The assessment comprises extensive medical tests and treatment planning discussions among the patient, caregivers and the transplant team. Apart from this, a general check-up is also conducted to study the patient’s existing medical conditions and their impact on the planned transplantation.

At HCG, every treatment or intervention we plan not only treats the patient’s condition but also preserves his/her quality of life.

Diseases that Cause Liver Damage

Liver transplantation becomes necessary in the case of both acute and chronic liver failure. Following diseases causes damage to the liver:

• Hepatitis B
• Hepatitis C
• Chronic alcohol consumption
• Non-alcoholic steatohepatitis ( Fatty Liver )
• Autoimmune disorders
• Cryptogenic Cirrhosis
• Hemochromatosis
• Drug-induced liver damage

In addition to liver failure, liver cancer may develop as a result of many of these diseases. There are also cases of sudden liver failure, with unknown causes, called acute or sub-acute fulminant liver failure. In these cases, liver transplantation may become necessary

Types

Liver transplantation is classified into two types based on the donor:

1. Deceased Donor Liver Transplantation (DDLT)

For transplant from a deceased donor, the patient has to be listed as per his/her blood group by the Zonal Coordination Committee, which is responsible for fair distribution of cadaver livers among those hospitals offering liver transplantation facilities. When the liver is available, the hospital will inform the patient accordingly and upon the patient’s consent, the expert team will prepare for the transplantation.

The waiting periods are usually as long as a few months. Unfortunately, patients with hepatocellular carcinoma (HCC) cannot wait this long due to the aggressiveness of the disease. In cases like these, when donors are not available, the specialists delay the disease progression through minimally-invasive procedures, such as TACE, TARE or RFA.

In a few cases, the liver is harvested from a brain dead donor, whose family is willing to donate the organ. The liver harvested this way is transplanted to the suitable candidate. Usually, the whole liver is transplanted to a single recipient or it could be split into two parts to help two patients.

2. Living Donor Liver Transplantation (LDLT)

Living Donor Liver Transplant is a type of liver transplantation wherein a part of the liver from the living related donor is removed and transplanted to the patient looking for liver transplantation.

These transplants are as successful as deceased donor liver transplants. They also reduce the risk of health deterioration and death for patients who would otherwise have to wait on the list for the next available deceased donor organ.

Advantages of Living Donor Liver Transplantation

• The recipient receives an organ with excellent graft function
• This procedure reduces recipient waiting time for liver transplant
• It helps the team to plan the transplant before the recipient’s health deteriorates further
• It reduces the risk of death for the patient while waiting for a suitable donor

Disadvantages of Living Donor Liver Transplantation

• Placing an otherwise healthy individual (the donor) at risk
• Risk of other health complications

Assessment of Living Donor

Potential donors have to undergo a thorough evaluation conducted by the transplant team. The evaluation involves a series of blood tests, imaging tests like ultrasound, X-rays, etc., and consultations with a specialist for sufficient information about the procedure.

• Donors must be in excellent physical and emotional health
• Donors should not have any history of cancer, or any active infection at the time of donation
• Donors must have normal and healthy liver function
• The blood vessels to the liver and bile ducts in the liver must be suitable for transplantation. (This is determined by a Contrast-Enhanced CT scan of the abdomen and MRCP)
• Donors should have caregivers, family and friends who can support them before, during and after surgery

Guidelines for Living Donors

• The living donor must be aged between 18 and 50 years
• Should be a blood relative or spouse of the recipient (HLA typing is routinely performed for assessing the relation). First-degree relatives can get clearance for the donation from a committee within the hospital. However, any second-degree relative should have to get a clearance from the state government. The transplant coordinator will assist the family by providing guidance, but it should be noted that the onus of obtaining the clearance rests solely with the family and the team will not be involved in obtaining the same.
• Living donation must be completely voluntary
• Donor safety is the priority during assessment & donation
• It is the donor’s responsibility to communicate if there are any concerns or issues that need to be addressed regarding the assessment or he/she has a change of heart and does not want to donate
• At any point, if the surgeon feels that the donor may not be a suitable candidate, he will not go ahead with the procedure as the donor’s safety is paramount.
• Once the tests and consultations are completed, the transplant team will meet to review the results. If there are no contraindications, the recipient is prepared to go forward; otherwise, he/she will be placed on the waiting list for a liver transplant.