Living donor liver transplant providing new lease of life to liver failure patients

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By: Prof (Dr.) Subhash Gupta

It is important to note that there is a huge burden of liver diseases in our country, and for those who develop end-stage liver disease, the only definitive treatment is a liver transplant. However, there is a huge scarcity of brain-dead organ donors in our country due to a lack of awareness. In such circumstances, living-related organ liver donors remain the only feasible option.

While Hepatitis B, Hepatitis C, Alcohol and Non-alcoholic fatty liver disease are among the top causes of chronic liver disease in the country, the other causes include autoimmune liver disease (as in this lady), which if not diagnosed and treated early, can lead to end-stage liver failure necessitating a liver transplant.

People should be aware that even patients with advanced liver failure can undergo liver transplant surgery as a life-saving procedure in highly specialized hospitals having excellent outcomes and better quality of life. When a potential cadaver liver is located, it is offered to recipients who are blood group compatible. A list of recipients awaiting a liver transplant is maintained by transplant centers and a suitable recipient is selected from such a list.

Living donor liver transplantation actually involves two operations that proceed almost simultaneously. In the donor operation, a part of the liver is surgically removed taking utmost precautions to avoid any damage to the donor. Upto 70% of the liver can be removed safely without impairing the donor. The remaining liver regenerates to its original size in 4-6 weeks’ time.

The liver patient is wheeled into the operating room at the same time. The diseased liver is completely removed and the donated liver is put inside the recipient’s body. The blood supply to the new liver is restored surgically and bile ducts (which carry bile from the liver to the gut and help in maintaining multiple body functions) are joined.

In India where living donor liver transplantation is the main mode of liver transplantation, a ‘match’ implies that a person related to the patient has voluntarily agreed to donate a part of his liver to the recipient. The donor then undergoes a series of tests to ensure compatibility with the recipient, and most important tests to assess his/her fitness for surgery. For living donor programs, the safety of the donor is of paramount importance. (The author is the Chairman, Centre for Liver & Biliary Sciences, Max Hospital Saket, New Delhi)

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