Liver Transplant Cost in India

The initial cost of a liver transplant in India is USD 20000. According to a study, patients who have undergone liver transplant have a survival rate of 89% after one year and 75% after five years in India. Liver transplants are generally successful and people can return to their normal activities. It can take a year or more for a full recovery.

What is a Liver Transplant?

The liver is the largest internal organ that has crucial functions that include the production of bile, processing of nutrients, absorption of fats, synthesizing proteins that help in clotting, removal of toxins and bacteria from the blood, and regulation of immune action. A liver transplant surgery is performed to remove a non-functional and damaged liver with a healthy and functional liver or a part of that liver from a living donor. This surgery is usually done as a last resort for patients who have severe complications because of last-stage chronic liver disease. It can be done in some rare cases of sudden liver failure, which was a healthy liver once.

Cost of Liver Transplant in Renowned City of India

Types of Liver Transplantation in India and Their Cost

Orthotopic Transplant: it is the most commonly performed surgery. In this, the entire liver is taken from a deceased donor who has passed recently and has no transmissible cancers or illness that may be transferred to the recipient. In this, an incision is made over the abdomen and the damaged or diseased liver is removed. Then the healthy donor liver is placed in the recipient and the bile ducts and blood vessels are connected. The incision is stitched back up with surgical staples or dissolvable stitches. To drain excessive fluids, drainage pipes or tubes are attached and are left for several days following the surgery. The starting cost for an orthotopic liver transplant is USD 30000-40000.

Living Donor Transplant: This means that the donor is alive and is willing to donate a part of their liver. They are operated on first as only a part, the left or right lobe of their liver is taken. The right lobe is larger and is recommended for adults whereas the left is smaller and is used for children. In this, the recipient’s liver is removed and then, the donor liver part is replaced with it. The biliary ducts and blood vessels are connected. After the transplantation, the placed lobe rapidly regenerates itself. Also, the removed part from the donor grows back. In the recipient, the new lobe grows to 85% of the actual liver size in a week. The starting cost for a living donor liver transplant is USD 23000-35000.

Split type Liver Transplant: In this, the liver from a recently deceased donor is transplanted to one or two recipients. The donor’s liver is divided into a right or larger lobe and the left or smaller lobe. The donated liver regenerates and grows to its original size. Only the livers obtained from younger, more healthy, and slimmer deceased donors are considered and examined for split liver transplantation. The starting cost for a split-type liver transplant is USD 30000-40000.

Auxiliary Liver Transplantation: In this, the entire recipient liver is not removed. This is done to preserve the original liver in case of rapid recovery or for the future possibility of gene therapy (metabolic or hereditary diseases except Wilson’s disease or cancer).

• Hepatectomy – the liver is surgically resected in this. The tumors are removed from the cells of the damaged liver, called the hepatocytes, in cases of liver cancer which does not spread to other regions of the body.
• Combined liver and bile duct resection – this procedure is done to remove tumors that are located high in the bile ducts. The gallbladder and the common bile duct are removed. Later a small part of the small intestine is attached directly to the remaining portion of the bile ducts. Hence, the bile flows from the liver to the small intestine directly.

Pre and Post Medical Tests for Liver Transplant

Pre-medical testing begins with the recipient’s examination. When the patient is found suitable for transplantation, potential donors in the family are tested accordingly. If no one in the family is suitable for transplant surgery, the patient is registered on the waiting list for deceased liver transplantation. This assessment lasts for 7-10 days.

>>Pre Tests

• ABO-Rh blood typing– the recipient’s blood group is tested with the donor’s blood group to determine if it is a match, based on A, B, O, and AB blood groups. The cost range is USD 3-5.
• Organ and blood function tests– Liver Function Test (LFT) and Kidney Function Test (KFT) are done to check the functionality and overall health of the enzymes, proteins, etc. synthesized by the liver. Complete a Blood Count test (CBC) to check the possibility of infections and clotting action.  The cost range is USD 8-20.
• Infectious diseases– Viral disease testing for HIV, Epstein-Barr, hepatitis B, hepatitis C, and Hepatitis C are done to make sure there are no additional infections. The cost range is USD 2-6.
• Antibody testing– Complexes called antibodies form when there is a wrong blood transfusion or foreign cells enter the body. It is necessary to test these before transplantation, if formed later, the donor liver may be rejected. The cost range is USD 8-12.
• Other tests like Serum sodium levels, Calcium, and Vitamin D levels, Creatinine Clearance, Urinalysis, etc.
• Electrocardiogram (ECG) is used to examine cardiac arrhythmias, cardigan ischemia, etc.  Cardiac stress testing is done to test Coronary Artery Disease (CAD) for patients over 40 years. The cost range is USD 2-6.
• A CT and/or MRI scan is done to examine the anatomy of the patient’s liver and how the blood vessels are attached to the liver. Sometimes the scan can identify the stage of cancer and ensure that cancer falls in the transplantation criteria. The cost range is USD 30-80.
• Doppler Ultrasound is performed to view the blood flow from and to the liver and to detect any abnormalities like masses or lumps. The cost range is USD 50-80.

>>Post Tests

The recipient’s immune system tries to reject and destroy any foreign object that enters the body. Immunosuppressive medicines are given to minimize this immune action. Regular check-ups are required after a liver transplant for some time. The post-operative recovery period is approximately 15-20 days.

• Blood Tests– Liver function tests are done to check the functionality of the transplanted liver in the recipient’s body. The cost range is USD 10-20.
• Ultrasound– If there are abnormalities in the blood tests, the doctor may suggest an abdominal ultrasound. This is performed around 3 months after the liver transplantation. The cost range is USD 50-80.
• Liver Biopsy– It is performed in response to access changes in the enzymes of the liver and/or abnormal image results. The cost range is USD 100-150.

Factors Affecting Liver Transplant Cost in India

• Currency: the major factor affecting liver transplant is the less value of Indian currency. Hence, liver transplants in India are cost-effective.
• Hospitals: Indian hospitals are remarkably efficient in delivering excellent medical treatments. Some hospitals provide liver transplants at subsidized rates.
• Doctors: The doctors in India are one of the leading doctors in the world who practice in renowned hospitals in the country. Doctors here have a lower fee.
• Location and status of the hospital: Excellent facilities are available in both private and public hospitals. However, there is a longer wait in public hospitals. If patients have an urgent liver transplant, they can opt for private hospitals. The best hospitals in India are located in cities like Delhi, Chennai, Mumbai, Hyderabad, and Bangalore.
• Age: Liver Transplant is a complex procedure and is usually performed in older patients who suffer from chronic liver disease or acute liver failure. It may be required for some infants suffering from diseases like Wilson’s disease, Cholestatic disorders, etc. The younger patients require more elaborative treatment.
• Pre and Post-Treatment Medications: The recipient’s body is made a receptacle to the donor’s liver, a foreign organ, through long-term anti-rejection medications. Apart from the surgical procedure, the pre and post-examinations are charged separately.
• Rehabilitation and Physiotherapy: These may help patients with liver diseases and transplants to improve their quality of life through muscle strength improvement that prevents exertion and increases aerobic capacity.

Cost Comparison of Liver Transplant with other Countries

Factors affecting The Cost in Other Countries for Liver Transplant

• In some countries, there can be a cultural prohibition against deceased donor liver.
• Some countries may not have an organized priority system. MLED scores play a major role in liver transplant surgeries.
• Some countries may fail to deliver universal healthcare for patients that do not cover physician fees, the cost of the surgery may be fixed, etc.
• Many countries may not have provisions for surgeries on specific diseases like alcoholic hepatitis
• In some countries, there may be low availability of living donors due to small family size and low consent rate

Success Rate of Liver Transplant in India

If one is suffering from liver failure, the doctor may recommend a liver transplant. It is an efficient treatment for increasing one’s years of survival after liver failure. Out of every 100 liver transplant patients, 95 patients survive and live a normal healthy life. Usually, patients recover within 3-6 months after surgery.  The survival rate of these patients after one year is 85% and 76%  after three years of surgery. The survival rate is about 65-70% after fifteen to twenty years after the transplant.

Top Hospitals for Liver Transplant in India

>>Delhi

Fortis Hospital, Shalimar Bagh

Fortis Hospital is one of the best hospitals for liver transplant surgeries. It is a multispecialty facility with advanced technologies and approximately 262 beds. It is credited with certifications from ISO and NABH. The hospital provides translators for international patients. A team of expert surgeons, hepatologists, dieticians, and psychiatrists provides excellent treatment to the patients.

Indraprastha Apollo Hospital

Indraprastha Apollo Hospital treats over 200,000 patients every year and provides 7000 beds. Hospital credentials include JCI, ISO, and NABH due to its exceptional healthcare services. The department of Gastroenterology and Hepatology offers Minimally Invasive Surgeries, Colonoscopy, and Endoscopic Ultrasonography for liver diseases.

>>Chennai

MGM Healthcare

MGM Healthcare holds certifications from NABL, NABH, and JCI. It is a super specialty hospital with highly trained surgeons who perform liver transplant and a variety of related liver diseases.

Sri Ramachandra Medical Center

Sri Ramachandra Medical Center is the first hospital to be associated with a university and is accredited by AABB, NABL, and JCI. It has 200 ICUs and More than 800 beds to provide premium treatment to patients. The liver transplant department is well-equipped with positive and negative pressure rooms. The department includes liver anesthesiologists, hepatologists, and surgeons to provide excellent treatments.

>>Mumbai 

Wockhardt Hospital

Wockhardt Hospital is accredited with NABH and JCI. It is a renowned hospital that provides patients with optimum healthcare services, specifically in disease related to the liver. It consists of 350 beds and an excellent team of surgeons.

Fortis Hospital, Mulund

Fortis Hospital is accredited by JCI and provides a wide range of healthcare services. It is the largest multiorgan transplant facility in Maharashtra. It is well-known for its excellent treatment of liver diseases.

>>Kolkata

Fortis Hospital, Kolkata

Fortis hospital is accredited by NABH. It consists of highly trained gastroenterologists and provides services like endoscopies, colonoscopies, endoscopic ultrasounds, ECRP, and capsule endoscopy for disease related to the liver, pancreas, and GI tract.

Apollo Multispeciality Hospital

Apollo Multispeciality Hospital has a modern infrastructure that consists of 500+ beds. It houses a wide range of highly skilled surgeons who provide the best treatments to patients from all over the world. The hospital also provides translators to international patients.

>>Hyderabad

Yashoda Hospital, Malakpet

Yashoda Hospital is certified by NABL and NABH for its admirable healthcare services. The hospital has over 500 beds and 500 specialists who provide excellent care to the patients. The hospital is well regarded for providing optimum quality care to liver failure patients.

Apollo Hospital

Apollo Hospital is accredited with NABH and JCI certifications. The hospital is reputed for providing advanced liver treatments. This is achieved with its multidisciplinary team approach, positive outcomes, and highly skilled doctors.

India’s Renowned Surgeons for Liver Transplant

Qualification: 

MBBS, MS (General Surgery), MCh (Surgical GAstroenterology/G.I. Surgery)

• He has been certified by FRCS
• He is an esteemed member of Association of Surgeons of India, British Transplantation Society, RCSED, RCPSG and ISOT.
• He can provide treatment for cirrhosis, end stage nonalcoholic fatty liver disease, etc.

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Qualification: 

MBBS, MS General Surgery, DNB Surgery

• She specializes in Liver Transplants
• She is the chief consultant in Columbia Asia, Mysore

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Qualification: 

MBBS, MS, DNB (HPB and Transplant Surgery)

•   He provides excellent treatment for liver diseases
•   Registrar in SGE and HPB Surgery in Sir Ganga Ram Hospital and Apollo Delhi

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Qualification: 

MBBS, DNB (General surgery), DNB (Surgical Gastroenterology)

• He can provide treatments for chronic diseases, structural and functional diseases, celiac disease, gastritis, etc.
• He is an active researcher and aims to bridge the gap between medical practice and research.

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Qualification: 

MBBS, MS, DNB

• He is memberships of IMA, RCSED and MNAMS
• He specializes in liver transplant and has several research papers on surgical gastroenterology, incidental carcinoma gallbladder, etc.

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Qualification: 

MBBS, MS

• He specializes in Liver Transplants
• He is a Consultant at Auckland Hospital, New Zealand

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Qualification: 

MBBS, MS

• He is experienced in Liver Transplant surgeries
• Honorary Consultant at Bangalore Medical College

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Qualification: 

MBBS, MS, DNB

• Senior Resident at All India Institute of Medical Sciences
• He is A member of IMA

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Qualification: 

MBBS, MD (Medicine), DM (Gastroenterology), DNB (Gastroenterology), Transplant Hepatology

• Primary Treatments by the doctor include chronic hepatitis B and C, ERCP, Pancreatic Cyst Drainage, etc.
• He is a member of INASL, API and ISG

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Condition That Leads to The Liver Transplant

>>Metabolic disorders

• Alpha-1 antitrypsin deficiency is a common hereditary condition that is defined by the reduced levels of this blood protein. It is produced in the liver and is released in the blood to protect the lungs from getting destroyed by the enzymes and white blood cells. Alpha-1 trypsin protects the lungs by trapping the enzymes that may attack healthy cells rather than old and damaged cells. This blood protein may not be produced in enough quantities or may be inefficient due to mutations.
• Wilson disease is a rare hereditary disorder that is found in children in which copper accumulates in the liver in large amounts. His disease causes liver damage which may become severe. Copper is a trace mineral and is required in small amounts. The excess copper is expelled out of the body by a copper-transporting protein. People with this disease cannot expel excess copper and hence, it reaches and damages other organs like the brain, central nervous system, RBCs, eyes, and kidneys.

>>Acute and Chronic Liver Disease

• Acute Liver Failure (ALF) is characterized by hepatic encephalopathy, acute liver injury, and increased prothrombin time. It is a severe injury to the liver with no pre-existing liver disease. It can occur due to two major reasons- viral hepatitis and drug-induced hepatitis.

Chronic liver disease can occur due to cirrhosis and hepatitis

• Cirrhosis is defined by severe scarring of the liver. Whenever there is damage to the liver, whether, through excessive alcohol consumption or viral infection, the hepatocellular cells (cells of the liver) try to repair themselves. It slows regular blood flow leading to an increase in blood pressure. Advanced cirrhosis is life-threatening.
• Hepatitis B (HBV) is a liver viral infection caused by the hepatitis B virus. It usually clears up within a month or two without treatment. When the infection persists for more than 6 months, it becomes chronic leading to chronic inflammation of the liver. It can spread through body fluids like blood, vaginal fluid, semen, etc. Hepatitis C (HCV) is caused by the hepatitis C virus and spreads through contaminated food and water. It can cause chronic liver inflammation.

Causes for Liver Failure

• Biliary atresia is a gastrointestinal disorder affecting the biliary system (tubular ducts and structures that drain bile from the liver to the small intestine). It primarily affects the liver and later affects the bile ducts inside the liver. As a result, the bile gets trapped inside the liver causing damage and scarring, leading to cirrhosis.
• Primary Sclerosing Cholangitis causes the bile ducts to become inflamed and scarred from the inside and outside of the liver. This leads to cholestasis or stoppage of the flow of bile. It is a progressive disease leading to liver cirrhosis over 10 to 15 years.
• Hepatocellular carcinoma (HCC) is the most common type of liver cancer. This type of cancer occurs in the cells of the liver. It can be caused by infections like hepatitis B or C, cirrhosis, anabolic steroids, obesity, diabetes, or excessive alcohol consumption.

Signs and Symptoms of Liver Failure

Symptoms and signs of liver failure take years to develop. They usually look like symptoms of other medical diseases and conditions which makes it difficult to identify the actual cause in the early stages. Symptoms worsen with disease progression.

• Nausea
• Fatigue
• Loss of appetite
• Blood in stool
• Diarrhea
• Blood in vomit
• Jaundice (yellowish appearing skin and eyes)
• Disorientation (uncertainty and confusion)
• Build up fluid in the abdomen, arms, and legs
• Dark coloured urine
• Skin itchiness

How to Prepare for a Living Donor Liver Transplant?

Most living donors are either friends or family members of the patient. There are some important steps to prepare for before the surgery:

• Blood tests, pap smear for women, colonoscopy for donors above 50, urine test X-rays, MRIs, Echocardiogram, etc, to ensure that the donor is healthy. The donor may also visit a counselor or social worker to clarify doubts and questions about the surgery and recovery.
• The donor should take their medicines as prescribed. Keep up with the appointments with the doctor. Sign informed consent forms after reading and understanding the information correctly and clearing any doubts.
• The donor should not take any nonsteroidal anti-inflammatory drugs a week before the surgery. Women should not take birth control pills for a month prior to the surgery. These medications can cause troubles in blood clotting. Vitamins and supplements need to be avoided.
• Diet and exercise are important as they help in post operative recovery. These help in fighting infections. If one is overweight, they may need to lose a few pounds as extra weight can strain the liver post surgery.
• Alcohol and recreational drugs should be avoided as soon as the donor surgery date is set. One may need a biopsy to ensure that the liver is healthy enough and can be donated.
• Smoking should be stopped 1-2 months prior to the surgery to decrease complications. Quitting right before the operation can increase the oxygen levels in one’s body. The lungs start to function better after 2 smoke free months.

Recovery After Liver Transplant Surgery in India

• After a liver transplant surgery, the patients have to stay in the hospital on an average of 2-3 weeks, depending on the recovery of the patient. After that, the patient can return home and recover at home for the next 3-6 months following a stringent diet, lifestyle choices and taking medicines prescribed by the doctor.
• After the surgery, the surgeon may suggest a nutrition specialist to the patients to aid them in understanding their dietary requirements. A diet low in sugar, salt and fat is recommended. Alcohol in any form should be avoided by the patients after the surgery.
• The dietician may also suggest a more active lifestyle for improving comprehensive mental and physical health. However, patients should not lift heavy weights or go swimming before three months.
• It is essential that the patient maintains regular checkups post surgery, as there is an increased complication of coronary artery disease due to weight gain, diabetes and high blood pressure.

Guidelines for a Liver Transplant in India

Guidelines for liver transplantation fall under The Transplantation of Human Organs Act, 1994. It applies to those States and union territories that adopt this act by a resolution passed in behalf of under clause (1) of Article 252 of the Constitution. It was amended in 2011.

• A close family is defined as a near relative in this THO Act. They can be parents, siblings, spouses children, and grandparents of the recipient. All of them can be donors as long as they are healthy, pass all tests for liver disease, and fulfill the requirements and guidelines by the law.
• The donor’s age should fall in the 18-55 age group
• The blood group of the recipient and the donor should be compatible
• Family friends, neighbors, well-wishers and staff are not acceptable liver donors
• Overweight people are not accepted as liver donors as they may have a fatty liver
• The donor liver should have enough in volume for the recipient and themselves after the surgery.
• The donor should have good mental and physical health overall. They have to undergo medical and psychological evaluation, and fully understand the complications and risks of the surgery before committing to donation.
• Donors need no objection certificate (NOC) from the state of domicile or embassy if they are near relatives or international nationals. The committee does not favor this much as there may or may not have been unnecessary monetary exchange.

Eligibility for Liver Donation in India?

For a living liver donor, the eligibility criteria are as follows:

• The donor blood type and anatomy of the liver should be compatible with the recipient for donation.
• The willing donor should be between 18 and 60
• The donor should agree to the pre-surgery examination process, surgery, and post-operative care.
• The psychological condition and health of the donor should be good
• They should be free of any serious health conditions like heart disease, diabetes, cancer, or liver disease.
• They should have a healthy BMI (lesser than 32)
• The donor should be willing to abstain from smoking and/or alcohol usage until recovery.

For a deceased liver donor: After the evaluation process is complete, the patient information is sent to various hospitals to register them in the waiting for a deceased liver donor. The patient is checked periodically and notified immediately on the availability of the deceased donor.

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