A liver transplantation is a surgery carried out to replace a diseased liver with a healthy liver from another person. It may include replacement of the patient’s diseased liver with an entire donor liver or with just a section of the healthy liver.
A liver transplantation is a surgery carried out to replace a diseased liver with a healthy liver from another person. It may include replacement of the patient’s diseased liver with an entire donor liver or with just a section of the healthy liver. Liver transplantation is rapidly being recognized as an important treatment for many liver diseases. The following are the answers to some of the most common questions that liver transplantation donors and recipients typically have about the procedure.
Answer: Liver transplantation is most commonly required by patients who have a liver failure due to cirrhosis, acute liver dysfunction, or liver cancer. Liver transplantation procedure is also recommended for children who have serious liver dysfunction known as biliary atresia (a childhood disease of the liver where one or more bile ducts are abnormally blocked or absent). Other common diseases that require liver transplantation include advanced liver disease due to hepatitis C, hepatitis B, or alcohol-induced damage, biliary problems, and metabolic diseases.
Answer: Most livers used for liver transplantation come from the organ donors immediately after their death. Organ donors are mostly adults or children who are critically ill or those who have been declared brain dead. When an organ is received from a deceased donor, the process is known as “deceased organ” transplant. A living family member or a friend can also donate a segment of his or her liver, which is the right size for the recipient. This type of transplant is known as “live” donor liver transplant (LDLT).
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Answer: Liver transplantation from a deceased donor is not the only option for treating liver disease. Live donation liver transplantation is a more common possibility. Criteria to be considered for a person to donate his or her liver include age, medical history, and current health status. The donor will need to undergo several tests such as blood tests, physical examination, X-ray for evaluation of the liver size, and also, liver biopsy. In addition, a live donor must have the compatible blood type and body size, as determined by the recipient’s height and weight. The donor must be between the age of 18 and 60 years. He or she must test negative for all liver diseases and should have no serious medical conditions such as diabetes, cancer, or heart disease.
Answer: The liver of the potential candidate being considered for live donor liver transplantation will be evaluated for its function through different blood tests. The quality of the liver is assessed through special imaging tests. The volume of the liver that will remain after transplantation will be estimated to ensure that it is enough for the donor’s own health and proper functioning. If the quality and function of the liver are normal, the remaining portion of the donor’s liver will be able to regenerate to its full volume and functioning within a few months after donation. If during the tests, there is a slight doubt that the remaining portion of the liver will not be sufficient for the donor, he or she is excluded from the donor list.
Answer: The live donor candidates for liver transplantation are familiarized beforehand about the risks associated with surgery, hospitalization, and recovery. The surgery for removal of the portion of the donor’s liver takes about five hours and the donor stays in the hospital for about a week after the surgery. About 50 to 70 percent of the donor’s liver is removed during the surgery. The liver starts to regenerate immediately and most of the regeneration is completed in the first two to three weeks after surgery. Live donors will have significant pain and discomfort after surgery for at least two to four weeks. Medications are given to manage the pain and other discomforts.
Answer: All the donor’s medical expenses are usually covered by the recipient’s insurance. Travel costs and time away from work are mostly not covered by the insurance and needs to be considered.
Answer: The donor will be required to pay a follow-up visit to the surgeon after two to three weeks of donation, and then one to two years after donation. Live donors are required to undergo a routine medical examination. Some of the risks after surgery include blood clots in legs or lungs, fluid retention, bile leakage or bile duct complications, and hernia. The liver donor can return to the normal routine gradually. However, he or she should avoid vigorous activities and exercises until the wound is healed completely, which takes about 6 to 8 weeks.
Answer: No, not everyone can donate a liver. The liver can only be taken from the recently deceased or a brain-dead donor or it can be retrieved from a blood-group compatible donor. Most of the countries allow only a blood-group matching close relative of the patient to undergo evaluation for donation. For example, in India, liver transplantation from only a related donor is carried out. However, such rules vary from one country to the other. Mostly, a specific country does not allow cadaveric liver transplantation for a foreign national.
Answer: Being a close relative of the patient does not guarantee that you will be accepted as the donor. There are certain tests that are conducted as a part of the evaluation before the transplantation. The donor is accepted only when all the tests are normal and the overall health of the donor is good. For example, someone with fatty liver disease or high bilirubin levels cannot be accepted as a suitable donor.
Answer: Apart from all the necessary documentation, the donor is usually required to submit an affidavit on a stamp paper establishing the relationship with the patient. The affidavit should also state that the donor has taken the decision out of his free will. It should state that there is no force involved. The affidavit should be notarized/attested by a gazetted government official and should also bear the photograph of the donor.
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Answer: A liver transplantation is recommended when the risk of death from a liver disease outweighs the risk of immediate and long-term risks involved in liver transplant. If the transplant is performed early, the patient will be exposed to unnecessary surgical complications and side effects of long-term immunosuppressants. If the transplant is delayed, it may endanger the effectiveness of the transplant, making the surgery more complicated.
Answer: There are certain complications that can render a patient unsuitable for liver transplant surgery. For example, patients with a tumor in their hepatic portal vein are not advised to undergo liver transplantation unless the tumor is cleared off completely. It is after the tumor has been completely treated and there is no residue that evaluation for liver transplantation begins. Risks associated with surgery involve technical difficulties in the removal of the diseased liver, implantation of the donor’s liver, and risks of being without any liver function for a short period of time. After surgery risks involve bleeding, poor function of the implanted liver, post-surgical infection, and rejection of the implanted liver by the body.
Answer: The overall survival after liver transplantation depends on a number of factors, including how well the body of the patient adjusts to the foreign organ. However, the success rate is usually between 80 to 95 percent in adult patients and 90 percent in children.
Answer: Recovery of a recipient depends on the illness of the patient prior to the surgery. Most of the patients spend a few days in the intensive care unit (ICU). They remain in the hospital for about 10 to 14 days after the surgery. The patient is monitored carefully in the ICU for all the body functions. Medicines are given to prevent rejection of the implanted liver. Frequent tests are carried out to monitor liver function and detect any evidence of rejection.
Answer: There are many degrees of liver failure and even with improper liver function, patients can remain quite well. Sometimes, with suitable circumstances and time, a failing transplanted liver can be replaced by a second transplant. In any case, anti-rejection medicines are given to the patients to minimize the chances of rejection.
Answer: Yes, they need to take the medicines throughout their lives. However, as the body adjusts to the newly transplanted liver, the dosage, and a variety of medicines can be reduced. Most patients lead a normal and productive life after the transplant.
Answer: Immediately after the transplant, the recipient will feel tired but will begin to feel better and stronger slowly. It is best to follow the instructions given by the transplant team at the time of discharge.
Answer: Hepatocellular carcinoma (HCC) commonly affects people with chronic liver disease such as hepatitis C and hepatitis B. The treatment of this condition depends on the extent of the disease and how deeply it has affected the liver. Therefore, the decision to conduct liver transplantation varies from one patient to the other. Usually, doctors prefer to treat HCC before figuring out any chances for liver transplantation. This may take a couple of months.
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Brig (Dr) Anupam Saha has been the foremost Gastro-Intestinal and Hepato-Pancreato-Biliary Surgeon of the Indian Armed Forces with more than 20 yrs of experience in performing complex operations for cancer and other diseases involving the Liver, Pancreas, Gall Bladder as well as other Gastro Intestinal surgeries involving the Colon, Rectum and the Gastro-Intestinal System. He is currently the HOD & Sr. Consultant of Dept of Liver Biliary Sciences at Venkateshwara Hospital