HexaHealth's Liver Transplant Guide: Procedure Simplified

Liver transplantation becomes necessary when the liver reaches a critical stage of dysfunction. It can be either acute (Suddenly) or chronic (gradually). Despite attempts with medical treatments, it cannot be completely treated. 

Those identified as potential candidates for liver transplantation undergo a thorough evaluation. A substantial 80% of liver transplants are prompted by the advanced stage of liver damage known as decompensated cirrhosis.

The indications of a liver transplant are:

1. Viral Hepatitis: Persistent and severe viral hepatitis infections, such as hepatitis B or C, can cause chronic liver damage, leading to the need for a transplant when the liver's ability to function becomes severely compromised.

2. Non-alcoholic Fatty Liver: In cases of non-alcoholic fatty liver disease (NAFLD), the liver accumulates fat without alcohol consumption. This progression to advanced stages can result in inflammation and scarring, prompting the consideration of a liver transplant.

3. Alcoholic Fatty Liver: Chronic and excessive alcohol consumption can lead to alcoholic liver disease, progressing from fatty liver to inflammation and cirrhosis. Presently, the primary reason for liver transplantation is liver disease related to alcohol consumption. In situations where the damage is irreversible, a liver transplant may be recommended. 

4. Acute Liver Failure: Sudden and severe liver dysfunction, known as acute liver failure, can occur due to various reasons such as drug toxicity or viral infections.
   This condition makes up about 5-6% of all liver transplant cases. In these cases, a rapid deterioration of liver function may necessitate an urgent liver transplant to save the patient's life.
   If patients don't undergo a liver transplant, they face a 100% mortality risk. This high risk is attributed to the failure of the liver itself or complications like infections and failure of multiple organs.

5. Liver Cancer: In India, a majority of liver cancer cases are observed in individuals with underlying liver disease. A liver transplant is a viable option for addressing the malignancy. It is required when the cancer stage has reached an advanced stage or is unresponsive to other treatments.
   

Liver donors are crucial in offering a beacon of hope and a fresh start to those facing life-threatening conditions. If you are wondering who can donate a liver? There are two distinct types of liver donors, each contributing to the life-saving transplantation process:

1. Living Donor: A healthy individual voluntarily donates approximately two-thirds of their liver, a segment that regenerates in both the donor and the recipient. Living donor transplantation offers a timely solution, minimising the waiting period for patients in need and enhancing the likelihood of a successful transplant.
   Becoming a liver donor for transplantation involves meeting specific criteria to ensure the success of the procedure. The eligibility criteria are: 

   1. Family Relationship: The ideal liver donor is someone closely related to the patient, usually a family member. It ensures a strong biological connection.

   2. Age Range: Donors should fall between the ages of 18 and 55, ensuring they are within an age bracket conducive to a successful liver donation.

   3. Weight Range: The donors are expected to weigh between 50 and 90 kg. It emphasises a healthy weight rather than excessive body fat.

   4. Blood Group Compatibility: Donors must either share the same blood group as the patient or possess blood group O, ensuring a compatible match for a successful liver transplant.

2. Deceased Donor (Cadaveric): Organs are sourced from individuals who have recently passed away, providing a lifeline to those in need of transplantation. By donating, individuals contribute to saving lives, as their organs can be used to benefit patients awaiting transplantation. 
   

   In cases where someone experiences brain death due to an accident, the liver (along with other organs) can be ethically used for transplantation with proper permission from the family. 

   Apart from the criteria mentioned in the living donor transplantation, the below requirements must be met for deceased donor liver transplantation:

   1. Age and Health Condition: Deceased donors are typically younger than 70 years old and should be in good overall health. They should be free from conditions that could affect the viability of the donated liver.

   2. Absence of Chronic Diseases: Donors should not have chronic diseases, especially those affecting the liver, to ensure the transplanted organ's functionality.

   3. Clear Consent or Donor Registry: Consent for organ donation must be clear, either through the deceased donor's prior registration in an organ donor registry or expressed consent from family members.

   4. Timely Procurement: The liver must be procured promptly after the declaration of brain death to ensure its preservation and viability for transplantation.

A thorough diagnosis and consultation with a liver transplant surgeon are done to assess the need for transplantation. 

Following diagnosis, the surgeon evaluates the patient's condition and recommends a liver transplant if deemed necessary. Individuals with alcohol-related problems should seek psychological and psychiatric assistance before undergoing a liver transplant. 

This precautionary measure aims to guarantee a minimum of six months of alcohol abstinence, preventing relapses that could lead to removal from the liver transplant waiting list.

The evaluation and selection procedure of a living donor liver transplant includes:

1. Potential donors within the immediate family are identified, considering compatibility and willingness to donate. 

2. Diagnostic tests are conducted to ensure compatibility between the donor and recipient, assessing factors like blood type and liver size.

3. The donor undergoes pre-transplant workup on an outpatient basis, while the recipient's workup, if needed for stabilization, is done on an inpatient basis. In emergency cases, the pre-transplant workup is expedited, often completed within 24-48 hours.

4. The donor undergoes a basic evaluation, including checks on blood group, CBC, LFT, Creatinine, HbsAg, Anti HCV, and imaging studies like ultrasound or CT scan for liver assessment. 

   
   

5. Based on the evaluation, if a match is found, the decision to proceed with a living donor transplant is made with the consent of both the patient and donor to proceed to a Legal Authorization Committee for further approval.
   

   Legal Authorization Committee

   Organ Donation Criteria	Requirement
   Marital Status	Yes
   Relationship Status	Yes (parent, sibling, relative)
   Evidence of Relationship	Yes
   Donor Photograph	5 passport size from different years including family
   Family Photograph	25 with white background (patient, donor, and donor's parent/siblings)
   Drugs	Yes
   Criminal Record	Yes
   Income Proof	Yes (3 yrs financial statements)
   Form 5 (HLA/DNA testing)	Yes (in some cases)
   Affidavit	Yes (Same city)

6. Government-authorized committees verify the documents of both the living donor and recipient to ensure authenticity.

7. If no suitable living donor is found, the patient may need to register for a deceased donor transplant in government registries.

After assessing the patient's reports, the decision for a liver transplant is determined by a Hepatologist, Gastroenterologist, or Liver Transplant Specialist. When the need for a liver transplant arises, individuals must carefully weigh factors such as the choice of hospital, the surgeon, and associated costs.

Cost of Liver Transplant

The expenses for a liver transplant in India differ based on factors such as whether it's for a pediatric or adult case. Below is the cost breakup of the transplant.

1. Preliminary assessments before the transplant: 1 - 1.5 lakhs

2. Comprehensive package covering surgery and hospital stay for both the donor and recipient: Approximately 14 - 23 lakhs

 The cost can vary based on the following variables:

1. Patient with additional conditions like TB, jaundice, kidney failure, hypertension, etc.

2. The choice of hospital and doctor contributes to the overall expenditure.

3. Various financing options are available, including cashless transactions, EMI or credit card payments, and medical loans, allowing flexibility in managing expenses.

4. Most health insurance plans cover the expenses associated with liver transplants. 
   

Our team at HexaHealth assists with paperwork to ensure a smooth approval and a cashless facility. For a simplified and hassle-free experience throughout the surgical process, contact us at 6366529758.

Top Liver Transplant Surgeons

To ensure top-quality care for liver transplant cases, numerous highly skilled surgeons stand out for their proficiency in advanced treatment methods. Here are some of the best surgeons to consider:

1. Dr Sanjay Goja

2. Dr KR Vasudevan

3. Dr Neeraj Goel

4. Dr Subhash Gupta

5. Dr Naimish N Mehta

6. Dr Giriraj Bora

7. Dr Neerav Goyal

8. Dr Nikhil Gupta
   

Top Liver Transplant Hospitals

With over 150 medical centres, HexaHealth has an extensive network of medical centres across the country, which distinguishes it as a provider of efficient healthcare. Among the top-rated healthcare brands within this network are:

1. Jaypee Hospitals

2. Max Healthcare

3. Apollo Hospitals

4. Narayana Health

5. Action Cancer Hospitals

6. Artemis Hospitals
   

Why Choose HexaHealth?

HexaHealth is India's leading healthcare provider, is committed to enhancing patient experiences. Wondering why we stand out for? Explore our benefits:

1. Easy booking for consultations with top-rated doctors for your convenience.

2. Assistance in selecting the best hospital based on location and financial considerations.

3. Access to second opinions from multiple specialist surgeons affiliated with the National Liver Board.

4. Hassle-free estimates for treatment costs, allowing you to plan accordingly.

5. Support managing finances and creating a treatment budget aligned with your needs. It includes medical loans with flexible EMI’s.

6. Commitment to prioritising quality in every aspect of your treatment.

7. Continuous personalised care support is available around the clock.

8. Inclusive post-operative care services, including home care and hospital transfers.

On the day of the transplant, the patient undergoes preoperative preparations, which may include fasting, medication adjustments, and final medical checks. The procedure includes:

1. Anesthesia Administration: Once in the operating room, the patient receives general anaesthesia to induce a deep sleep. It ensures they are unconscious and pain-free throughout the procedure.

2. Incision and Access: Surgeons make an incision in the abdominal area to access the liver. This careful approach minimises trauma and facilitates a smoother transplant process.

3. Liver Extraction and Transplant: The diseased liver is removed, making way for the healthy donor liver. This step demands precision and expertise to prevent any damage to surrounding tissues.
   The donor's liver is meticulously connected to the recipient's blood vessels and bile ducts. Surgeons ensure proper blood flow and biliary function for the new organ.

4. Closure of Incision: Once the transplant is completed, the surgical team closes the incision with sutures.

5. Postoperative Monitoring: The patient is then moved to the recovery area, where they are closely monitored for any signs of complications. This critical period ensures prompt intervention if needed.
   

Following a liver transplant, the patient typically spends 2-4 weeks in the hospital, the duration depending on their pre-transplant condition and recovery. 

Hospital Recovery after Liver Transplant

For donors, life returns to normal without long-term medications or dietary restrictions. In the hospital, the recipient, after the liver transplant, can expect the following:

1. Monitor Vitals: Healthcare professionals will closely monitor essential signs like heart rate, blood pressure, and oxygen levels to ensure a stable recovery.

2. Pain Control: Effective pain management strategies will alleviate discomfort, enhancing the patient's overall well-being during the initial recovery period.

3. Immunosuppressants: Post-surgery, the patient starts on immunosuppressant medications to prevent rejection, with adjustments and eventual withdrawal over time. However, these medications increase susceptibility to infection, requiring prophylactic antibiotics, antifungals, and sometimes antivirals.
   

At-home Recovery

Patients receive a detailed discharge summary with testing instructions and medication schedules. They are also provided with investigation and monitoring charts.

Families should learn about precautions, follow-up schedules, medications, symptoms of potential issues, and how to contact the transplant team in emergencies. A smooth recovery at home after a liver transplant includes:

1. Nearby Accommodation and Infection Prevention: Thoroughly clean the house with disinfectants. Choose accommodation close to the hospital with 24-hour transportation, minimal stairs, and a clean environment.

2. Visitor Restrictions and Precautions: Limit visitors for the first few weeks. Avoid contact with sick individuals and report any signs of illness. Patients should wear masks for the initial 3 months and avoid crowded places.

3. Medicine Adherence: Follow the prescribed medicines, especially immunosuppressants. This will ensure a rapid recovery. Over time, the need for these medications decreases, and they are gradually withdrawn. A minimal dose of at least one immunosuppressant is typically continued lifelong.

4. Personal Hygiene and Wound Care: Emphasise frequent handwashing. Maintain oral hygiene, trim fingernails, and follow wound care guidelines. Dressings may need changing 2-3 times a week initially.

5. Diet and Nutrition: Follow a high-protein diet for wound healing and liver regeneration. Hygienically prepare and consume food, emphasising fresh fruits, vegetables, and a balanced, low-fat, high-protein diet.

6. Food to Avoid: Avoid fried or greasy foods, leftover food, raw eggs, or partially cooked items. Steer clear of overripe fruits and expired packaged foods. Adjust the diet based on blood sugar and potassium levels.

7. Activity and Exercise: Gradually resume walking and routine activities. Regular exercise enhances energy levels and muscle strength. Physiotherapists guide limb exercises to reduce complications.

8. Rest and Avoiding Heavy Lifting: Prioritise adequate rest and sleep. Avoid lifting weights over 5 kg, including babies, and abdominal exercises. Speak to the transplant physiotherapists to optimise the exercise schedule.
   

Follow-up

Consistent follow-ups and hospital visits play a crucial role in ensuring the success of a liver transplant. Here's a guide for both donors and recipients on the necessary follow-up steps to maintain overall health and address any concerns promptly.

For Donors 

Donors should have regular follow-ups every 5-7 days during the first month after the transplant. After the initial phase, donors undergo testing and reviews at 3 months and then at 1 year post-transplant.

For Recipients

1. Frequent Lifelong Follow-ups Initially: Recipients require frequent follow-ups initially, with a schedule provided at discharge. As stability is achieved, visits become less frequent, ranging from 3-6 months.

2. Travel and Remote Reporting: Once reports stabilise and medications are adjusted, recipients can travel. They are advised to email reports to the doctor and visit the clinic every 3-6 months.

3. Contacting the Transplant Team in Case of Problems: In case of issues, recipients are urged to contact the transplant team. It is essential to identify a local physician or gastroenterologist for urgent solutions.

4. Routine Monitoring and Record-keeping: Routine monitoring of blood pressure, blood sugar, diet, exercise, and insulin administration is advised. Post-transplant coordinators guide patients and donors in maintaining records, preferably managed by family members.

In India, several thousand liver transplants are performed annually, achieving a commendable success rate of approximately 95%. Most patients enjoy a comfortable and healthy life after a transplant, experiencing an excellent quality of life.

The other aspects to consider after the procedure are:

1. Daily Activities: The majority can resume normal daily activities, including work, around 2-3 months post-surgery. Children can typically return to school after three months.
   
   While sports and exercise are feasible after three months, caution is advised with contact sports for the first six months.

2. Driving: Individuals can typically resume driving in about two months post-transplant. Patients are advised not to drive under the influence of pain medications containing narcotics.
   
   Travel, including occasional train/plane journeys, is usually possible in 2-3 months. For longer trips, discussions with the transplant team are recommended to ensure sufficient medication supply and local medical support.

3. Sexual Activity and Family Planning: There are no restrictions on sexual activity, which can be resumed when comfortable. Donors may resume sexual activity within a month, while recipients typically wait 2-3 months.
   
   For women, conception is advised to be delayed for up to 6 months after donation and 12 months after transplantation. Discussions with the transplant team are crucial for recipients planning pregnancy and addressing medication concerns that might affect the child or breastfeeding.
   
   Oral contraceptives and hormone use should be coordinated with hepatologists and gynaecologists.

Liver transplantation (LT) emerges as a highly successful for individuals facing advanced liver failure. It has an impressive success rate of approximately 95%. It offers patients a pathway to a healthy life.

HexaHealth is committed to delivering top-notch and cost-effective liver transplant surgeries in India, ensuring accessibility for those in need.

Don't hesitate to reach out for details on the procedure, costs, potential side effects, hospital stay, financing options, and post-surgery recovery. We are here to provide comprehensive information and support.

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