Who can Donate Liver for Transplant?

The liver donors serve a unique purpose in providing hope and a new lease on life for those in need. Two kinds of donors can be considered for liver transplant:

1. Deceased Donor (Cadaveric): Organs are obtained from individuals who recently passed away. Deceased donor liver transplant helps save lives by utilising organs from individuals who have generously chosen to donate upon their death.
   When someone has been in an accident and is brain-dead, the liver (and other organs) may be used with due permission from the family for transplant to any patient who needs it.
2. Living Donor: A healthy person donates roughly 2/3rd portion of their liver, which then regenerates in both the donor and recipient. Living donor liver transplant allows for timely interventions, minimising wait times and increasing the chances of successful transplantation.

Specific criteria must be met to be eligible as a liver donor for transplant. The eligibility criteria of the ideal donor are:

1. Family Relationship: The preferred liver donor is someone from the patient's family, ensuring a close biological connection.

2. Age Range: Donors should be between 18 and 55 years old, ensuring they are in an age group conducive to successful liver donation.

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

4. Blood Group Compatibility: Donors must share the same blood group as the patient or have blood group O for a compatible transplant.

Ineligible Donors in Liver Transplantation

Individuals with certain health conditions may be ineligible to be liver donors. The following factors exclude individuals from being potential donors in a liver transplant:

1. Prior Hepatitis B or C Infection: People with a history of Hepatitis B or C are not considered eligible for liver donation due to potential complications and risks associated with the transplant.

2. HIV Infection: Those who are diagnosed with HIV are ineligible as liver donors. The virus may pose additional risks during the transplant process.

3. Active Alcoholism or Frequent Heavy Alcohol Use: Individuals engaged in active alcoholism or who regularly consume heavy amounts of alcohol are excluded from being liver donors. It is due to the impact of alcohol on liver health.

4. Undergoing Treatment for Psychiatric Illness: Individuals currently undergoing treatment for psychiatric illnesses are not eligible as liver donors. Their mental health conditions may affect the overall success of the transplant.

5. Recent History of Cancer: Individuals with a recent history of cancer are not considered suitable donors. The presence of cancer may complicate the transplant procedure and pose risks to both the donor and the recipient.

6. Significant Medical Condition: Individuals with a significant medical condition like diabetes, chronic kidney diseases, etc, are ineligible as liver donors due to the potential impact on the success and safety of the transplant.

Before the day of the liver transplant, thorough pre-transplant evaluations ensure a seamless process. From tumour assessments to a comprehensive array of blood investigations, each step is meticulously designed to pave the way for a successful liver transplant.

Donors undergo pre-transplant workups as outpatients (OPD basis) to assess their suitability for the procedure. It ensures they are in good health for the donation.

The pre-transplant workup generally spans 5-7 days in normal cases. However, in emergency situations, it can be expedited, taking place within 24-48 hours. 

Below is the day-wise pre-transplantation workup of a donor:

Day-1

Living donors undergo a thorough evaluation on the first day. It includes health surveys, blood tests, viral serology, imaging studies, and assessments by independent healthcare professionals to ensure their suitability for surgery. 

The tests on day-1 include:

1. Tumor Evaluation (for cancer cases): Assessing the presence and extent of tumours is crucial for determining the overall health and suitability for transplant.

2. Blood Investigations: Identifies compatible donors and recipients. It evaluates overall blood health.

3. Viral Markers:  Screening for hepatitis, HIV, and syphilis infections.

4. Viral Infections and Immunity: Assessing immunity and detecting active viral infections.

5. Tumour Markers and Immunoglobulins: Overall immune system health is monitored.

6. Autoimmune Markers: Evaluating autoimmune factors that may impact transplantation. It examines the presence of autoimmune liver disease.

7. Viral Load Testing: Measuring the amount of hepatitis C and B viruses in the blood. 

8. Urine Tests: Assessing kidney function and protein levels in urine.

9. Thyroid Function and Lipid Profile: Evaluating thyroid function and lipid levels for overall health.

10. Arterial Blood Gas: Measuring oxygen and carbon dioxide levels in the blood to assess respiratory function.

11. Chest X-ray (PA): Obtaining a comprehensive view of the chest to evaluate lung and heart health before surgery.

Day-2

On the second day of the pre-transplantation workup, various diagnostic tests are performed to ensure the donor's suitability for the procedure. The tests are:

1. Ultrasound (Whole Abdomen): A thorough abdominal ultrasound is conducted to assess the condition of the liver and surrounding organs.

2. Hepatic Doppler:  Imaging by Doppler focuses on the blood vessels in the liver, providing insights into the blood flow in this organ.

3. Pulmonary Function Tests (PFT): Tests are conducted to evaluate the donor's lung function, ensuring their respiratory health is suitable for the transplantation process.

4. ECG (Electrocardiogram): An ECG is performed to assess the rhythm of the heart and detect any abnormalities.

5. ECHO (Echocardiogram): This test provides a detailed view of the heart's structure and function, ensuring the donor's cardiac health is optimal.

6. Dobutamine Stress ECHO (including Bubble ECHO): Stress testing of the heart, including dobutamine, helps evaluate cardiac function under exertion. Bubble echo detects potential heart defects.

7. CT Calcium Scoring: A computed tomography scan is employed to assess calcium deposits in the coronary arteries, aiding in the evaluation of heart health.

8. CECT (Triphasic) Abdomen: Contrast-enhanced computed tomography offers a detailed view of the blood vessels and structures in the abdomen, providing crucial information for the transplant assessment.

9. Hepatology Review and Endoscopy: A comprehensive review by hepatologists and endoscopy helps evaluate the overall liver health and identify potential issues that may impact the transplant process.

Day-3

As the evaluation process for potential liver donors continues, the third day of pre-transplantation workup focuses on ensuring the donor's overall well-being. This involves assessments from various medical specialists to guarantee suitability for the transplantation process.

1. Cardiac, Pulmonary, and Neurological Clearance: Rigorous assessments by specialists ensure the donor's heart, lungs, and neurological functions are in optimal condition, minimizing risks during the liver transplant.

2. Psychiatry, Dietician, Physiotherapy Assessment: Evaluations by psychiatrists, dieticians, and physiotherapists aim to assess the donor's mental health, dietary habits, and physical well-being, contributing to an overall understanding of their fitness for the transplantation procedure.

3. Anaesthesia Check-up: Anaesthesia specialists conduct a thorough examination to ensure the donor can safely undergo the anaesthesia required for the liver transplant, addressing potential complications.

Once the donor is deemed suitable, the patient and the donor must proceed with the Legal Authorization Committee. The process of legal authorisation for liver donation involves a set of essential requirements to ensure compliance with regulations. 

Below are the necessary documents and proofs to be provided:

1. Married Donor: The donor must be accompanied by their spouse.

2. Unmarried Donor: Parents or siblings (with a No Objection Certificate from parents) must be physically present for the legal authorisation committee.

3. Certificates for Verification: Provide death certificates or divorce certificates for parents, next of kin, or spouse of the donor, if applicable.

4. Photographic Evidence: Submit wedding photographs and images from at least five family occasions spanning various years where the patient and donor are seen together.

5. Family Gatherings: Include old and recent family photographs featuring the patient and donor.

6. Passport-size Photographs: Provide 25 passport-size photographs with a white background for the patient, patient's relative, donor, and donor's spouse/parent/siblings.

7. Income Proof: Submit income proof for the donor and donor's spouse/parent/siblings, such as bank statements for the last three years or any other relevant financial documents.

8. HLA/DNA Testing: Complete HLA/DNA testing using Form 5. The HLA/DNA testing is necessary as it helps to determine the risk of acute rejection of the liver after transplant. 

9. Document Attestation: For second-degree donors, obtain Form 20 and document attestation from the Tehsildar, along with the Tehsildar's email ID for verification.

10. Affidavit Format: Utilise the affidavit format provided by the hospital where the donation process will take place, and ensure it is prepared in the city of admission.

11. Documentary Proof: Present at least three to four documentary proofs for both the patient and the donor. These may include a passport, Aadhar card, voter's ID card, ration card, driving license, school leaving certificate, or any other document demonstrating the claimed relationship.

Once the legal authorisation process is completed, the donor is considered suitable for transplant surgery.

Donor surgery begins first and lasts around 10-12 hours. It involves removing 50-60% of the donor's liver. The timing of the recipient surgery, lasting approximately 6-8 hours, is coordinated with the progress of the donor's liver. 

Below is the description of the whole process:

1. General anasesthesia is given to the patient after positioning them in supine position.

2. Surgeons start by taking a section of the donor's liver for transplant, typically through a stomach incision.

3. The specific part of the donor's liver chosen depends on both its size and the requirements of the recipient.

4. Following this, the surgeons remove the damaged liver from the recipient and insert the donated liver section into the body.

5. The blood vessels and bile ducts are meticulously connected to the new liver during the surgery.

6. Post-transplant, both the transplanted liver in the recipient and the remaining portion in the donor regenerate rapidly, restoring to normal volume and function within a few months.

Following the transplant, patients typically remain in the hospital for approximately 2-4 weeks, depending on the individual's recovery progress.

After leaving the hospital, patients are advised to stay in proximity for 2-4 weeks to facilitate close monitoring and prompt medical attention if needed.

Liver regeneration starts immediately after the surgery, reaching normal size within six to eight weeks. Close monitoring for signs of recovery and liver regeneration occurs during the early post-surgery period.

The recovery phase for the donor is explained below:

• In the initial recovery phase, you might experience some discomfort at the incision site, but it's usually well managed with pain medications.

• Post-discharge guidelines include refraining from lifting anything over 20 pounds for at least six weeks and avoiding driving while on sedating medications for two to three weeks.

• Regular walks are encouraged, and you may need assistance initially.

• Depending on your job, a return to work might be possible six to eight weeks after surgery.

• Ongoing recovery is closely monitored through routine clinic visits and laboratory tests.

HexaHealth stands by your side throughout your treatment journey. We've got you covered. You can be assured that you get comprehensive support without any limitation from:

1. Partnering with you at every step, from doctor appointments to diagnostic tests and admission planning.

2. Offering support beyond hospital visits, including out-of-hospital assistance, psycho-social counselling, and disease education.

3. Collaboration with leading hospitals in India equipped with specialized liver transplant departments.

4. Providing financial aid by facilitating zero-cost EMI options for treatment costs, with a limit of up to ₹ 4,00,000 for a duration of 12 months.

5. Tailoring funding solutions to meet your specific needs, offering lower-than-market interest rates for higher tenures and amounts.

Dedicated to your well-being, HexaHealth recognized the need for a holistic approach to address this challenge. Introducing the National Liver Board, a team of leading experts in liver health committed to guiding every patient with liver disease towards a speedy recovery.

Liver transplantation (LT) stands out as an exceptionally effective treatment for individuals with advanced stages of liver failure. With a success rate of around 90%, living donor liver transplants pave the way for patients to enjoy healthy lives. 

HexaHealth is dedicated to providing affordable, top-notch liver transplant surgeries in India. Feel free to reach out for information on the procedure, costs, potential side effects, hospital stay, financing options, and recovery after surgery.

To read more about liver transplant, click on the links below: