The future of liver transplantation in India should move toward a more accountable, equitable, and accessible form. This is solely attributed to the awareness among Indian citizens who have shown tremendous faith in voluntarily donating their liver as living donors as well as consenting for deceased donation. India’s liver transplant programme might be flourishing but is marred by the lack of any mechanism for a registry or mandatory reporting of results too
What is living liver donation?
Whena part of the liver is donated by someone who is living to someone awaiting aliver transplant, it is referred to as living donor liver transplant.
“Donor” is the person who gives their liver.
‟Transplant candidate” or ‟Recipient” is the person waiting for a liver transplant.
Aliving – donor liver transplant process involves transplanting a portion of theliver from a living donor into a recipient whose liver no longer functionsproperly.
Theremaining liver in the donor’s body regenerates within couple of months andreturns to its normal volume and capacity after surgery. Even the transplantedliver portion grows and restores its normal functioning in the recipient.
Accordingto Dr.Ravinder Pal Singh Malhotra, Director & HOD – Center for LiverHealthy Human Clinics. ” over 15% of the patients undergoing live donorliver transplant are from abroad. With growing awareness and the rising burdenof liver ailments over 85% of them are live donors. This has also attractedforeign patients namely from, the Middle East, Pakistan, Sri Lanka, Bangladeshand Myanmar to India for liver transplant. Over 200 cases undergo transplantannually, which shows the rapid progression of LDLT in India. And over 2500living donor transplants have been conducted until now”
LDLT is transparent in India
Transplantingliver from a live donor is a very transparent activity in India. It is a wellorganized process with the recommendations and clearance required from theconcerned specialists. Donations done apart from the first degree relationsneeds to get clearance from the state appointed Authorization committee. If aforeign patient needs to donate or get a transplant done, the necessaryapproval from the concerned embassies along with the State clearanceCertificate is a mandate. The donor risk is discussed and thesuccess of the recipient operation is also explained to all patients.
How to be a Living liver donor?
Liverdonation has become very safe, with a surgery performed to remove a part ofliver from the donor used for transplant. Within a time span of 2-3 weeks thedonor recovers completely well as the liver regenerates itself. There arecertain criteria for becoming a live donor, which includes –
The donor should be within the age limit of 18-55 years and willing.
To eliminate any risk of fatty liver the person donating the liver should not be more than 85 kgs or the respective BMI (<25).
The donor should either possess the same blood group as of the recipient or universal donor ‘O’.
Thedonor is then thoroughly checked for complete screening tests like – CBC, PT,LFTs, Serum creatinine, HBsAg, HCV antibody, HIV I,II, Chest X ray, ECG andUltrasound of the abdomen.
TheGrowing need for LDLT in India
After2 unsuccessful attempts in 1995 and 1996, the first successful deceased donorliver transplant (DDLT) was performed in 1998. However, due to the sporadicavailability of deceased donor organs, a patient requiring liver transplantwould almost certainly die before an organ could become available. Livertransplantation remained a realistic option only for the few who could affordthe astronomical costs of travelling overseas for the procedure.
In India where historical and cultural issues have impeded the readyavailability of cadaveric organs for donation, at least currently, LDLT is theonly realistic option. Some of the inherent hurdles in DDLT include timelyavailability of a deceased donor organ before the patient becomes too sick toreceive a transplant, organ harvesting and transport, likelihood of marginalgrafts due to paucity of expertise in management of brain dead donors anddifficulty for the recipient to arrive at the transplant centre at shortnotice. It is no wonder therefore, that more than 70% of the liver transplantsperformed in this country till date have been LDLTs.
Scope and feasibility in India
Beforeassessing its feasibility in India, it is pertinent to define thepre-requisites for establishing an LDLT programme. Obviously the procedure isvery resource intensive and requires skilled multidisciplinary manpower. It ishowever not imperative that the centre has experience in performing DDLT thoughsuch experience can be beneficial. At least two surgeons with significantexperience in advanced hepatobiliary surgery and assistant surgeons arerequired per surgical team. The surgical team has to be actively supported by agroup of highly skilled and experienced anaesthetists, critical care physiciansand transplant hepatologists with a round-the-clock access to diagnostic andinterventional radiology, dialysis, and endoscopy, immunology, pathology, transfusion,microbiology and biochemistry services of the highest quality. At least twostate of the art operating rooms equipped with rapid infusers, cell savers,non-invasive cardiac output monitors, ultrasonic surgical aspirator, argoncoagulator and on-site laboratory are necessary. In the post-operative period,a modern intensive care facility with invasive monitoring, laminar flow andskilled nursing staff form the remaining links in the chain.
LDLThas become a necessary supplement to DDLT in India. It is also required topromote public acceptance of liver transplantation. It might even help inpromoting deceased donor organ donation. However, it is necessary to adopt anextremely cautious attitude so as to prevent unregulated proliferation of LDLTcentres. Strict adherence to and fostering of internationally accepted norms oftraining and set-up as well as internal and external auditing of results mustbe made compulsory before permitting centres to carry out LDLT. In particular,the living donor must be protected under all circumstances if continuingclinical benefits are to be reaped from LDLT.