How to get a new liver

Liver diseases are on the rise in India and have now become a serious burden among the common man. Apart from congenital causes, liver diseases may arise as a result of poor lifestyle and alcoholism. Liver failure causes many problems, including malnutrition, issues with blood clotting, bleeding from the gastrointestinal tract and jaundice. Brain function may deteriorate because the liver cannot remove toxic substance build up in the blood.

This disorder is called hepatic encephalopathy. Liver failure can also lead to kidney failure, which is called hepatorenal syndrome. In some cases, liver transplant is considered as a way out.

Liver transplant may be necessary for patients who suffer from:
n Liver damage due to alcoholism
(alcoholic cirrhosis)
n Long-term (chronic) active infection (Hepatitis B or C)
n Primary biliary cirrhosis
n Liver vein clot (thrombosis) or Budd-Chiari syndrome
n Birth defects of the liver or bile ducts (biliary atresia)
n Metabolic disorders associated with liver failure
n Acute liver failure
n Wilson’s disease (a rare inherited disease with abnormal deposition of copper throughout the body, including the liver, causing it to fail)
n Liver cancer

How it is done
The transplant involves a major operation to remove the diseased liver and replace it with a normal donor liver placed in its usual position in the right upper abdomen. The surgery may take between six and eighteen hours to complete. At least three surgeons, two anaesthetists and half a dozen nurses are needed during the operation. The diseased liver must be disconnected from four major blood vessels and the tube that carries bile from the liver to the intestines, known as the bile duct, has to be disconnected from the bowel. The new liver is then put in place and the major blood vessels and bile duct reattached to complete the operation.

The healthy liver is obtained either from a living donor or from a donor who has recently died (brain dead) but has not suffered liver injury. The diseased liver is removed through an incision made in the upper abdomen. The new liver is put in place and attached to the patient’s blood vessels and bile ducts. The operation can take up to 12 hours to complete and may require large volumes of blood transfusions.

In a live donor liver transplant, a portion of the liver is surgically removed from a live donor and transplanted into a recipient immediately after the recipient’s liver has been entirely removed. A potential donor should:

n Be either a relative or spouse
n Have a compatible blood type
n Be in good overall health and physical condition
n Be older than 18 years of age and younger than 55 years of age
n Have a near normal body mass index (not be obese)
A donor must be free from:
n History of Hepatitis B or C
n HIV infection
n Active alcoholism or frequent heavy
alcohol use
n Any drug addiction
n Psychiatric illness currently under treatment
n A recent history of cancer

Success rates
nIn case of living donor: Technically, it is feasible to remove part of the liver from a living person and transplant it to a patient who needs a new liver. Depending on the size matching of the donor and recipient, either the left side (about 35-40 per cent) or the right side (60-65 per cent) of the liver will have to be removed. The liver which remains in the donor will grow to its original size in six to eight weeks time. The survival rate of a living donor transplant is over 90 per cent. There are risks, like complications of the investigations and surgical procedures, but the possibility of donor death rate is of 0.2-0.5 per cent.

nIn case of cadaver transplant: This is a well-established practice in the Europe and US. Unfortunately, the availability of deceased donor liver is a problem area in India. Depending on your blood group, you may have to wait for 12-36 months before you get a new liver. During this waiting period, you may develop complications like spontaneous bacterial peritonitis (infection of the fluid in the abdomen) which, if repetitive, may produce severe adhesions in your abdomen rendering liver transplantation difficult, if not impossible.

(The author is senior consultant & director, BLK Super Speciality Hospital, New Delhi)