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Liver Transplant Surgery



Liver is one of the vital organs of our body which performs more than 500 functions. There is currently no way to compensate for the absence of liver function in long term, although liver dialysis can be used short term. Some of the very important functions performed by a liver are processing of digested food from the intestine, controlling the levels of fats, amino acids and glucose in the blood , providing immunity against infection, cleaning the blood of particles and infections including bacteria , detoxify, by metabolizing and/or secreting, drugs, alcohol, and environmental toxins, helps in manufacturing bile juice that aids the process of digestion of lipids in the small intestine , acts as a store house for storing iron, vitamins and other essential chemicals , helps in breaking down of food and turning it into energy and it regulates , manufactures and helps in breaking down of numerous hormones in the body.

How does the Liver look like?

Weighing about 3 lb (1.36 kg), the liver is the largest glandular organ of the body. Our liver is reddish brown in colour and is divided into four lobes of unequal size and shape. The liver lies on the right side of the abdominal cavity beneath the diaphragm. Blood is carried to the liver via two large vessels called the hepatic artery and the portal vein. The heptic artery carries oxygen-rich blood from the aorta (a major vessel in the heart). The portal vein carries blood containing digested food from the small intestine. These blood vessels subdivide in the liver repeatedly, terminating in very small capillaries. Each capillary leads to a lobule. Liver tissue is composed of thousands of lobules, and each lobule is made up of hepatic cells, the basic metabolic cells of the liver. Liver is one of the vital organs of our body and performs many functions. Your liver just happens to be the largest organ in your entire body. The normal human liver weighs about three and a half pounds, and is about 4.5 inches thick, 6.5 inches long, and about 8 inches wide. It is basically separated into 3 zones in which each zone has its own special function to perform. It has a dual blood supply, which is unique for most organs and can although you might at first consider it one of nature's flukes, they serve an important purpose. The first part is the portal vein, and then the hepatic artery. This artery brings oxygen rich blood back to the liver from the heart, lungs and branches of your aortic artery. Tiny branches of both of the hepatic artery and portal vein interweave with tiny ducts all throughout the liver that are used to secrete bile.

What Liver Does?

Your liver is also considered a gland, and the largest at that, because it produces and secretes bile, among many other complex and important functions. One major function in the liver is to manufacture proteins that help the blood clot and maintain the volume of blood in the body, the main protein being albumin. The liver also synthesizes, processes, and stores fats, including energy rich fatty acids and cholesterol. It also stores carbohydrates that are used as the source of glucose in your blood that are used by your brain and the red blood cells, and it metabolizes these carbohydrates. As stated before, it also works to produce and secrete bile. This bile contains acids that aid in the absorption of vitamins k, d, e, a, as well as fats. The liver can also eliminate harmful byproducts of the body, such as bilrubin and ammonia that are produced when old red blood cells and proteins have been broken down. As if your liver doesn't do enough for you already, it also detoxifies your system by metabolizing environmental toxins, alcohol and drugs.

It produces enzymes and proteins which are responsible for most chemical reactions in the body, for example those involved in blood clotting and repair of damaged tissues.

The liver works diligently to keep you free of disease. Because of its importance in your body, any sign of trauma to the organ itself or any liver function trauma in general is a major problem.

Where is the Liver Located?

It is located below your diaphragm, but primarily in the upper right section of your abdomen. Most of it is contained within the ribcage, but it also extends over into the upper left abdomen and the middle of your upper abdomen. This is because the liver is such a strange shape, dome like and irregular with two large lobes and two smaller lobes. When you breathe, your liver actually gets pushed down by your diaphragm, sending the lower edge down past the lowest rib.

What are the conditions affecting the Liver?

  • Hepatitis : Inflammation of the liver, usually caused by viruses like hepatitis A, B, and C. Hepatitis can have non-infectious causes too, including heavy drinking, drugs, allergic reactions, or obesity.

  • Cirrhosis : Long-term damage to the liver from any cause can lead to permanent scarring, called cirrhosis. The liver then becomes unable to function well.

  • Liver Cancer : The most common type of liver cancer, hepatocellular carcinoma, almost always occurs after cirrhosis is present.

  • Liver Failure : Liver failure has many causes including infection, genetic diseases, and excessive alcohol.

  • Ascites : As cirrhosis results, the liver leaks fluid (ascites) into the belly, which becomes distended and heavy.

  • Gallstones : If a gallstone becomes stuck in the bile duct draining the liver, hepatitis and bile duct infection (cholangitis) can result.

  • Hemochromatosis : Hemochromatosis allows iron to deposit in the liver, damaging it. The iron also deposits throughout the body, causing multiple other health problems.

  • Primary Sclerosing Cholangitis : A rare disease with unknown causes, primary sclerosing cholangitis causes inflammation and scarring in the bile ducts in the liver.

  • Primary Biliary Cirrhosis : In this rare disorder, an unclear process slowly destroys the bile ducts in the liver. Permanent liver scarring (cirrhosis) eventually develops.

How is Liver problem diagnosed?

  • Liver Function Panel : A liver function panel checks how well the liver is working and consists of many different blood tests.

  • Blood Tests

  • ALT (Alanine Aminotransferase) : An elevated ALT helps identify liver disease or damage from any number of causes, including hepatitis.

  • AST (Aspartate Aminotransferase) : Along with an elevated ALT, the AST checks for liver damage.

  • Alkaline Phosphatase : Alkaline phosphatase is present in bile-secreting cells in the liver; it's also in bones. High levels often mean bile flow out of the liver is blocked.

  • Bilirubin : High bilirubin levels suggest a problem with the liver.

  • Albumin : As part of total protein levels, albumin helps determine how well the liver is working.

  • Ammonia : Ammonia levels in the blood rise when the liver is not functioning properly.

  • Hepatitis A Tests : If hepatitis A is suspected, the doctor will test liver function as well as antibodies to detect the hepatitis A virus.

  • Hepatitis B Tests : Your doctor can test antibody levels to determine if you have been infected with the hepatitis B virus.

  • Hepatitis C Tests : In addition to checking liver function, blood tests can determine if you have been infected with the hepatitis C virus.

  • Prothrombin Time (PT) : A prothrombin time, or PT, is commonly done to see if someone is taking the correct dose of the blood thinner warfarin (Coumadin). It also checks for blood clotting problems.

  • Partial Thromboplastin Time (PTT) : A PTT is done to check for blood clotting problems.

  • Ultrasound : An abdominal ultrasound can test for many liver conditions, including cancer, cirrhosis, or problems from gallstones.

  • CT Scan (Computed Tomography) : A CT scan of the abdomen gives detailed pictures of the liver and other abdominal organs.

  • Liver Biopsy : A liver biopsy is most commonly done after another test, such as a blood test or ultrasound, indicates a possible liver problem.

  • Liver and Spleen Scan : This nuclear scan uses radioactive material to help diagnose a number of conditions, including abscesses, tumors, and other liver function problems.

What are the treatment options available?

  • Hepatitis A Treatment : Hepatitis A usually goes away with time.

  • Hepatitis B Treatment : Chronic hepatitis B often requires treatment with antiviral medication.

  • Hepatitis C Treatment : Treatment for hepatitis C depends on several factors.

  • Liver Transplant : A liver transplant is needed when the liver no longer functions adequately, whatever the cause.

  • Liver Cancer Treatment : While liver cancer is usually difficult to cure, treatment consists of chemotherapy and radiation. In some cases, surgical resection or liver transplantation is performed.

  • Paracentesis : When severe ascites - swelling in the belly from liver failure -- causes discomfort, a needle can be inserted through the skin to drain fluid from the abdomen.

  • ERCP (Endocscopic Retrograde Cholangiopancreatography) : Using a long, flexible tube with a camera and tools on the end, doctors can diagnose and even treat some liver problems.

What is Liver Transplantation or Liver Transplant Surgery?

All liver functions remain normal even if 70% of it is removed (provided the remaining 30% is healthy). Hence, in persons with cancer of the liver, large portions of cancerous liver can be removed without causing harm or compromise to liver function. Similarly, more than half the liver can be removed from the donor for transplantation purposes, without causing any derangement of liver function or any other serious harm to the donor. The liver is the only organ in the body which can regenerate itself after large portions of it are removed. Small remnants of liver grow back to normal size within a few weeks. This is another reason why it is safe to remove large portions of liver from living donors and persons with liver tumours. This is also why half livers transplanted into liver failure patients are very successful since they soon grow to normal size.

Liver Transplant Surgery is only the treatment option for more advanced stages of cirrhosis and can be done by donation by a brain dead person or by a close relative with matching blood group.

What are the indications for a Liver Transplant Surgery?

A patient suffering from liver cirrhosis and who is assessed to have a life expectancy of less than a year is generally considered for a Liver transplant surgery. Patients who are suffering from severe liver disease should consult a liver doctor at the earliest. The medical treatment or the liver transplant surgery (as per doctor's recommendation) would be more effective the earlier the problem is diagnosed and treatment is started. Therefore, timely treatment is very important in getting good results. If a liver transplant surgery is done timely on a patient who is in a reasonable health condition, with a good donor liver then there are high chances of success. Some of the symptoms of liver failure due to cirrhosis are black stool, blood vomiting, water in the abdomen, drowsiness and mental confusion, excessive bleeding from minor wounds,Jaundice,Kidney dysfunction, Excessive tiredness, Low hemoglobin and other blood counts.

How a Liver Transplant Proceduredone?

A liver transplant surgery starts with a detailed evaluation and a battery of tests for both the recipient and the donor. The evaluation of the recipient is done in three phases to establish definite diagnosis, determine the severity of liver disease and the urgency of the transplant. The functioning of all the vital organs is properly checked.

Before the liver transplant procedure the patient, donor and other family members are counselled about the procedure, hospital stay, the likely course after surgery, follow up and aftercare in order to help them to make up their mind and understand the process thoroughly.

There are two types of Liver Transplant Surgery

  • Cadaveric donor (deceased donor) liver transplant

  • Living Donor Liver Transplant

In a Cadaveric Donor Liver Transplant, the liver is taken from a Cadaveric Donor for transplantation. A Cadaveric Donor is a brain dead person (refers to the irreversible end of all brain activity and the patient is on advanced life support system). In this case a donation is possible from a person whose family wishes to donate the person's organs before discontinuing life support. Cadaveric transplants are not practical for overseas patients since in India there is long waiting list for Cadaveric Donors since cadaveric organs are not frequently available and the wait for such donors may extend to several months.

In a Living donor Liver Transplant surgery, the donor is a living and active person. In this case the liver donation is possible from a close relative of the recipient. Due to a lack of cadaveric donors in India, majority of the transplants currently performed are living donor liver transplants whereby a portion of the patient's relative's liver is removed and is used to replace the diseased liver of the patient. For Overseas patients, only living donor liver transplants are recommended, which requires them to bring a healthy, willing donor (a close relative or family member only) with them when they come for a transplant.

Note : In a Living Donor Liver Transplant Surgery, the donor must be a close relative or family member only. The suitability of the donor for the donation would be determined by the Liver Transplant Team after studying the various aspects and performing a series of medical tests.

Who can be a Liver Donor?

As deceased (cadaver) donor Liver transplants is restricted to Indian citizens therefore international patients (foreign patients seeking Liver transplantation in India) are only able to undergo Living Donor Liver Transplantation. International Patients seeking Liver transplantation in India are required to bring their own potential Liver donor or donors who should fulfill the following requirements.

  • The donor must have no significant medical condition that will increase the risk of surgery or Liver failure.

  • The donor must be mentally competent to be counseled and give voluntary informed consent for Liver donation.

  • The donor must not be under coercion to donate.

  • The donor should be between 18 years to 60 years of age.

  • The donor can be a spouse, parent, sibling or grandparent and documentation showing statutory declaration of relationship to the patient is mandatory.

Please take note that under Indian Organ Transplant law, it is illegal to sell or buy anorgan for the purpose of transplantation. This aims to deter organ trading syndicates and unscrupulous middlemen. Please take a note that tissue and blood group incompatibility or sensitized recipients are not barriers to transplantation and will have to be assessed and counseled on an individual basis.

Liver Transplant Surgery in India

The cost of Liver Transplant Surgery depends upon the hospital and the location you choose. There are many good Liver transplant hospitals across various cities in India. Whenever a quote is given for a Liver transplant surgery, it is only for the initial work-up/investigations, surgery and for certain days of hospital stay. However the patient has to stay for a long time in a hotel or guest house before and after surgery for paper work and recovery. This stay may be for 25-45 days. The cost of hotel stay and food is not included in the cost of Liver transplant surgery. The cost of hotel stay would be additional and you need to make the payment as per actuals to hotel or guest house directly. The cost of hotel or guest house stay would depend on the type of hotel or guest house you choose. There are many options available and cost may range between 60 US Dollars per night to 180 US Dollars per night depending upon the hotel or guest house you choose. We will help you to find suitable hotel or guest house which meets your preference and the budget.

In India, the Liver transplant surgery comes under the purview of Transplantation of Human Organ Act, 1994. Hence unlike other medical treatments, for a Transplant Surgery like the Liver Transplant Surgery in India, there are certain legal formalities that are to be fulfilled. The patient and the donor have to bring certain set of documents in original when they come to India for a Liver Transplant Surgery. All the scanned copies of the documents should be sent to us by email (medical@treatmentassistance.in) for verification. This should be done before the patient and the donor decides to travel. To know the complete list of documents please write to us or call us anytime.

How to get started?

It is simple. Just scan the following documents and send it to us by mail to info@mentorsethicare.com.

  • Recent Medical Reports

  • CT Scan Images, CT Scan Reports and

  • HLA match report of the patient and the donor

Once we get the medical reports, one of our patient service associates will contact you and guide you through the entire process step by step.

For more information on high quality and low cost Liver transplant surgery in India, you can write to us at info@mentorsethicare.com or call us anytime at 0091 9611 231 188


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