LIVER TRANSPLANT COST IN INDIA 

Overview

Liver transplant is a surgical procedure to remove a diseased liver and replace it with a healthy liver from a donor. A liver transplant can be performed by transplanting a liver from a deceased donor and also from a living donor. The number of people waiting for new livers is much larger than the number of available livers, so a liver transplant is reserved for people who are critically ill. Some people receive a liver transplant right away, while others spend many months waiting for a liver transplant. If you or a loved one has end-stage liver disease (also known as chronic liver failure), and standard medical and surgical therapies no longer work, a liver transplant may be a lifesaving option.

About the Liver

The liver is the largest abdominal organ. The liver weighs about 1200 – 1500 grams in an average roughly 2% of body weight. Liver, though a single organ, broadly it can be divided into two parts – right and left liver and 8 independent segments (each having its own blood supply and biliary drainage) functioning as a single organ. Liver as a whole has a hepatic artery supplying oxygenated blood, a portal vein carrying blood from intestines to liver and bile ducts draining bile formed in the liver to intestines. Blood from the liver is delivered-to-heart-via-three-hepatic-veins. Liver produces bile which is drained by the biliary tree. Gall bladder is a reservoir for the bile and lies on the liver bed, and is attached to the bile duct. It regulates the delivery of bile into intestines. Liver is endowed with a remarkable capacity to regenerate after division into parts. Functions of Liver The liver is in the right upper abdomen. The liver serves many functions, including the detoxification of substances delivered to it from the intestines, and the synthesis of many proteins.

• The liver is the powerhouse of the body. It is the main organ of metabolism i.e. it involves, series of breaking down and making up of chemically reactive and generation of energy
• The liver converts food into chemicals necessary for life and growth
• Liver processes and removes drugs, alcohol and other substances generated in a body that may be harmful for the body
• The liver produces elements necessary for the absorption of fats and vitamins
• The liver manufactures important proteins that are necessary for normal blood clotting and building muscle
• Liver maintains the hormonal balances
• Liver stores important vitamins

Who requires a Liver Transplant?

A liver transplant may be necessary for patients who suffer from:

• liver damage due to alcoholism (Alcoholic cirrhosis)
• Malignancies involving liver: Hepatocellular carcinoma, Hepatoblastoma, Hilar Cholangiocarcinoma, etc
• primary biliary cirrhosis
• long-term (chronic) active infection (hepatitis B or C)
• liver (hepatic) vein clot (thrombosis)
• birth defects of the liver or bile ducts (biliary atresia)
• metabolic disorders associated with liver failure (e.g., Wilson\’s disease)

CONDITIONS LEADING TO LIVER FAILURE/ TRANSPLANT

Conditions that may lead to liver transplant include:

• Acute liver failure: Rapid deterioration of the liver function, which can happen because of viruses or other infections, drug overdose or other toxins, cancer or autoimmune disease
• Alpha-1-antitrypsin deficiency: A genetic disorder leading to abnormal amounts of A1AT protein in liver cells
• Cholangiocarcinoma: Bile duct cancer, a rare cancer that is treated at only a few transplant centers, including the Washington University and Barnes-Jewish Transplant Center
• Cirrhosis: A chronic degenerative disease of the liver that may result from alcoholism or hepatitis B or hepatitis C.
• Hepatocellular carcinoma: Cancer that starts in the liver cells
• Primary biliary cirrhosis (PBC): A slow deterioration of the bile ducts in the liver
• Primary sclerosing cholangitis: Disease leading to scarring of the bile ducts
• Wilson's disease: An inherited disorder that causes too much copper to accumulate in the liver, brain and other organs.

Patients require hospital care for one to four weeks after liver transplant, depending on the degree of illness. After liver transplantation, patients must take immunosuppressive medications for the rest of their lives-to-prevent-immune-rejection-of-the-transplanted-organ.

Types of a liver transplant?

The Liver Transplant Procedure A liver transplant involves the preparation of the donor liver, removal of donor's liver, removal of the diseased liver, and implantation of the new organ. The liver has several key connections that must be re-established for the new organ to receive blood flow and to drain bile from the liver. The structures that must be reconnected are the inferior vena cava, the portal vein, the hepatic artery, and the bile duct. The exact method of connecting these structures varies depending on specific donor anatomy or recipient anatomic issues and, in some cases, the recipient disease. For someone undergoing liver transplantation, the sequence of events in the operating room is as follows:

1. Incision
2. Evaluation of the abdomen for abnormalities that would preclude liver transplantation (for example- undiagnosed infection or malignancy)
3. Mobilization of the native liver (dissection of the liver attachments to the abdominal cavity)
4. Isolation of important structures (the inferior vena cava above, behind, and below the liver; the portal vein; the common bile duct; the hepatic artery)
5. Transection of the above-mentioned structures and removal of the native, diseased liver. (Figure 7)
6. Sewing in the new liver: First, venous blood flow is re-established by connecting the donor's and the recipient's inferior vena cava and portal veins. Next, arterial flow is re-established by sewing the donor's and recipient's hepatic arteries. Finally, biliary drainage is achieved by sewing the donor's and recipient's common bile ducts.
7. Ensuring adequate control of bleeding
8. Closure of the incision

Some facts about liver transplant

• A liver transplant is needed when the liver fails, usually because of long term disease.
• About 1,00,000 people in India die of liver failure every year. The first successful liver transplant was done in 1967.
• The number of liver transplants has been steadily increasing for more than 15 years.
• Cirrhosis is the most common reason for liver transplant
• Donated livers can come from either diseased donors or living donors.
• The five-year survival rate of liver transplant patients is over 75%.

Time

One needs to remain in ICU for seven days after the medical procedure and an additional 3 weeks in transplant care unit following which the patient is released from the hospital. Be that as it may, the donor will remain at the medical clinic for about seven days. The patient or recipient needs to come to India around about 3-4 weeks before the transplant for pre-transplant evaluation and remain for around two months post-discharge. So an aggregate of around 10-12 weeks is required for you to recuperate well after liver transplant medical procedure in India.