Over the past few decades, there have been lots of changes in the field of organ transplantation. Among all organ transplants, liver transplantation has seen the greatest advances. At present, more than forty years after Dr. Starzl made the first ever successful liver transplant, over 100,000 liver transmutations have been carried out in the world. Consistent advancements in immunosuppressive therapy, preoperative management, and surgical techniques have led to an amazing graph and patient survival rates have become a lot better.
Types of liver transplant in India
Living donor liver transplant:
Because of the lack of cadaveric organ donors, healthy relatives can come forward as donors. Living Donor Liver Transplantation (LDLT) is presently the most helpful alternative to get over organ shortage among adults. One part of the liver of the donor gets harvested for transplants in the recipient. The reduction in waiting period for the living donor organ might decrease the risk of death or decompensation before transplant. Thus, it improves the overall chance of success.
The main advantage of LDLT is that the graft quality can be ensured with greater certainty in this case. Since both the recipient and donor operations can be carried out at the same time, the graft ischemia time is lesser. The disadvantages are mainly towards the health of the donors.
Adult to adult LDLT needs transplanting of the donor’s right lobe in the recipient. It needs harvesting the right lobe graft minus the middle hepatic vein, but with the preservation of the tributaries. This vein remains on the donor side for better outflow from the residual liver. The preserved tributaries get reconstructed before getting implanted in the recipient.
Because of the elective nature of this surgery and the option to undergo transplant at a relatively early stage of the disease, rather than getting worse in the waiting list for a cadaver organ, the results of LDLT have improved to over 95 percent.
Deceased Donor Liver Transplant:
Deceased Donor (Cadaveric) Liver Transplant (DDLT) is the most common type of liver transplant all over the world. To be eligible for deceased donor liver transplant, the patient has to register as a potential organ recipient in the organ distribution network of the state. They can get a liver transplant when an organ is allocated to them by the network.
The damaged liver gets removed and the donated one gets transplanted in that place through a process called orthotopic liver transplant. The patient who has liver cirrhosis is sicker than a typical patient going through surgery. He has reduced antifibrinolytic factors, low platelet count, and raised INR with coagulopathy.
Chances of bleeding increase because of portal hypertension, which ultimately leads to both anesthetic and surgical challenges. Moreover, the risks of reperfusion injury remain even after the graft implant. The anastomoses of the portal vein, hepatic vein, the calibrated hepatic artery, and the bile ducts need proper surgical techniques and an experienced surgeon.
The demand for liver transplant in India
Liver transplant came to India several decades after the world already started performing it. However, the past couple of years have registered a tremendous increase in the total number of liver transplants successfully done in the country. In fact, India is now the regional transplant center for the entire South East Asia. Nearly 25 to 30 percent of the total transplants every year are carried out on patients coming from other nations.
As per the Global Health Observatory data provided by the WHO (World Health Organization), the burden of liver disease in the country is large enough with more than 22 deaths per 100,000 population due to liver cirrhosis. In other words, there is a rising demand in India for liver transplant due to increasing instances of chronic liver illnesses and cirrhosis. Conservative estimates suggest that about 20,000 patients in India need a liver transplant annually. And yet, only about 800 to 1000 liver transplants are presently performed each year on Indian patients.
There are two major obstacles faced by patients who need liver transplant in the country. Firstly, the cost of a liver transplant is pretty high. Though the procedure is still carried out in India at half the cost compared to the developed countries, it’s still an expensive surgery. Secondly, there is a problem of donor availability. The wait for a cadaveric organ donation is long enough, and getting a LDLT is not an easy one.
There is a major discrepancy between the total number of liver transplants done in the country and the total number of patients needing a transplant. Using the expertise available for both types of liver transplant, many patients can get an assured treatment for the fatal liver diseases. Getting referred early for the transplant makes it easier for patients to weigh and explore both the options and choose the most convenient one.