Liver Transplantation at SGRH

The Department is one of very few in the country that has an established state-of-the art facility for Liver transplantation for both, adults and children using cadaveric as well as livers from living donors. Currently, this is the only definitive treatment available for patients dying due to acute or chronic liver failure.

SGRH endeavours to provide world class care to such patients at a small fraction of its cost abroad.

The Department consists of faculty who have trained and worked extensively in the best centers of the world in the UK, Japan and Seoul, and have earned international acclaim in clinical liver transplantation and research and, have subsequently made pioneering achievements in Liver Transplantation in India in the recent years.

A sound base is provided to the Department's liver transplant activities by a highly academic Department of Hepatology and Gastroenterology which boasts of internationally reknowned faculty who have trained and shaped the careers of many Hepatologists and Gastroenterologists across the country in the last decade.

1. Liver Help Online - free help line for expert advice from our Liver Specialists
   In order to avail this facility, please register with us by providing us some details about yourself. One of the above experts will answer all your queries by e-mail within 48 hours.
   

2. Who needs a liver transplant?
   Persons with one or more of the following problems should seek expert advice regarding liver transplant. The transplant doctor can then suggest if liver transplant is appropriate.

   1. Those with end-stage chronic liver disease complicated by tiredness, fatigue,
      weight loss, repeated attacks of blood in the vomit or stool, low serum albumin or prolonged prothrombin time, hospitalization for intractable (which keeps accumulating inspite of medicines) ascites, infection in the ascites (spontaneous bacterial peritonitis or SBP), attacks of excessive drowsiness, mental confusion or coma or excessive jaundice.

   2. Those with severe acute liver failure which is not improving with medicines.
      Acute liver failure is said to be present when the duration of illness is a few days or weeks. It may be caused by Viral Hepatitis, Wilson's disease, drug overdose, Budd-Chiari syndrome(obstruction to the hepatic veins or IVC draining the blood from the liver) or some unknown causes.The illness is characterized by worsening coma, jaundice, prothrombin time (PT), liver tests (SGOT / SGPT / Alk phos, GGT) and kidney function, and falling blood glucose levels.
      

3. Where does the donor liver come from?
   There are two sources of the donor liver

   1. Cadaver liver: 
      This liver is provided by voluntary donation by the family of a person who is brain dead in an ICU of a hospital. Brain death can occur in a person due to fatal head injury from an accident or severe brain hemorrhage or irreversible brain damage from other reasons. His/her other organs can be kept intact by life support systems for a few days. If the family of such a person agree, organs such as the liver, both kidneys, heart, lungs, pancreas and corneas can be removed upon discontinuance of life support systems, and can be used to save lives of many critically ill patients on the transplant list.

   2. Portion of liver form a living person:
      Living donor liver transplantation is a recent concept in which a living person can donate a part of his/her liver to save the life of an individual dying from liver failure without any danger of major complications or death to the donor. The amount of liver removed from the donor depends on the weight of the recipient - heavier the recipient, larger the portion of liver required. However, the liver has a lot of reserve whereby only 20-30% of normal liver is enough to sustain life. To ensure donor safety, liver surgeons always leave behind at least 40-50% liver in the donor. The liver also has a unique capacity to regenerate whereby it regains its full size in both the donor and the recipient within 6-8 weeks.
      

4. Details of the transplant operation
   The transplant operation is done in 3 stages.

   The first is to remove the liver from the donor. In case of a cadaver donor, the whole liver is removed, perfused with special preservation solutions and kept surrounded by ice until it is transplanted into the recipient.

   In case of a living donor, approximately half the liver is removed by special bloodless liver splitting techniques, and perfused and kept in ice in the same way as above.

   The second stage is the back table stage which is done while the liver is in cold storage just before it is connected to the recipient. In this stage, the blood vessels of the new liver are cleaned and prepared for their connections in the recipient.

   The third stage is the recipient surgery or the actual transplant. In this operation, the patient's diseased liver is carefully removed and the new liver is put in by connecting the liver blood vessels and the bile duct in the recipient to the corresponding parts of the new liver.

   Living Donor Liver Transplant at Sir Ganga Ram Hospital

   1. Donor operation Liver before division
   2. Liver after division
   3. Divided donor liver showing liver blood vessels to both halves
   4. Half Liver to be transplanted into recipient
   5. Liver after transplantation into recipient

5. Advantages & Disadvantages to Living Donor Transplantation

   When utilizing a Living Donor organ, the doctors, surgeons and patients (the donor and the recipient) can schedule the surgery at a time that will optimize the results of the procedure. The procedure is scheduled when the transplant recipient is in better health and in a better condition for recovery.

   The liver itself is also in a healthier condition. Although the recipient is only receiving a partial organ, they will receive a graft (piece) sufficient to sustain life while the liver re-grows to a normal size. Also, the time that the liver needs to be chilled (ischemic time) is minimized, reducing tissue damage and further insuring a healthy organ transplant.

   Best of all, as the transplant recipient is receiving this life-saving gift from their loved one.

   The downside is that the donor who is a healthy person, has to undergo major surgery which although safe, entails about a week of hospitalization and about 3 weeks rest at home.
   

6. Who makes a good donor candidate
   Any healthy person aged 18-65years who is of matching blood group with the recipient can be a liver donor. However, a definite opinion on the suitability of a person for liver donation can only be obtained after detailed examination and tests by the transplant team.

Other features

• Fix an appointment with a liver transplant doctor

• Fix an appointment at the SGRH Liver clinic

• Meet our previous liver donors

• Meet our previous patients

The Liver Transplant Team at SGRH (group photograph)

The SGRH offers a comprehensive and multi-disciplinary approach to the treatment of irreversible liver disease that is delivered through their Liver Transplant Team that includes specialists in: