Deceased Donor Liver Transplantation
Deceased donor liver transplantation is a surgery in which a person's body is declared brain dead and his family is willing to donate liver to the patient for transplantation. Deceased donor liver transplant is gaining momentum in India.
Deceased donor is a person who is declared “brain dead” but who can donate other organs of his body as the blood supply to these organs is maintained. The organs of a brain dead person can be used for transplantation if the next-of-kin give consent. Donor should be blood group compatible.
Patient evaluation – Patient undergoes an evaluation for the cause of end-stage liver disease and for the fitness for a major surgery like liver transplantation. As end stage liver disease has adverse effects on other organs of the body, a multidisciplinary team (including Hepatologist, Transplant surgeons, Anesthesiologist, Cardiologist, Chest physician, Dental surgeon, Psychiatrist, Gynecologist for female recipient) evaluates the patient and then he is placed on the waiting list for deceased organ. The waiting time apart from the availability of organ (shortage of donors), depends on the general medical condition of the patient. Hundreds of people die each year while waiting for a cadaveric liver to be offered. Organ donation after “brain death” is still in infancy in India. However, it is slowly and steadily making a place in the transplant program, which to a large extent at the moment is living related.
Patient preparation after the organ is available – Once the transplant team gets information regarding organ availability, the recipient on the waiting list for cadaveric liver transplant is contacted and admitted to the hospital. Simultaneously the retrieval team gets involved in the organ procurement while the patient is prepared for the surgery. Liver once retrieved is transported to the recipient hospital in a cold preservative solution.
Operation – The operation involves removal of the diseased liver and replacing it with a healthy liver from the deceased donor. The whole new liver with the conduits (arteries, veins and bile duct) are joined to the corresponding structures in the patient. This operation of liver transplantation usually lasts for 6-8 hours.
Post Transplant Care – Patient usually stays in hospital for 2-3 weeks depending on the pre-transplant condition and his recovery. Post transplant patient is started on medications (immunosuppressants) to prevent the individuals own body reacting to the new liver and rejecting it. These medications which are three in the initial part, is continued for life-long, however the number of medications get reduced to single or at the most two which are continued in a small dose. After transplantation patients have a good quality of life and most of them lead a comfortable and healthy life.
Who can donate liver?
Deceased donor liver transplantation is a surgery in which a liver is donated by a deceased person whose family wishes to donate the liver for liver transplantation and who comes under the criteria for deceased donor liver transplant. There are some frequently asked questions regarding deceased donor liver transplantation.
Q. Liver can be donated by whom?
A. The entire liver is obtained from a brain dead person, whose family wishes to donate for liver transplantation.
Q. Liver can be donated with a motive of?
A. The person's family who is donating liver for deceased donor liver transplantation must donate of their own free will without financial motivation.
Q. What is the eligible age to donate liver?
A. The age of the deceased person to donate liver for deceased donor liver transplantation should be 18 - 55 years.
Q. Who is compatible for liver transplant?
A. The blood groups and the HLA profiles of the recipient and the deceased donor must match with each other.
Tests during pre-liver transplantation
There are various tests which are prescribed by doctors to surgeon during pre-liver transplantation. Tests which are prescribed by doctors are as follows:
Laboratory tests are prescribed by doctors to assess the health of deceased person's organs, including deceased person's liver which includes blood tests, urine tests.
Imaging tests are prescribed by doctors which are Ultrasound, CT scan, MRI of the liver and other abdominal organs.
Heart tests are prescribed by doctors to determine the health of deceased donor’s cardiovascular system.
Financial counseling to help recipient to understand the cost of a transplant and post-transplant care, and to determine what costs are covered by insurance.
Precautions taken post-liver transplant surgery
There are some precautions which are to be taken by the recipient. Precautions which are to be taken by the recipient are as follows:
•    The recipient must stay under observation post-liver transplant surgery in hospital for 2-3 weeks.
•    At home, 2-3 weeks of recuperation for recipient is needed after discharging from hospital.
•    A recipient can resume his normal activity 6-8 weeks post-liver transplant surgery.
•    Sexual activity can be resumed when the doctor gives an affirmative nod for it or when the recipient feels well enough post-liver transplant surgery.
•    Heavy physical exercise, sports including lifting weights can be resumed 3 months post-liver transplant surgery.