Liver Transplantation 

What is a liver transplant? 

Liver transplantation is a surgical procedure performed to remove a diseased or injured liver and replace it with a whole or a portion of a healthy liver from another person, called the donor. Since the liver is the only organ in the body able to regenerate, a transplanted segment of a liver can grow to normal size within weeks. 

When is a liver transplant recommended? 

A liver transplant is recommended when a person’s liver no longer functions adequately enough to keep them alive. A successful liver transplant is a life-saving procedure for people with liver failure. 

Liver failure can happen suddenly – called acute liver failure – as a result of infection or complications from long-term problem – called chronic liver disease – progresses over months, years or decades. Chronic liver Disease is usually the result of cirrhosis, a condition in which healthy liver tissue has been replaced with scar tissue making the liver unable to carry out its normal functions. 

What are the common conditions that cause someone to need a liver transplant? 

  • Long term alcohol consumption
  • Chronic liver infection – HBV, HCV
  • Autoimmune hepatitis. 
  • NASH, or nonalcoholic steatohepatitis 
  • Liver cancer 
  • Some genetic conditions- Wilson disease where dangerous levels of copper build up in the liver, and hemochromatosis where iron builds up in the liver. 
  • Diseases of the bile ducts include primary biliary cholangitis, primary sclerosing cholangitis,and biliary atresia. 
  • Biliary atresia,a disease of absent or malformed bile ducts usually identified shortly after birth, is the most common cause of liver failure and transplant in children. 

How are candidates for liver transplant selected? 

·      Physician refers to a transplant centre

·      Where a team of specialists from a variety of fields will evaluate you to determine if you are a suitable candidate. 

·      The transplant team usually consists of the following members: 

o   Transplant surgeon

o   Hepatologist

o   Transplant coordinator 

·      Evaluation will include assessment of your: 

o   Assessment of liver function 

o   Assessment of general fitness

o   Assessment of  mental and emotional health 

o   Ability to adherence to post transplant follow up and medication 

o   Compliance of patient as well as family member 

What tests are required for evaluation? 

Extensive testing is required 

This usually includes: 

·       History and physical examination

·       Psychological and social evaluation 

·       Diagnostic tests to evaluate

·       The status of heart, lung and other organs 

·       Imaging studies, 

·       CT scans and ultrasound, to assess your liver and blood flow through various vessels 

·       Multiple blood tests to determine

·       Your blood type, 

·       kidney function 

·       liver function, 

·       Check for other infectious, immune, and inherited diseases 

·       HIV, hepatitis, drug and alcohol screening. 


Where do livers come from for liver transplant ? 

·      Deceased donor transplantation – brain death / cadaver 

·      Living donor transplantation – donation by 1st degree relatives

What is Deceased Donor Transplantation ?

·      Organ donation done after patient is brain death 

·      Cause of brain death

o   Head injury 

o   Intracranial bleed

o   Infarct in brain 

o   Brain tumour

·      In these patient when GCS is 3/15 then twice apnoea test is done before considering option organ donation 

·      Patient need to register with organ donation body of respective state

·      They can register in only one centre in particular state in India 

·      They can register in multiple state in India at a time 

·      Based on waiting list they are allotted organ

·      These transplant are performed in emergency

·      Recipient need to be in respective hospital with in 6 hrs of information 

·      These transplant can happen at any time may be middle of night 

·      It is mandatory to accompany one or two close relatives along with patient for necessary care preparation and consent.

·      Finances need to be ready once registration is done as you may need it in emergency

What is Living  Donor Transplantation ?

·      A living-donor liver transplant in which a portion of the liver from a healthy living person is removed and placed into someone whose liver is damaged. 

·      The donor's remaining liver regrows and returns to its normal size, volume and capacity within a couple of months after the surgery. 

·      At the same time, the transplanted liver portion grows and restores normal liver function in the recipient.

·      Before liver transplant donor undergoes stage work up to see feasibility , safety and suitability for donation of organ