Liver Transplantation

What is Liver Transplant?

Liver Transplant is the largest organ of our body. It helps in digesting food, storing energy, and removing poisons from our body. If our liver fails, we can approach our doctor for treatment. Doctors do liver transplants when other treatments can’t keep a damaged liver working. A liver transplant is an operation that replaces a patient's diseased liver with a healthy liver from another person.

Liver Anatomy and Function

The liver is an essential organ. The liver serves many critical functions including metabolism of drugs and toxins, removing degradation products of normal body metabolism and the synthesis of many important proteins and enzymes. Blood enters the liver from two channels, one of them is the hepatic artery and the other is the portal vein, bringing nutrients and oxygen to liver cells. Blood leaves the liver via the hepatic veins which drain into the inferior vena cava which enters the heart immediately. The liver forms bile, a liquid that helps dissolve fat and eliminate metabolic waste and toxins via the intestine. Each hepatocyte makes bile and discharges it into microscopic channels that join to form bile ducts. 

Who Needs a Liver transplant in India ?

Liver transplant surgically replaces a failing liver with one that is healthy. At this time, transplantation is the only cure for liver insufficiency or liver failure because no device or machine can reliably perform all of the functions of the liver. People who require liver transplants usually have one of the following conditions.

Acute Liver Failure

Acute liver failure, also known as a fulminant hepatic failure, occurs when a healthy liver suffers a massive injury resulting symptoms of liver insufficiency. Any number of things can lead to acute liver failure but the most common causes are acetaminophen overdose, viral infections, and ingestion of a toxin such as poisonous mushrooms.

Chronic liver failure/ Cirrhosis

The liver has a unique ability to repair itself in response to injury. Cirrhosis is a situation when scar tissue replaces healthy liver tissue. This stops the liver from working normally. Cirrhosis is a long-term (chronic) liver disease. The damage to your liver builds up with time.

Symptoms Leading to Liver Transplant in India 

Transplantation of the liver is usually required where the organ is either significantly diseased, or failing, because of chronic or acute illness. Symptoms leading to a liver transplant often reflect advanced liver disease or failure, including:

• Jaundice
• Ascites
• Hepatic Encephalopathy
• Portal Hypertension
• Severe Fatigue
• Persistent Nausea or Vomiting
• Itching
• Bruising and Bleeding
• Muscle Wasting
• Edema
• Dark Urine and Pale Stools
• Frequent Infections

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Risk Factors of Liver Transplantation

Liver transplantation is a very technical surgery and is associated with a high risk. Although, it can be very effective in performing operations which can save lives, there are several dangers that go with it throughout and after the operation is conducted. It is in knowing these risk factors that patient and or families of patients can be prepared in case of an occurrence of such complications.

• Bleeding
• Infection
• Bile Duct Complications
• Clotting Issues
• Anaesthesia Reactions
• Rejection of the Donor Liver
• Infection Risks
• Kidney Damage
• Diabetes
• High Blood Pressure
• Increased Cancer Risk
• Recurrence of Liver Disease
• Organ Dysfunction
• Graft Failure

Causes of Chronic Liver Injury 

Viral Hepatitis

• Hepatitis B: Hepatitis B infection scores for 5% of liver transplants performed in the United States of America.
• Hepatitis C: This is the most common virus resulting in liver transplantation in the United States, affecting nearly 50% of all liver transplant recipients.

Alcoholic Liver Disease

• Liver failure due to high alcohol abuse is the second most common indication for liver transplantation.

Genetic Liver Disease

• Hemochromatosis: It is excess iron deposition in the liver 
• Wilson's disease: It is abnormal copper metabolism 
• Glycogen storage disease: It is an inherited metabolic disorder
• Tyrosinemia: It is a disorder of tyrosine metabolism

Who Are Not Candidates for a Liver Transplant?

There are many people with liver disease (who want a liver transplant) but not all are appropriate candidates for liver transplantation. A patient must be able to survive the operation and the potential post-operation difficulties and must take the medicines that prevent rejection and infections and frequently visit a clinic and have laboratory tests, and not engage in activity that would injure the liver in any way, such as drinking alcohol. The conditions listed below are generally considered to be absolute contra-explanations to liver transplantation.
Severe medical illness that limits short-term life expectancy

• Cancer outside of the liver
• Uncontrollable infection 
• Alcoholic or Drug addict
• Severe, uncontrolled psychiatric disease

Why Choose Liver Transplant in India?

India has developed into a preferred destination for the liver transplantation due to medical competence as well as reasonable charges. Following are the factors that make it desirable to go for liver transplant in India:

• Highly Skilled Surgeons
• Advanced Medical Facilities
• Cost-Effectiveness
• High Success Rates
• Shorter Waiting Times
• Comprehensive Support for International Patients

What Makes Liver Transplant in India Stand Out?

The pioneers have identified some significant parameters that set India as a leading country for liver transplantation.

• Pioneering Medical Institutions
• Comprehensive Organ Donation Initiatives
• Record-Breaking Achievements

Infrastructure and Facilities at Liver Transplant in India

Liver Transplant in India is one of the best hospitals for transplants that combine professional medical competence with advanced technology in transplant surgery. The hospital is equipped to meet the international health care standards; thus improving the quality of care by reducing risks faced by the patient during the treatment process.

Modern Operating Theatres: Hospital boasts up-to-date operating theatres with the most appropriate surgical instruments, up-to-date imaging systems as well as monitoring systems. Adequate measures towards sterilization and a well-proportioned air circulation system also reduce risks of infections, hence appropriate for liver transplant surgery.

Dedicated Transplant ICU: Patients that require intensive care are admitted to a separate Intensive Care Unit for the transplant patients so they may be attended by hepatologists, transplant surgeons and critical care physicians. Since the patients are closely observed every day and night as well as having individualized attention after the surgery, the ICU helps in recovery without Complications.

Advanced Diagnostic & Imaging Facilities: They possess better diagnostic devices such as MRI, CT scan, Doppler ultrasound, and technologies in assessing liver function. These enable accurate pre-transplant evaluations and continuous post-transplant monitoring.

Comprehensive Patient Care: A number of patients are provided outpatient services that are enhanced by well-furnished, spacious, private patient rooms. Patient coordinators are always assigned to families and are useful in taking families through the treatments. Counselling, nutritional aptitude, and physiotherapy help in the process of promoting the healing.

International Patient Services: Besides, the hospital provides services such as visas, interpreters and treatment for international patients. 

Safety, advanced techniques, and heartfelt care makes Liver Transplant India receive a great attention from the patients who need a liver transplant surgery.

International Patients at Liver Transplant India

India has emerged as as a favorite destination for global patients interested in Liver Transplantation with the availability of best of medical infrastructure, best human resources in terms of surgeons and an affordable cost structure. Most of the hospitals offer full service that deals specifically with international patients’ right from the time when they make appointments to when they need to be operated upon and beyond. Key facilities and services include:

• Medical Consultation
• Visa Assistance
• Travel Coordination
• Accommodation Arrangements
• Language Support
• Advanced Surgical Facilities
• Experienced Surgical Teams
• Rehabilitation Services
• Follow-up Consultations
• Medication Management
• Transparent Pricing
• Local Sim Cards
• Currency Exchange
• Arranging Patient’s local food

Medical Visa Process

Step 1: Eligibility for Medical Visa

A medical visa is also known as M visa, which is issued to the foreign patients visiting India for sharing medical treatment. It is possible to invite only two persons – relatives or other persons connected with the applicant in any other way – to accompany the applicant on the Medical Attendant Visa (MX visa). The patient should be in search of treatment in any accredited hospital in India.

Step 2: Gather Required Documents

You will need:

Medical documents: A letter from the hospital of India stating that the medical condition of the patient has been treated and they have undergone through liver transplant.

Client Medical History: Information on the liver disease: diagnosis report, treatment and doctor advice.

Visa Application Form: Intended visa application form duly completed, which could only be downloaded from the website of Indian embassy in your country.

Passport: Valid for at least six months with at least two blank pages.

Necessary number of photos as per the provision of the Indian Visa with the size of passport photographs. Evidences of the ability to meet the medical costs: Banks statements or a sponsorship letter. Proof of Residence: National ID, utility bills, or similar documents.

Treatment Plan & Organ Transplant Approval:

The Indian hospital’s approval for the transplant. If the organ donor is accompanying the patient, then he or she also requires permission according to the Indian laws on organ donation.

Step 3: Apply for the Medical Visa

This can be done by going directly to the official website of the Indian embassy or the Indian consulate in the country of your residence.

The e-Medical Visa or Regular Medical Visa application form has to be completed. In case if the visa fee is applicable then the candidate will have to pay this fees online. Send the application with necessary documents to the nearest Indian consulate or the visa centre where such facilities are offered.

Step 4: Wait for Processing & Approval

Delivery time is 3-7 working days and may vary depending on the country. If granted, the visa gets stamped on the passport to show that the holder is entitled to enter the country of destination.

Step 5: Travel to India & Report to the Hospital

When going for medical purposes, clients should ensure to carry all their medical documents and a copy of their visa. Register with the local Foreigner Regional Registration Office (FRRO) if necessary within 14 days from the arrival in India. Continue with medical assessment of the hospital and its transplants.

Types of Organ Donors

Brain dead organ donors

Most livers which used for transplantation are obtained from patients that are brain dead. Brain death is usually due to a stroke or trauma to the head from blunt injury. The trauma has stopped all the brain functions although other organs including the liver may continue to function normally.

Cardiac death organ donors

Sometimes a patient suffers a devastating brain injury and carries a dull neurological prognosis but fails to meet the strict proof defining brain death in that there is still detectable brain function. In these circumstances, the patient's family may decide to withdraw medical support with the intention of allowing the patient to die. In this scene, death is not defined by brain death but rather cardiac death. Organ donation can be performed after cardiac death but, again, only if the family gives consent.

Living Donors

Each person has only one liver and would die without it functioning; it is possible to donate a part of the liver for transplantation into another person. The segmental anatomy allows surgeons to create grafts of varying size, depending upon the recipient's requirement for liver tissue. The partial livers in the persons, donor, and the receiver will grow again to provide a normal liver function for both individuals.

The Liver Transplant Operation

A liver transplant involves the removal of the liver from donor and removal of the diseased liver from the patient and implanting the new organ. The liver has several connections that must be re-established for the new organ to receive blood flow and to eject bile from the liver. The exact method of connecting these structures varies depending on donor and anatomy or the patient’s anatomic issues and, in some cases, the patient’s disease.

Rejection

Rejection in medical science is a term that is applied to organ dysfunction caused by the patient’s immune system reacting to the transplanted part. Injury to the liver is usually mediated by immune cells. Rejection typically causes no symptoms; patients do not feel anything different. The first sign is usually abnormal laboratory test results. A liver biopsy is performed when rejection is suspected. The tissue is analysed and inspected under the microscope to determine the pattern of liver injury and also to look for the presence of immune cells.

Acute cellular rejection occurs in about half of all liver transplant patients within the first year after transplantation with the highest risk period within the first four to one and a half month of transplantation. Once the patient is diagnosed, treatment is generally very effective. The first line of treatment is usually high dose corticosteroids. The second step of rejection treatment is the preparation of strong antibodies. This is believed that the liver has the unique ability to regenerate itself. Chronic rejection occurs in 7% all transplants. The strongest risk factor for the development of chronic rejection is repeated acute rejection or refractory acute rejection. Liver biopsy shows loss of bile ducts and annihilation of small arteries.

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Outcomes

Usually, outcomes of liver transplantation are good, but outcomes vary significantly depending on the indication for liver transplant as well as factors associated with the donor and acceptor. The overall patient survival one year after liver transplant is 89%. Patient survival five years after liver transplant is 75%.

How many successful surgeries of liver transplants are done in the last year?

India does approximately 1500-2000 liver transplants every year. Here are some other facts about liver transplants in India:

• Medanta Liver Transplant Institute: The hospital has conducted more than 2500 liver transplants since 2009 with the success rate of 95% and infection rate less than 10%. 
• Live donor liver transplants: Liver transplant by using the live donor was first done in India in 2010. 
• Organ donation: The Transplantation of Human Organs Bill was enacted in 1994 but come into force in 1995. However, because of scarce availability of cadaver donors for organs, less than 131 liver transplants have been done in the time frame between 1994 and 2004.

Best Hospitals for Liver Transplant in India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket
• BLK-Max Super Speciality Hospital, New Delhi

Best Doctors for Liver Transplant in India

• Dr. Giriraj Bora
• Dr. Arvinder Singh Soin
• Dr. Vivek Vij
• Prof. Dr. Subhash Gupta
• Dr. Abhideep Chaudhary

Why Choose Liver Transplant in India With GetWellGo?

GetWellGo is a medical tourism company specialising in providing one stop solutions to the foreign patients intending to undergo liver transplant in India. Here are several reasons to consider GetWellGo for your liver transplant needs:

• Doctor and Hospital Selection
• Cost Transparency
• Travel and Accommodation Arrangements
• Language Assistance
• Visa Assistance
• Post-Treatment Care
• Advanced Medical Technology
• Experienced Medical Professionals

Case Study of our Patients Treated for Liver Transplant in India

Liver Transplant for a Two-Month-Old Nigerian Infant at Medanta Hospital

• Patient Name: David
• Age: 2 months old
• Gender: Male
• Country of Origin: Nigeria
• Doctor Name: Dr. A. S. Soin
• Hospital Name: Medanta Hospital, Gurgaon
• Treatment: Liver Transplant

A two month old baby from Nigeria was diagnosed with Neonatal Hemochromatosis; which is a metabolic disease caused by excessive accumulation of iron in the liver thereby leading to liver failure. Local doctors who attended to the baby said that the baby’s condition was critical, and therefore needed liver transplantation as the only acceptable treatment. After the research done, the family sought to seek medical help from GetWellGo to help organise for the procedure in India.

After that, the baby was brought to Medanta Hospital in Gurgaon and admitted to Dr A.S. Soin, one of the leading liver transplant surgeon. Failure to undergo the surgery, the child, who was taken to the medical centre by the parents, deteriorated further and a team of pediatric hepatologists and surgeons recommended that the organ transplant had to be done immediately.

The liver transplant surgery was very challenging due to the infant’s low birth weight of 2.1kg and sepsis, chronic malnutrition, and dysfunction of other organs. However, when in the hands of a medical practitioner like Dr. Soin and his crew, the process was accomplished satisfactorily. The child was thus admitted and kept in the specialized Pediatric Transplant Intensive Care Unit and slowly made significant progress. Despite this, he required round-the-clock supervision in the ward after the operation and he fully recovered, and was then discharged with extensive instructions on what to do in future and changes that had to be made.

In as a way of appreciation, the baby’s parents said:

This hospital was excellent especially the LTP surgeon Dr. Soin who saw our child. To which we are eternally indebted here in India for the kind of care and professionalism that you have exhibited.”

This case also aims to showcase the experience and dedication of the Medanta Hospital in catering to the needs of international clients in terms of international health care, especially in pediatric liver transplant.

Liver Transplant for a One-Year-Old Kenyan Child at Indraprastha Apollo Hospital

• Patient Name: Paul
• Age: 1 year old
• Gender: Male
• Country of Origin: Kenya
• Doctor Name: Dr. Subhash Gupta
• Hospital Name: Indraprastha Apollo Hospital, Delhi
• Treatment: Liver Transplant Surgery

A one year old child from Kenya was detected to have biliary atresia, a medical condition whereby the bile ducts do not develop well and the liver begins to fail. After developing these ailments, pediatricians in Kenyan recommended a liver transplant as the only solution for the child’s cure. Based on the information gathered by the family, they sought help from GetWellGo to help arrange for quality treatment in India.

Upon arrival of the child to Indraprastha Apollo Hospital New Delhi, the child was admitted under the theatre of the celebrated liver transplant surgeon Dr. Subhash Gupta. A team of pediatric hepatologist and transplant specialist undertook the assessment of the patient. Since the case was so emergent, the father offered to be a suitable match as a live liver donor and help the child by donating a part of his liver to the child.

The surgery is particularly risky given the age of the child with no facility for the surgery to be done in the country for children below five years, but it was successfully done by Dr. Gupta with the assistance of a team of 50 doctors. The child was kept under direct observation in the pediatric transplant ICU for around-the-clock post-operative monitoring and supervision by a qualified and very caring and attentive nurse and had made great progress. The child was treated and over the period of two weeks, the child was discharged with a full recovery and detailed discharge instruction.

For this, the child’s parents’ were feeling gratitude:

This disease had caused a lot of concern to us despite the fact that through the help of Indraprastha Apollo Hospital’s Dr. Gupta, our child is alive today. The level of care and treatment given to us in India in my view was superb.”

This case tells that Indraprastha Apollo Hospital has developed competence in pediatric liver transplants as also the hospital’s commitment to embrace international patients.

Liver Transplant for a 41-Year-Old Iraqi Patient at Manipal Hospital

• Patient Name: Mr. Maad Ali
• Age: 41 years old
• Gender: Male
• Country of Origin: Iraq
• Doctor Name: Dr. Shailendra Lalwani
• Hospital Name: Manipal Hospital, Delhi
• Treatment: Liver Transplant Surgery

A 41 years old male patient from Iraq had been diagnosed with liver cirrhosis which significantly affected his health and wellbeing. The doctors in his practice in Iraq warned him that only liver transplant remains to be done while his health deteriorated. Based on such considerations and after conducting a thorough research, the patient and his family sought help from GetWellGo to help them seek for specialized treatment in India.

When the patient reached Manipal Hospital in Delhi, he was fortunate to be under the care of Dr Shailendra Lalwani, who is a highly experienced liver transplant specialist. With the involvement of hepatologists, transplant surgeons and several other medical experts in the assessment, the panel reached a consensus that a liver transplant was the only option.

The transplant surgery was conducted effectively and the patient was admitted and observed in the special transplant ICU. Providing adequate caring and lengthy recovery period after operations and surgeries, he gained much progress. Following, he was discharged with discharge instructions and the pattern of life that he should follow in order to ensure he has recovered fully.

Thus, the patient said in his kindness response,

I would first of all like to express my thanks to Dr. Lalwani and the team at Manipal Hospital. I would like to highlight the work of three persons; they have helped me change my life by their knowledge and good nature. Undoubtedly, it was the best decision to come to India, and treatment was more than what I expected.”

FAQ

1. What are the advantages of Liver Transplant?

• Life-Saving Procedure: Make an opportunity for the patients with irreversible liver failure to survive.
• Improved Quality of Life: It is used in cases of symptoms such as fatigue, jaundice and fluid retention delivering the physical and mental improvements.
• Better Health Outcomes: Help to decrease complications of chronic liver diseases, including hepatic encephalopathy and portal hypertension.
• Potential to Treat Underlying Conditions: Treats diseases such as hepatocellular carcinoma, autoimmune hepatitis, and viral hepatitis.

2. What is the Liver Transplant Success Rate?

• Short-Term Success: The one year survival rate ranges from 85-90%.
• Long-Term Success: The 5-year survival rate currently stands between 70 and 75 % depending on the body tissue of origin.
• The outcome varies from one patient to the other, health status, and cause of liver failure and follow up after the surgery.

3. Who is eligible for liver transplant?

Candidates for liver transplantation are typically those with:

• Liver disease at its final stage includes cirrhosis, hepatitis, NAFLD/NASH.
• Liver cancer that has not spread to other parts of the body; cancer that is primarily located in the liver alone.
• Hepatitis-acute liver disease due to toxins, infections or other diseases.
• Patient-specific risk factors: no lifestyle, chronic or acute conditions precluding surgery.

4. How long is the recovery period?

• Hospital Stay: Total admission for hospital stay is 7-10 days depending with the state of the patient.
• Full Recovery: Usually ranges from 6 months to 1 year in which patients attend routine check-ups and Physical therapy sessions.

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