What is liver transplantation?
As we learnt in an earlier blog, liver transplantation is a procedure to replace a part/whole of liver with a new functioning liver. It is done in two ways:
1) Deceased donor liver transplantation
2) Living donor liver transplantation
Deceased donor liver transplantation (DDLT)
Deceased donor liver transplantation is where liver is donated by a person who has been declared brain dead and does not have any chances of resuming brain activity in future. One such person can donate 8 organs – heart, lungs (2), liver, kidneys (2), pancreas and intestine and tissues like corneas, heart valves, bones/tendons, skin and arteries/veins.
The legal formalities in DDLT
The process of DDLT is very simple. One has to register oneself in the liver recipient waiting list, maintained by a regional organ transplant committee, in order to be eligible for an organ allotment. The list is sub-categorized according to the blood group. Once a family gives consent for organ donation from a brain dead declared relative, the zonal organ transplant committee is notified by the hospital. The committee informs the local hospitals which are licensed to perform liver transplantation surgery. The liver is offered to the person on the top of the waiting list according to the blood group. If a patient rejects the organ for some reason, the offer is passed over to the next in waiting. Once a patient accepts the organ, he/she is admitted to the hospital where he/she is registered.
The liver retrieval surgery from the donor and the recipient surgery are generally done simultaneously. The donor liver is retrieved from the donor and is packed and transported to the hospital where recipient surgery is being done. Once the diseased liver is removed from the recipient and the donor liver is prepared for implantation, the final step of implanting the liver is carried out in the recipient.
Living donor liver transplantation (LDLT)
Living donor liver transplantation is where a part of liver is donated by a healthy person. Liver has a remarkable quality to grow back to normal size, if injured or cut. So, when a part of liver is cut from the donor, his/her remaining liver grows back to normal size in 2-3 months. Similarly, the part of liver that is received by the recipient also grows to normal size in 2-3 months.
A person, in order to be eligible for liver donation, should generally have a matched blood group with the recipient. However, blood group incompatible liver transplants are also being performed in large numbers nowadays. The donor should be at least 18 years of age and should not be more than 55 years of age. The donor should be related to the recipient. In exceptional circumstances, non-related person may be accepted as an organ donor.
The donor and the recipient are evaluated exhaustively before the surgery. Once the evaluation and the necessary paperwork are complete, a state-appointed committee sits together. It interviews the recipient, donor and the family members and scrutinizes the paperwork. Once the committee gives a go-ahead for the transplant, the donor and recipient are admitted to the hospital and surgery is done. The donor and the recipient surgeries are done simultaneously. The donor surgery generally takes 6-8 hours, and the recipient surgery generally goes on for 10-12 hours.
DDLT versus LDLT
DDLT and LDLT have their advantages and disadvantages. There is minimal risk to the donor in LDLT, whereas this risk is not relevant in DDLT. The organ available in DDLT is larger in size and so is suitable for very obese recipients. However, there is a waiting period in DDLT, which is generally from 6-12 months in India. So DDLT is not suitable for patients who need urgent liver transplantation like the sick patients and acute liver failure (ALF) patients. A patient who has been advised liver transplantation and who does not have a potential liver donor in the family, should get oneself listed for DDLT. The long-term outcomes after DDLT and LDLT are similar.
