Liver Transplant Consultant: Liver Transplant in India - Not Just an Operation ...

Liver Transplant Consultant: Liver Transplant in India - Not Just an Operation ...: Liver Transplantation is not just an operation its a process and a beginning of a new relationship which is between the patient, the tra...

Liver Transplant in India - Not Only an Operation but a Process

Liver Transplantation is not just an operation its a process and a beginning of a new relationship which is between the patient, theLiver transplant team and the transplant institute. As we all know that, to maintain a healthy relationship we need purity, dedication and transparency from both sides – Health care workers as well as the patient and his family. And one should pledge to maintain this relationship.

Shortage of organs, immediate finances, lack of pre and post transplant education, failure to understand pre transplant management in detail, pros and cons of liver transplant, life long medication, post transplant life, effect of transplant children and donor safety are the major patient issues.

A new organ gives new life but only well-informed execution can optimize the chances of success to the satisfaction of patient and the family. It is important that the patient and care givers are fully guided and educated regarding the process to prepare themselves for this major undertaking. This precisely where the role of experienced coordinator matters most to facilitate solving minor and major problems that may creep up before, during and after the operation. This can be done through education and counselling sessions, group interactions and guidance. In my considerable experience, I have had occasions of dealing with the patients and families of the patients with liver failure who resign themselves to death even when some of them can be saved by timely emergency liver transplantation. A majority of them have no way of getting timely, reliable, round the clock information. Drawing from my experience with over 50 such cases, we provide a 24 hrs helpline - +91 – 9266882222 service to answer queries, educate, counsel and motivate such patients who can be saved by liver transplantation if they arrive in time. All these issues need to be reinforced repeatedly by transplant coordinator to keep the family vigilant and motivated life long. Apart from education Transplant Registry has become a necessity if we intent to create a patient centric synergies. Every developed country has Transplant Registry which maintains records of patient with organ failure on waiting list, updates their health status regularly, number of transplants done every year, type of transplants done every year – whether living or cadaveric, result of transplant, immediate survival rate, so that a patient is fully aware of the actual scenario of livertransplant in India before taking this major decision i.e. Liver transplant. After this a patient and his family cannot blame any doctor, institute in any phase of transplant.

Liver Transplant between Different / Mismatched / Incompatible Blood Groups – Views and Comments

First time in India, doctors in Gurgaon, Haryana on Wednesday claimed to have successfully conducted a liver transplant with donor and recipient with different blood groups, giving a new hope to thousands of patients suffering from organ failure.

Liver Transplant Consultant, Jyotsna Verma, comments, “But one must keep in mind all pros and cons, facts related to such kind of surgery which involves more cost (about 25% or even more) and also increases risk related to Liver transplant specially in adults in comparison to children below 5 years of age. We not only need to increase the numbers of transplants but there is a need to increase the success rate of liver transplant by proper selection, conduct and close follow up of all post transplant patients. Also there is dire need to start Transplant Registry in India like other countries which are far ahead of us in Liver Transplantation so that patients opting for such surgeries must get full knowledge about the facts related to transplants”.

Dr. Vivek Vij, Chief Surgeon, Fortis Hospitals, Delhi and NOIDA, comments, “ABO incompatible transplants are feasible in liver and kidney transplant. Results are best in the children. This kind of liver transplant is recommended in children and adults in emergency settings only. New strategies like plasma exchange to decrease antibody count below 1:16, Rituximab and infusion of Prostaglandins E1 and Gabexate Mesylate into liver may improve outcomes and survival almost equivalent to ABO compatible liver transplant”.

Dr. Vinay Kumaran, Chief Surgeon, SGRH, Delhi, comments, “Transplantation of the liver from a donor with an incompatible blood group has been used in desperate situations where no other donor is available. The results, particularly in adults, have been inferior with higher mortality and more serious complications. Relatively better results have been obtained in infants. The cost of the protocols used to prevent antibody mediated rejection in such cases has led to reluctance to attempt this in India but there may be a role in selected cases”.

               

Dr Rahul Kakodkar, Senior Consultant Surgeon, Gurgaon Haryana, said, "The purpose of the entire treatment was to suppress the antibody levels in body to less than eight units for at least three weeks after the transplant so that the body adapts to the mismatched liver. This kind of transplant is not recommended for patients with Autoimmune Cirrhosis. Cost of the procedure is definitely increased but varies from patient to patient. “

Dr. Puneet Dargan, Senior Consultant Surgeon, Fortis, Noida and Delhi, comments, “ABO-incompatible live transplantation (ILT) is  occasionally performed due to a relative high risk of graft failure. Knowledge of both graft and patient survival rate after ILT is essential for donor selection and therapeutic strategy. ABO-Incompatible liver grafts should be viewed as an important treatment option in selected adult patients with acute liver failure in need of an emergency liver transplant”.

"Thousands of liver transplants that could not happen because the donor's blood group was different from the one of the recipient can now happen. With this surgery, we have conquered the mismatch blood group barrier that did not allow many patients of organ failure undergo a transplant," Dr AS Soin, Chief liver transplant surgeon, Gurgaon, Haryana, said.

Dr Neelam Mohan, Paediatric hepatologist, Gurgaon, Haryana, said, "There was no cadaver donor even after waiting for six months. She had reached the stage of coma and her survival was dependent on the transplant. It was then that we decided to go for the mismatch blood group transplant (scientifically termed as ABO-incompatible transplantation).

 Liver Transplant Helpline : 9711224402, Liver Disease Helpline 9266777585