By Dr. Sandeep Jha, Surgical Gastroenterology
Sometimes a person requires a liver transplant – a surgery that involves the removal of the diseased part of the liver and replacing it with a healthy liver. This healthy liver or a part of a liver comes from a donor. This is called liver donation. A government survey estimates that every year, around 20,000 people in India require a liver transplant.
When is a liver donation needed-
In the last stage of liver failure, medication and treatments do not have much effect. The liver rejects everything. Liver failure can be acute (progresses rapidly and becomes terminal in weeks) or it can be chronic (progressing slowly over the years). It is at the end stage that as a last resort, doctors opt for a liver transplant for which liver donation is necessary.
What are the chief causes of liver failure?
Some of the many causes of liver failure are-
• Hepatitis C
• Early stage liver cancer
• Cirrhosis of the liver
• Wilson’s disease
• Primary sclerosing cholangitis
• Alcoholic liver disease
• Biliary duct atresia
• Cystic fibrosis
A transplant from a living liver donor-
Living donor liver surgery means extracting a part of a person’s liver (sometimes as much as 60%) to donate it to a patient who requires a liver transplant. This is possible because of the liver’s unique ability to regenerate itself. It takes for around 4 months for both the donor’s and the recipient’s liver to re-grow and remodel into a whole new organ.
Often family members volunteer to donate liver for their ailing loved one. A number of tests are performed to test if the donor’s liver will be compatible with the recipient’s. Both the donor and the recipient must be nearly the same size physically or the portion of the liver harvested from the donor might not be sufficient.
There are two benefits of live donor liver transplant-
• The survival rate of people who received a liver from someone in the family is quite high.
• There are more people who require a liver transplant than there are livers available. The longer a person waits (depending on her/his position on the transplant list), the more critical her/his condition becomes. If a family member were to donate a part of a healthy liver, surgery can be performed immediately.
Risk factors involving living donor living transplant-
With this kind of surgery, there are no additional risks for the recipient. The risks to the donor include heavy bleeding and infection. The donor might also require a blood transfusion. The mortality rate for the donor is 1 out of 250.
The donor might need to stay in the hospitalization for a week. It takes 4-6 weeks for the donor to heal completely. The larger the portion of the liver donated, the more time it takes to heal. The recipient is kept under observation in intensive care for a few days and another 10 days in the hospital.
Liver from deceased persons
This type of surgery comprises the bulk of all liver transplant surgeries.
Today with the government and non-government organisations coming together to spread awareness on the importance of organ donation, more and more people are registering themselves as organ donors. Many people donate their livers. In the case of livers from deceased donors, the liver is split into two and given to two transplant patients.
Liver transplant is the only way to save a person in the last stages of liver failure.