Evaluation of Liver Transplant Candidate
Patient of ESLD is given adequate information about disease, life expectancy and quality of life with disease with and or without transplant. Patient has to understand the disease process, the best available treatment for him/her, affordability, magnitude of transplant surgery, complications of surgery and need of drugs after transplant. Patient is made to understand seriousness of disease, gravity of the problem, complicated nature of surgery, need of support of family members and impact of transplant in their personal life.
Overall health status of patient, associated illnesses, blood group and body weight are evaluated. Patient has to undergo multiple blood test to know liver function, kidney function, coagulation function, viral disease markers and so on. Doppler Ultra-sonography is performed to evaluation liver vessel patency and flow. Contrast enhanced CT scan is performed to evaluate volume of liver, anatomy of vessels and biliary system and in case of tumour; size, number and extra hepatic disease. Consultations from various specialist doctors are sought to rectify associated illness and optimize patient for surgery.
Is matching of blood group essential?
Blood group of a donor should be identical or compatible to transplant candidate’s blood group. Positive and negative type is not important for organ transplant. Mismatch between blood groups cause reaction between donor and patient’s cells which may cause rejection of graft
Blood group compatibility chart
|Donor Blood Group
||Patient Blood Group
|A or O
|B or O
|A, B, AB or O
Note : The Rh factor (+/-) of blood type is not important in compatibility
What is tissue typing? And is it required for liver transplant?
Tissue typing means identifying six codes present in an individual’s tissue and matching compatibility with donor. These codes (HLA Human Leukocyte Antigens) are based on genetic make up of an individual. Blood test identifies and matches these codes between donor and recipient. Unlike Kidney Transplant tissue typing is not required for liver transplant.
However HLA typing may be required to prove relationship between the patient and the donor according to Human Organ Transplant Act (HOTA) in case of LDLT.
Evaluation of Cadaveric Donor
What does brain death mean? How does it differs from death of person?
The general idea of death (classical death) is that when the heart stops beating and the lungs stop breathing. Brain death differs from classical death. There is irreversible loss of all brain stem (life centre of human body) functions and the patient is clinically and legally dead. But heart can be kept beating and the lungs can be kept breathing for some time by means of an artificial machine (ventilator) in brain death. This mechanism which maintains oxygenated blood flow in the body can keep organs like heart, lung, liver, kidney and pancreas alive for a few hours.
Brain death can be confusing, particularly for families who are confronted with the sudden death of their dear ones; because a brain dead person on a ventilator is pumping oxygen and air into the lungs making the person’s chest rise and fall.
This makes some families expect that if their loved ones are continuously kept on ventilator they will sustain life. But the truth is, brain dead is DEAD, and no recovery is possible. There is no method to revive a brain that has been deprived of blood and whose cells have died. Brain death has to occur under controlled situation in the hospital. It is important to note that, Every one dying can not be a donor for an organ. And every patient on ventilator in ICU cannot be a organ donor as many of them die vegetative. Only brain dead get chance to donate their organs.
Is coma different from brain death?
A patient in coma is not dead and that person can be revived. Unlike a brain dead person, the brain waves and brain stem functions are active and the body is able to maintain vital functions such as regulating the temperature, blood pressure and respiration. Whereas, in the case of brain death the person has no brain waves and no brain stem function; therefore the inability to manage body functions. The organs can be kept alive for a few hours with mechanical assistance.
How does one get cadaver donor?
Organs harvested from dead donors are obtained from hospitals. Waiting list is created at all leading transplant Centres. Organs are distributed according to priority, blood group compatibility, weight of donor to recipient ratio, size of liver and quality of liver.
Deceased or dead or cadaveric donors are those who have declared brain dead, but still have functioning organs if life supports are maintained deliberately for certain time period. Usually young patients dying of road traffic accidents or sudden brain haemorrhage and arriving within a time limit are suitable as cadaveric donor. Stringent evaluation is done to exclude previous history disease, cancer, active infection and some other factors are taken into consideration prior to harvesting of organs. Blood investigations and grouping are done on urgent basis. From brain dead patients not only liver but other organs like cornea, kidneys, hearth, lung or pancreas may be retrieved. While performing the retrieval surgery on a brain dead patient, same utmost care and precautions are exercised, as in performing surgery for live patients. Retrieved and harvested organs are preserved in special solution. Transplant from a cadaveric donor is always done on emergency basis. Thus one brain dead patient may give life to many patients.
Evaluation Of Living Donor
Law in India permits organ donation from a close relative only and rarely on altruistic ground from non related individual. Donors a re interviewed and explained the need of transplant. They are evaluated for willingness, medical, surgical, psychological and socio-economic aspects. Healthy donors with blood group compatibility and weight and size matching are the most important considerations prior to screening of donors. Donor has to understand noble concept of donation part of own body to a beloved one and gift of life to the patient, who is at verge of dying if not transplanted. Donor has to fully agree voluntarily for organ donation and understand risks of surgery. As said earlier; liver is gifted naturally to regenerate if a part of it is removed.
Donor has to undergo may blood tests to evaluate overall health condition, CT scan to know volume and anatomy of liver, MRCP to know biliary anatomy and surgery. Persons of 18-55 years of age group are acceptable as donors. Volume of liver is evaluated so that it is more than sufficient volume is left for the donor and enough for recipient to sustain life.
Making an informed donation
Ask me about any questions you have. You should understand all aspects of the donation process, including the risks and benefits. It is important to be completely honest with the transplant team about your feelings, concerns and fears about being a donor. Your consent to become a donor is completely voluntary. You should never be under pressure to become a donor. You have the right to delay or stop the donation process at any time of the evaluation process. The reasons behind your decision will be kept confidential by the transplant team. Talk in detail with your loved ones, such as family members and close friends. Talk with other people who have been living donors and learn more about the experience of other living donors before making a final decision. Fully consider how donation may impact your physical and emotional health, as well as your family life, financial situation, and current and future health and life insurance status.
Medical and psychological risks
Since living donors require general anesthesia and undergo major surgery, they are associated risks involved. Surgical complications can include pain, infection, blood loss (requiring transfusions), blood clots and allergic reactions to anesthesia, pneumonia and injury to surrounding tissue or other organs, and even death. Please not that there has be no national systematic long-term data collection on risks associated with living organ donation. Based upon limited information that is currently available, overall risks are considered to be low. Risks can differ among donors. Some possible risks of liver donation include wound infections; hernia; abdominal bleeding; bile leakage; narrowing of the bile duct; intestinal problems including blockages and tears; organ impairment or failure that leads to the need of transplantation; and even death. Negative psychological symptoms are possible during the healing process and even years after the donation. Your donated organ may not function in the recipient after it is transplanted. You and/or the transplant recipient may have medial problems from the surgery. Scarring or other aspects of the donation process could possibly contribute to problems with body image. You may have feelings of regret, resentment or anger. You have symptoms of anxiety or depression. Treatment for these conditions can be lengthy, costly and could possibly include the use of medications with risks and side effects. You have to understand personal, familial, social, financial and professional problems that may follow your operation. You should receive adequate support from family members.
Positive aspects of living donation
The gift of an organ can save the life of a transplant candidate. It’s heartening and a great relief to see your beloved one alive when he/she is in misery and nearing to death. Some donors have reported positive emotional experiences, including feeling good about giving life to dying person. Transplants can greatly improve recipients’ health and quality of life, allowing them to return to normal activities. They can spend more time with family and friends, do more physical activities, and pursue interests and hobbies. Transplant candidates generally have better results when they receive organs from living donors as compared to organs from deceased donors. In addition, better genetic matches between living donor and candidates may decrease risk of organ rejection. A living donor makes it possible to schedule the transplant at a time that is convenient both for the donor and the transplant candidate.
Recovery from Surgery
Please talk to transplant team members to understand what to expect, although the surgery and recovery process can differ among living donors. Consider talking with other donors and contacting the organizations. As a liver donor, you may stay in the hospital up to 10 days or longer in some cases. The liver typically regenerates in two months. Most liver donor returns to works and normal activities in three months, although some may need more time. Attend follow-up visits to clinic regularly as advised and do blood or other investigations to make sure that you are recovering approximately. Think about how the donation process may affect your daily activities. How much time off will you need for work? How will this affect your care giving responsibilities such as childcare or caring for an elderly relative? How it is going to affect your personal life and body image.
Consult regarding all your problems related Liver Disease, Liver Transplant, Living Donor, Cadaveric Donor, Pre-Transplant Preparation, Peri or Post Transplant Care, Organ Transplant Act in India and abroad, Liver Transplant in India, China, Singapore etc.or any queries related to this field.
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India Liver Transplant provides information on liver transplant in India and abroad, cost of liver transplant, success rate of liver transplant, liver transplant in China, liver transplant in Delhi, about pros and cons of liver surgery, treatment for common liver diseases, cirrhosis, jaundice, hepatitis, liver donor, risks to liver donor's life, cadaveric liver transplant, liver cancer treatment, liver transplant medicines, post liver transplant life, care, precautions and sucess rate, acute liver failure by India's most experienced liver transplant coordinator Jyotsna Verma who worked with pioneers of Liver transplant surgery in India, Dr. A. S. Soin, Dr. Samiran Nundy, Dr. Subash Gupta, Dr. Vivek Vij, Dr. Rahul Kakodkar, Dr. Vinay Kumaran, Dr. Mohammed Rela, Dr. Anand Ramamurthy, and worked with best liver transplant team at Liver Transplant Unit Sir Ganga Ram Hospital(SGRH), Institute of Liver Transplantation and Regenerative Medicines, Medanta - The Medicity, Gurgaon and Fortis Hospitals, NOIDA and has been to ILBS (Institute of Liver and Biliary Sciences).
Last Update: 2015/09/24 Next Update Due:2015/10/25 Test Update(Japan, Korea, Switzerland and France) :2015/09/22-29
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[Liver Transplant in India]: Jyotsna Verma ( Liver Transplant Consultant(India) )
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tissue typing , blood groups compatibility, matching of blood groups, process of evaluation of liver transplant, liver transplant evaluation process, evaluation of liver transplant, liver transplant evaluation