When my dad started having the symptoms for “decompensated cirrhosis” stage, we received the advice from the doctors that we should start to plan for liver transplant in the next 3 months. Post decompensated cirrhosis stage, there are few cases where liver can respond well to medical supervision, but the percentage is very low.
The patient at this point needs frequent attention and monitoring from hepatologist hence hospital visits can become more frequent but at the same time is not at the very critical juncture (ALF – Acute Liver Failure) where transplant is required within few weeks.
To initiate/plan for the transplant the patient medical file needs to be consulted with the transplant surgeon who have their own procedure to prepare for the transplant. For the transplant, you also need a donor whose liver can be used for the patient (recipient in surgical terms).
The donors are of 2 categories:
1)- Living Donor: Liver is the part of the body that can regenerate itself, hence a living person can give a part of the liver which the body can regenerate. However, the surgery is complex so important to understand the complications and risks involved with the doctor.
2)- Deceased Donor: A person who has opted for organ donation, upon his death can act as donor.
Going through the process of availing liver from deceased donor in India can be a long and tedious journey, hence close to 90% of liver transplant happens using living donor.
Liver transplant is one of the most complicated surgery, hence taking all the precaution and procedure to avoid/minimize risk before the actual surgery is important.
We, therefore, consulted some of the top liver transplant surgeons that comes on google search in India and found that private institute in India lacks the procedure that’s done before surgery for both recipient and donor. It seems they are willing to take more risk during the surgery and it’s most likely due to the pressure on the surgery teams in private sectors to generate numbers.
In our case, my dad was getting treated for his liver disease for 3 years at ILBS (Institute of Liver and Biliary Science, Delhi) under Dr. Sarin, hepatologist team. Based on the initial consultation with transplant coordination department at ILBS, we knew their procedure are a bit lengthy but for a reason. For example, my dad had UTI (Urinary tract Infection) and at ILBS we were told, given it’s a planned surgery and not an emergency case, it had to be resolved before transplant can be done. At private institute, they didn’t have such concern and were ready to perform the surgery.
To give further idea, my dad had to get approvals from 7 specialists (like Urologist, Endocrine, Pulmonary, Cardiologist etc.) before he could be considered ready for surgery.
Similarly, for me to act as living donor I had to go through a series of medical tests to ensure 1)- I have a healthy liver and 2)- I have no medical history or fitness issues which can cause complications during or post-surgery.
ILBS therefore works more towards success rates of their transplant surgery rather than number crunching. Having said that there is also constant queue for transplant at ILBS and per my observation at least 3 surgeries were getting performed every week. Further, they are semi-funded by the government and transplant package is relatively cheaper than in a complete private institute in India.
In summary, the idea is not to say only go to ILBS for liver transplant but ensure to go to a place where similar proper procedure before the surgery is followed. In separate blog, I have covered these pre-surgery steps in more detail.
Reference: Here is a good article on the protocols and intricacies of liver transplant process – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4723645/