JIPMER
Jawaharlal Institute of Postgraduate Medical Education & Research

Liver Transplantation

INTRODUCTION

A liver transplant is a surgical procedure to remove a diseased liver and replace it with a healthy liver from a donor. Most liver transplant operations use livers from deceased donors, though a liver may also come from a living donor. Liver transplantation is a treatment option in end stage liver failure and liver cancers. .Chronic liver disease is common in Pondicherry and neighboring districts of Tamilnadu and common causes are viral hepatitis and alcoholism. JIPMER is managing more than 4800 patients with chronic liver disease and more than 170 liver cancers every year and in a significant proportion of these patients, liver transplantation is the only option.

Liver transplantation facility is not widely available and in India, only very few public sector hospital are performing liver transplantation. Corporate hospitals are charging above 25 lakhs for liver transplantation and majority of the patients cannot get the facility due to this exorbitant cost. The need for setting up the facility of liver transplantation in public sector hospitals is of topmost importance and is a set goal in national health sector priorities. Keeping this priority in mind JIPMER has initiated the liver transplant facility.

JIPMER liver transplant unit has an advanced and dedicated 4 bedded liver ICU with the cutting-edge technologies including HEPA filter,CRRT and Telecommunication systems.It also has an avant-grade two bedded pre- operative unit and dedicated consultation room and counseling room at surgical gastroenterology OPD.A state of the art transplant OT is under construction in the super specialty extension block.

LIVER TRANSPLANT LICENSE


JIPMER has registered under the under National Organ and Tissue Transplant Organization (NOTTO) and Transplantation of Human organs Act 1994  and obtained the license to perform liver transplantation on 10.05.2016 from the Directorate General of Health Services, New Delhi, India.          

Liver transplant License

INDICATIONS FOR LIVER TRANSPLANT

Liver transplantation is an established treatment in patients who have a likelihood of poor survival or impaired quality of life secondary to acute or chronic liver disease.

Liver transplantation is indicated for conditions that result in liver cirrhosis,  which is defined as irreversible injury to the parenchyma of the liver resulting in widespread fibrosis and nodule formation),acute liver failure, hepato cellular carcinoma and certain syndromes.

Indications for Liver Transplant

 

PRETRANSPLANT WORK UP

Liver transplant is a major procedure and because of its complexity it is necessary to evaluate the fitness of the patient. Liver transplant evaluation includes a battery of tests that consist of basic blood tests, Biochemistry analysis , viral markers, Tumor markers, Auto immune markers, Radiology evaluation, CT Scan, Cardiology evaluation such as  ECHO, Angiogram,Endoscopyetc. The patient will be evaluated by the team of specialists including cardiologist, pulmonologist, Gastroenterologist, Anesthetist, Dentist, Psychiatrist, physiotherapist and dietitian. Once the patient is found to be fit, he/she will be listed for transplant and put on the waiting list for deceased donor organ if there is no suitable live donor found.

Pretransplant Evaluation

 

LIVING DONOR LIVER TRANSPLANT

Living donor liver donation involves the resecting the partial or half of the donor’s liver and placing it in the recipient’s body.The liver will grow back to the necessary normal amount on both the donor and recipient

Any adult (more than 18 years in age) may opt to donate a part of his liver for a patient of liver disease requiring a liver transplant. In most situations this donor would be a primary blood relation of the potential recipient, and if he is of sound mental health and under no coercion, the transplant team should proceed to evaluate the donor for living donation. The donor must conform to the accepted criteria according to THOA, and if the donor is not a direct relation of the recipient, his acceptance would be subject to confirmation of altruism by the appropriate Authorization committee for the purpose approved by the appropriate health authority.

Generally speaking, a donor should be more than 18 years in age, but as young as possible. Living donors more than 60 years in age are not welcome unless they appear physiologically and chronologically much younger. The donor should ideally be free from any disease, or any other condition which could adversely affect outcome following surgery.

Living donor Liver  Transplant

 

 

TRANSPLANTATION OF HUMAN ORGANS  ACT 1994

The legislation called the Transplantation of Human Organ Act (THO) was passed in India in 1994 to streamline organ donation and transplantation activities. Broadly, the act accepted brain death as a form of death and made the sale of organs a punishable offence.The Act was amended in 2008 and recently in 2011 and  new set of rules were released in 2014.

Transplantation of Human organs Act 1994

Transplantation of Human organs Act Amendment 2011

THOA  rules 2014

 

 

TRANSPLANT PROCEDURE

Liver transplant procedure involves the removal of diseased liver of recipient and replacing it with the partial (live donor) or entire (deceased donor) liver of the donor. The blood vessels (hepatic artery, hepatic vein and portal vein), bile ducts of the donor and recipient will be anastomosed. The surgery will take place in 12-14 hrs and lot of blood products will be needed for the patient.

Living donor liver transplant will be an elective procedure in which the surgery is scheduled on a particular day where as in deceased donor liver transplantation the recipient has to wait on the list till a suitable deceased donor available and it will be of emergency procedure.

POST OPERATIVE CARE

After the transplant, the recipient will be kept in liver transplant intensive care unit under continuous hemodynamic monitoring till he/she stabilizes. Frequent blood tests and ultra sound will be done to monitor the functioning of transplanted liver. It may take a week to recover from the surgery if the post-operative period is uneventful. Few patients may develop complications such as acute rejection, Bile leak, internal bleeding which may necessitates resurgery.

Post operatively the patient has to be on immunosuppressant drugs lifelong which may predispose to certain infections. Hence infection control activities such as hand hygiene, avoiding the persons with known infections, crowd and Vaccinations against certain viral infections will be done.

IMMUNOSUPPRESSANTS

The human body has developed a very sophisticated series of defenses against bacteria, viruses, and tumors. The machinery of the immune system has evolved over millions of years to identify and attack anything that is foreign or not "self." Unfortunately, transplanted organs fall into the category of foreign, not self. A number of drugs are given to transplant recipients to dampen the responses of their immune system in an attempt to keep the organ safe and free of immunologic attack. If the immune system is not sufficiently weakened, then rejection - the process by which the immune system identifies, attacks, and injures the transplanted organ - ensues.

Immunosuppressants

 

FOLLOW UP

Liver transplantation is a lifelong commitment. After the surgery the person has to be on continuous medicines(immunosuppressants) and monitoring the function of transplanted liver by doing investigations at regular interval to detect early signs of infection and rejection.  

Patient Education

PATIENTS UNDER EVALUATION

 

ORGAN DONATION

Organ donation is a noble act. By doing organ donation we are gifting life even after our death. Anybody can donate organs irrespective of age,sex,or any other variables.To register for organ donation please log on to http://notto.nic.in/Admin/Login.aspx and upload the necessary details. Organ donation is a family decision. So, it is important to inform the family members regarding our wish of organ donation.

 

JIPMER also offers you the option of formally pledging your organ(s) and you will be issued a ‘Donor Card’ once you pledge your organs.

 

The donor card offers you the opportunity to document your wish to donate your organs.

 

Steps for pledging your organs and obtaining a donor card from JIPMER:

 


  1. Know about organ donation and discuss with your family members. Taking family members into confidence is very important. The reason why this is important is that in case of an emergency or an untoward incident, your family will be the first to be contacted. Only after seeking their permission can the doctors go ahead with retrieving your organs. If your family is aware of your decision, your wishes will be carried out the way you would have liked. If the family is not aware and do not agree with your wish organ donation cannot happen.

  2. Download the Organ donation request form from here

  3. Fill the form in triplicate (3 copies are needed), sign it and bring it to the Medical Social Worker, Dept. of Nephrology in Super Specialty Block (OPD Room no.308, II floor) from Monday to Friday 9am to 1 pm. For further details please contact 0413-2297091

  4. You will be issued a ‘Donor Card’ from JIPMER

  5. You should carry the ‘Donor Card’ with you always. It will have the contact number in case you meet with an emergency and also will have your blood group.


PHOTOS LIVER TRANSPLANT

Hepatitis B and Hepatitis C awareness