Liver Transplant Treatment Cost in India

?The liver is the largest internal organ and it performs many critical functions as follows:

• Removal of toxins and bacteria from the blood
• Regulation of immune response and prevention of infection
• Medication, hormones, and nutrients are processed
• Production of bile to absorb fat-soluble vitamins and cholesterol, fats.
• Production of protein for a blood clot

So any damage to this organ is a life-threatening case. In a liver transplant procedure, the patient’s liver is removed which is no longer functioning properly and replaced with a healthy liver or part of the liver from a living or deceased donor. This method of treatment is only reserved for patients with end-stage chronic liver disease.

Since the human liver grows and returns to its previous normal volume after surgical removal, hence living donor is considered as an alternative to waiting to receive a liver from deceased donor liver.

Liver allocation can be a difficult process where they need to assess available organs and then distribute it as per the priority list of patients prepared. A priority list is prepared by assessing the following conditions:

• Jaundice condition
• Measuring prothrombin time or ability to clot.
• Creatinine measuring kidney function

All the above factors will be calculated for assessing the importance and urgency of a liver transplant.

Various conditions are considered for an organ donation:

• Braindead organ donors: If any individual suffers a brain death because of massive trauma to the head or a large stroke, it will stop all brain activities. However, if the liver is found to be functioning, it can be used. A team of surgeons will be dispatched to operate on the victim and remove the healthy liver and store it in such a way so that it may be used later during the liver transplant.
• Cardiac death organ donors: In some cases, an individual can suffer from a life-threatening brain injury but still carries out the functions of the organ in a very weak way. In such a case, brain death cannot be declared and if the patient’s family wishes to discontinue life-sustaining support to allow a painless death to the patient then in such case cardiac death is declared and with the consent of the family, the organ donation can be carried out.
• Living donors: without a liver, no individual can survive. But the liver is an organ that can be donated in parts for transplantation to progress. In both the donor and the recipient, the liver will grow to its full capacity and finally perform normal functions.

The primary legislation for organ donation and transplantation in India was first enacted in 1994 and primarily requires safeguards against commercial transactions of human organs for therapeutic purposes, transplantation, preservation and removal of organs too.

Initially, the Act was implemented in few states and thereafter other states followed. An amendment was proposed and was passed in 2011 and notified in 2014. The Act aims at ensuring all the above steps for the transplantation procedure in India.

The team at Medivenue will help the patient understand the law, direct them to the accredited and approved lists of hospitals of relevant state and facilitate in the documentation procedure to ensure that patients have a seamless dealing for liver transplantation.

Patients who are candidates for a liver transplant have one of the following conditions

Acute liver failure:  These patients are usually on the top priority list for liver transplants since they can die within days if the liver is not transplanted. It can happen as a result of viral infection, an overdose of any medicine and or ingestion of any toxic product like poisonous mushrooms which has a damaging effect on an otherwise healthy liver.

Chronic liver failure:  In response to repeated injuries and then repairs happening over the years, the liver can get scarred permanently resulting in a condition called cirrhosis. The reasons behind chronic liver failure are:

• Alcoholic liver disease
• Viral hepatitis
• Autoimmune liver disease
• Metabolic liver disease
• Biliary atresia
• Caroli’s disease ( bile duct abnormality)
• Genetic liver disease
• Vascular liver disease
• Hepatocellular carcinoma

Signs and symptoms of liver disease include:

• Fluid retention in cavities or legs
• Gastrointestinal bleeding
• Encephalopathy resulting in confusion and in extreme cases coma
• Jaundice giving a yellowish tinge to the skin

Liver transplant exclusion criteria also must be considered before liver transplants since there are many candidates on whom liver transplantation cannot be performed since the liver transplant success rate will be really low. Here is the list:

• Severe medical illnesses that are irreversible
• Severe pulmonary hypertension
• Spread of cancer outside the liver
• Uncontrollable infection
• Active abuse of a substance (drug and alcohol)
• Uncontrolled psychiatric disease
• A medical background of non compliance found

The basic tests that are conducted to find out the suitability of liver transplant are:

• Liver biopsy where part of liver tissue will be tested for cancer growth
• Lung function
• Blood test
• Chest x-ray
• Echocardiogram and stress echo
• Coronary angiography
• Kidney function test
• CT scan
• MRI (Magnetic Resonance Imaging) scan
• Endoscopy to test whether any gastrointestinal bleeding is involved

The patient is incubated and to help the patient breathes he or she is connected to a ventilator all throughout the surgery.  The surgery is carried out in general anesthesia where the patient has no sense at all. The skin covering the abdominal region is sterilized and then covered in thin but tightly secured drapes filled with beta dine. The surgical incision is made in this region above the abdomen.

The donor's liver is kept ready on a different operating table submerged in a sterile iced cold solution for storage. The liver transplant surgeon clamps off arteries, veins and bile ducts for bypassing them. The patient’s diseased liver is gradually isolated from the body and all the while doing this the surgeon ensures minimum loss of blood by exposing blood vessels slowly.

Since this is a vital surgery, an anesthetist will constantly monitor the effects and the amount of anesthesia that is being administered to the patient.

The liver is detached from the patient’s body and is sent to the pathology department for further study.  For a very short period of 40 minutes, the patient will be lying without the liver and till the new liver is again surgically connected to the body.

Now the new liver is inserted in the patient’s body through the chest cavity and the surgical team will start making all the connections. First, the vena cava (the body’s largest vein) is connected and there after the portal vein is connected.

After connection of the portal vein, the surgeon will open the clamps that were attached earlier and now the liver will enter a time of profusion. Blood will start flowing in the new liver changing its color from beige to pink and finally into a dark and healthy purple.  Another sign of a good flow of blood is when some amount of blood oozes out from the new liver’s artery. Sutures are now employed to close the region which is made of smooth synthetic material.

The surgeon must check the new liver for yellow-colored bile output to be sure the donor's liver is working properly. The surgeon must conduct a Kasai technique for ensuring bile duct discharge to the intestine. The surgeon will then remove the weakened ducts from the liver. This is achieved by removing the ducts at the spot where bile is about to get drained by short and stable parts of the patient's intestine. The Kasai procedure creates a Y-shaped passageway for the drainage of bile from the liver into the intestine.

The length of the intestine between the stomach and the bile duct is so balanced to avoid the reflux of food into the liver.

Ultrasound must be conducted to be sure that blood is flowing normally through the arteries and veins that were addressed during the surgery. 

Once that is done the abdomen can be stitched closed and completed.

After the closure of the incision, the patient will be transferred to ICU to be further monitored for a period.

A liver transplant surgery preparation can be physically and mentally draining.  The patient can be on the waiting list depending upon the urgency of his or her case.  Preparation would involve carrying out all the tests and adhering to medication prescribed by the doctor. But on an emotional level, the patient must ask valid questions like what can be the side effects after liver transplant, life expectancy after liver transplantation and lifestyle changes that may be required after the transplant surgery.

One may have to adhere to a diet that will have protein components to build up muscles and that will further aid in the recovery period.

The patient will be kept under observation for at least two days in ICU and in serious cases, it can stretch for a few weeks till the medical team is sure that the conditions are stable.

When the patient is released, they need to continue their weekly visits for a month and as conditions improve they are reduced.

Complication or problems after liver transplant surgery is not uncommon which include the following states:

• Hemorrhage
• Thrombosis
• Rejection
• Recurring diseases like Hepatitis C.

Often antiviral medicines are given to prevent rejection of the new transplant which suppresses the body's general immunity. The dosage is high in the initial days while it is lowered over time if the medical team points out that the body is not handling the new liver as a foreign matter. But this has to be done for the whole of life. As a consequence of the dosage, side effects may arise after the liver transplant.

Since the body’s general ability to fight infections will decrease with the medicines, the medical team will give medicines to avoid infection but apart from that the patient also needs to be careful with avoiding contact with people who are suffering from infection and be on their guard.

A new approach is explored to reduce the risks of liver transplant surgeries.  This is known as “hepatocyte transplantation”, a technique that gets 10% of the diseased liver replaced with healthy cells from a deceased donor. This procedure brings down the cost, risks and even the recovery time after the liver transplant.?

Liver transplant in India is way cheaper than in Europe or the USA. It ranges from $30,000 to $38,000.