Liver transplant is a surgery to remove a diseased or injured liver and replace it with a healthy whole liver or a segment of a liver from another person, called a donor. People with either acute or chronic liver failure may need a liver transplant to survive. This is a viable treatment option for end-stage liver disease and acute liver failure. The surgical procedure is very demanding and ranges from 4 to 18 hours depending on an outcome. Numerous anastomosis and sutures, and many disconnections and reconnection of abdominal and liver tissue, must be made for the transplant to succeed, requiring an eligible recipient and a well-calibrated live or cadaver donor match. After a transplant, the patient can lead fairly normal life and is free from the disease.
Liver Transplants are classified as.
Deceased Donor Liver Transplant (DDLT): In this procedure uses a liver that becomes available when a person who is brain dead (but heart is till beating) and his or her family donates the organ for transplantation.
Living Donor Liver Transplant (LDLT): In this procedure a piece of liver is removed from a living donor and transplanted into a recipient. The procedure, performed after the diseased liver has been removed, is possible because the liver regenerates or grows. The liver’s unique ability to regenerate itself – combined with technological advances – allows more people to be donors.
Auxiliary Transplantation: Auxiliary liver transplantation entails attaching a portion of a healthy donor’s liver to a portion of a recipient’s diseased liver. The donor liver remains intact until the native organ regenerates, at which point the diseased liver may be removed.
- Hepatitis B
- Hepatitis C
- Long-term alcohol consumption
- Cirrhosis
- Hemochromatosis (an inherited disorder that causes the body to absorb and store too much iron)
- Malnutrition
- Acetaminophen (Tylenol) overdose
- Liver cancer
- Viruses including hepatitis A, B, and C (especially in children)
- Reactions to certain prescription and herbal medications
- Ingestion of poisonous wild mushrooms
- Biliary Artresia (malfunction of the bile ducts)
- Wilson’s Disease ( a rare inherited disease with abnormal deposition of copper throughout the body and liver)
- Alpha 1 Antitrypsin Deficiency (abnormal accumulation of alpha-1 antitrypsin protein in the liver resulting in cirrhosis
- Primary Biliary Cirrhosis ( a condition where the immune system inappropriately attacks and destroys the bile ducts)
- Sclerosing Cholangitis (scarring and narrowing of the bile ducts causing the backup of bile in the liver
Liver or hepar is a large, meaty organ that sits on the right side of the belly. Weighing about 3 pounds. The liver’s main job is to filter the blood coming from the digestive tract, before passing it to the rest of the body. The liver also detoxifies chemicals and metabolizes drugs.Liver transplantation is surgery to remove a diseased or injured liverand replace it with a healthy whole liver or a segment of a liver from another person, called a donor. People with either acute or chronic liverfailure may need a liver transplant to survive. Liver transplantation is a viable treatment option forend-stage liver disease and acute liver failure. The surgical procedure is very demanding and ranges from 4 to 18 hours depending on outcome. Numerousanastomoses and sutures, and many disconnections and reconnections of abdominal and liver tissue, must be made for the transplant to succeed, requiring an eligible recipient and a well-calibrated live or cadaveric donor match. After a transplant, the patient can lead fairly normal life and is free from the disease. Liver Transplants are classified as
Deceased Donor Liver Transplant (DDLT): In this procedure uses a liver that becomes available when a person who is brain dead (but heart is till beating) and his or her family donates the organ for transplantation.
Living Donor Liver Transplant (LDLT): In this procedure a piece of liver is removed from a living donor and transplanted into a recipient. The procedure, performed after the diseased liver has been removed, is possible because the liver regenerates or grows. The liver’s unique ability to regenerate itself – combined with technological advances – allows more people to be donors.
Auxiliary Transplantation: Auxiliary liver transplantation entails attaching a portion of a healthy donor’s liver to a portion of a recipient’s diseased liver. The donor liver remains intact until the native organ regenerates, at which point the diseased liver may be removed.
Why India?
India has today worlds best doctor and Hospitals for liver transplant. The technology adopted is far superiror than any other technology for liver transplant surgery in the world . Following reasons make India top destination for liver transplant. n the recent years, India has emerged as the top destination for medical tourism, as the health infrastructure is rapidly augmenting and the quality of care steadily improving. There are several JCI accredited hospitals in India, which provide the same or better quality of medical care at lower costs. With highly trained and qualified medical teams, the clinical outcomes of the liver transplant surgery are comparable to those in the United States.
Best success rate for liver transplant
- Cost of Liver transplant in India is lower as compared cost of liver transplant in Malaysia ,Singapore and other countries (cost comparison)
- India has the largest research center for liver.
- No waiting list for liver transplant
- Best medicine available for liver transplant
- Best Facility for liver transplant available
Why Alphine Life Solutions for Liver transplant
Alphine life today has achieved and known as the worlds top most rated status for medical services in liver transplant. We understand the priority , medical needs and care for liver transplant. We are one of the best liver Transplant counsellor in India
Following reasons make us top medical tourism company for best liver transplant
- Associated with the best Hospital for liver transplant having latest Technology
- Best Doctors on our panel having highest success rate for liver transplant (98%) and have performed more than 2000 liver transplants.
- Offer economic medical travel with best medical outcomes
- Certified and trained Nurse or personal assistant during hospital stay and after surgery.
- Economical Accommodation After surgery for Patient, Donor and Family Members
Visa processing
- Arranging Appointment and coordinating with Doctors for check up before and after surgery
- Coordinating with hospital and providing assistance for test to be conducted before and after surgery.
- 24 X & dedicated team
- Providing Interpreters if required
- Ensure high-quality, accredited and transparent health care.
- Many satisfied patients from around the world
- Best Liver Transplant Coordinator in India
We at Alphine Life are associated with best hospitals for Liver transplant in India and top surgeons for liver transplant in India. You may contact us by
sending us your medical reports and asking for a quote. Please be assured of best and low cost treatment from world class hospitals and Doctors
Criteria for Liver Transplant
The most common causes of chronic liver failure (where the liver fails over months to years) include
- Hepatitis B
- Hepatitis C
- Long-term alcohol consumption
- Cirrhosis
- Hemochromatosis (an inherited disorder that causes the body to absorb and store too much iron)
- Malnutrition
- The causes of acute liver failure, when the liver fails rapidly, however, are often different. These include
Acetaminophen (Tylenol) overdose
- Liver cancer
- Viruses including hepatitis A, B, and C (especially in children)
- Reactions to certain prescription and herbal medications
- Ingestion of poisonous wild mushrooms
- Biliary Artresia (malfunction of the bile ducts)
- Wilson’s Disease ( a rare inherited disease with abnormal deposition of copper throughout the body and liver)
- Alpha 1 Antitrypsin Deficiency (abnormal accumulation of alpha-1 antitrypsin protein in the liver resulting in cirrhosis
- Primary Biliary Cirrhosis ( a condition where the immune system inappropriately attacks and destroys the bile ducts)
- Sclerosing Cholangitis (scarring and narrowing of the bile ducts causing the backup of bile in the liver
Which tests are required before getting a liver transplant
Before having a liver transplant you will need to have a number of tests to help the doctors decide whether this operation is the best treatment for you. This period of assessment, which lasts around five days, can be a difficult time but it is important that the doctors see that you are fit enough to have the operation. You may also have to repeat a number of tests during your assessment for a transplant.
Blood tests
Blood tests are used to understand your general health and find out if there are any factors which can cause problems in people with transplants. People with cirrhosis have a much higher chance of getting liver cancer (hepatocellular carcinoma, or HCC), therefore your test will also check for cancers.
Chest X-ray
A chest X-ray uses radiation to form a picture of your heart and lungs so that your doctors can tell whether these organs are working well.
Lung function
Lung function tests are used to check how much air is moving in and out of your lungs.
Blood oxygen test
In order to measure the amount of oxygen in your blood, doctors will take a small amount of blood from a vein in your wrist.
Electrocardiogram (ECG)
An electrocardiogram, commonly called an ECG, is used to find out how your heart is working. Leads are attached by pads to your chest, arms and legs and linked to a machine which measures the electrical activity in the heart.
Echocardiogram and stress echo
An echocardiogram is another heart test and is used to assess the size of your heart and its ability to pump blood properly. The procedure is similar to ultrasound where a probe, like a microphone, is moved by hand over your heart area to send sound waves through your skin. It will record any reflected sound waves and send them to a computer which is able to process the waves as pictures. In addition to this procedure you will be required to perform a physical exercise, such as running or walking on a treadmill, so that doctors can compare your heart action following activity.
Coronary angiography
During a coronary angiography a dye will be injected into your arteries and an X-ray will be taken. This helps doctors understand how healthy your arteries are and whether there are any problems that could make the transplant too risky to carry out. This test is only required in selected cases where there are risk factors such as coronary disease, age (over 60), smoking and hypertension (high blood pressure).
Kidney function tests
Problems with the kidneys are a common side effect of liver failure. Tests for kidney function include blood and urine tests.
Ultrasound scan/Doppler ultrasound
Ultrasound is the same technology used to confirm all is well in pregnancy. Gel will be applied to your skin, which may feel slightly cold. A probe will be moved across your skin to send sound waves into the liver area. The reflected sound waves, or echoes, are picked up through the probe and used to build a screen image of the liver’s condition. This painless test is often used to check the condition of the bile ducts.
CT scan (computerised tomography)
A CT scan uses special X-ray equipment to give doctors a detailed picture of your internal organs and body tissue, particularly the chest and abdomen. To help with this you will be given a dye which you might either swallow or have injected into your veins. You will then lie on a bed which will be passed through a scanner.
MRI (magnetic resonance imaging)
An MRI scan uses magnetic fields to create a computerised image of the body that is even more detailed than a CT scan. As with a CT scan, you will be asked to lie on a bed which will be passed through a scanner.
Liver biopsy
A liver biopsy is a process where a tiny piece of the liver is taken for study. A fine hollow needle is passed through the skin into the liver and a small sample is withdrawn. The test is usually done under local anaesthetic and may mean an overnight stay in hospital, although some people may be allowed home later the same day. As the test can be uncomfortable with a small risk of internal bleeding or bile leakage, a stay in bed of at least six to eight hours is required.
Endoscopy
During an endoscopy a very thin tube with a tiny camera is lowered down your throat and into your stomach. This is usually done under local anaesthetic. Endoscopy is used to find out whether the tiny veins (varices) in your stomach and gut are damaged or bleeding
Liver donor requirements
- Any member of the family, parent, sibling, child, spouse or a volunteer can donate their liver. The criteria for a liver donation include:
- Being in good health
- Having a blood type that matches or is compatible with the recipient’s, although some centres now perform blood group incompatible transplants with special immuno suppression protocols
- Having a charitable desire of donation without financial motivation
- Being between 18 and 60 years old
- Being of similar or bigger size than the recipient
- Before one becomes a living donor, the donor must undergo testing to ensure that the individual is physically fit. Sometimes CT scans or MRIs are done to image the liver. In most cases, the work up is done in 2–3 weeks
IT IS IMPORTANT TO NOTE THAT Alphine Life DOES NOT ARRANGE DONORS. THE DONOR FOR LIVER TRANSPLANT HAS TO BE A CLOSE RELATIVE OF THE PATIENT (SIBLING/ PARENTS/ CHILDREN/SPOUSE). IN CASE THE DONOR IS NOT A CLOSE RELATIVE, GOVERNMENT PERMISSION IS REQUIRED AND IS GIVEN ONLY IF IT IS
Generally, a liver transplant follows this process:
- You will be asked to remove your clothing and given a gown to wear.
- An IV (intravenous) line will be started in your arm or hand. Other tubes (catheters) will be put in your neck and wrist. Or they may be put under your collarbone or in the area between your belly and your thigh (the groin).These are used to check your heart and blood pressure, and to get blood samples.
- You will be placed on your back on the operating table.
- If there is too much hair at the surgical site, it may be clipped off.
- A catheter will be put into your bladder to drain urine.
- After you are sedated, the anesthesiologist will insert a tube into your lungs. This is so that your breathing can be helped with a machine (a ventilator). The anesthesiologist will keep checking your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
- The skin over the surgical site will be cleaned with a sterile (antiseptic) solution.
- The doctor will make a cut (incision) just under the ribs on both sides of your belly. The incision will extend straight up for a short distance over the breast bone.
- The doctor will carefully separate the diseased liver from the nearby organs and structures.
- The attached arteries and veins will be clamped to stop blood flow into the diseased liver.
- Different surgery methods may be used to remove the diseased liver and implant the donor liver. The method used will depend on your specific case.
- The diseased liver will be removed after it has been cut off from the blood vessels.
- Your surgeon will check the donor liver before implanting it in your body.
- The donor liver will be attached to your blood vessels. Blood flow to your new liver will be started. The surgeon will check for any bleeding where you have stitches.
- The new liver will be attached to your bile ducts.
- The incision will be closed with stitches or surgical staples.
- A drain may be placed in the incision site to reduce swelling.
- A sterile bandage or dressing will be applied.
care and conditions post liver transplant.
In the hospital
After the surgery you may be taken to the recovery room for a few hours before being taken to the intensive care unit (ICU). You will be closely watched in the ICU for several days. You will most likely have a tube in your throat. This is so you can breathe with the help of a machine (a ventilator) until you can breathe on your own. You may need the breathing tube for a few hours or a few days, depending on your situation.
You may have a thin plastic tube inserted through your nose into your stomach to remove air that you swallow. The tube will be taken out when your bowels start working normally again. You won’t be able to eat or drink until the tube is removed.
Blood samples will be taken often to check your new liver. They will also check that your kidneys, lungs, and circulatory system are all working.
You may have IV drips to help your blood pressure and your heart, and to control any problems with bleeding. As your condition gets better, these drips will be slowly decreased and turned off.
Once the breathing and stomach tubes have been removed and you are stable, you may start to drink liquids. You may slowly begin to eat solid foods as directed.
Your anti-rejection medicines will be closely watched to be sure you are getting the right dose and the right mix of medicines.
When your surgeon feels you are ready, you will be moved from the ICU to a private room. With help of physiotherapy sessions You will slowly be able to move about more as you get out of bed and walk around for longer periods of time. You will slowly be able to eat more solid foods
At home
Once you are home, you must keep the surgical area clean and dry. The surgeon and his team will give you specific bathing instructions and inform you the name and dosage of medicines to be taken. Any stitches or surgical staples will be removed at a follow-up office visit, if they were not removed before leaving the hospital.
You should not drive and also limit your activity until your surgeons tells you to.
Contact or visit your surgeon immediately, if you have any of the following:
Fever. This may be a sign of rejection or infection.
Redness, swelling, or bleeding or other drainage from the incision site
More pain around the incision site. This may be a sign of infection or rejection.
Vomiting or diarrhea
Rejection in liver transplant
What is done to prevent rejection?
You must take medicines for the rest of your life to help the transplanted liver survive in your body. These medicines are called anti-rejection medicines (immunosuppressive medicines). They weaken your immune system’s response.
Each person may react differently to medicines, New anti-rejection medicines are always being made and approved. The Surgeon will create a medicine treatment plan that is right for you. In most cases you will take a few anti-rejection medicines at first. The doses may change often, depending on how you respond to them.
Because anti-rejection medicines affect the immune system, people who have a transplant are at a higher risk for infections.Some of the infections you will be at greater risk for include:
- Oral yeast infection (thrush)
- Herpes
- Respiratory viruses
- For the first few months after your surgery, you should avoid contact with crowds or anyone who has an infection.
Each person may have different symptoms of rejection. Some common symptoms of rejection include:
- Fever
- A yellowing of the skin and eyes (jaundice
- Dark-colored urine
- Itching
- Swollen or sore belly
- Feeling very tired (fatigue)
- Being easily annoyed
- Headache
- Upset stomach
The symptoms of rejection may look like other health problems. Contact surgeon or his team about any concerns you have. It is important to see them and speak with them often
Stay after Liver transplant
For recipient:
On arrival the hospital will conduct pre medical test which takes 5 to 6 days. After confirming the test the recipient is admitted for transplant. There is no waiting time for liver transplant and it is immediately done after all clearances (medical and legal). The recipient is kept for 7 days in ICU thereafter 15 days in Private room. Recipient after discharge are required to stay in India for 30 days for follow up visit and checking of parameters by surgeon.
For Donor
On arrival the hospital will conduct pre medical test which takes 5 to 6 days. After confirming the test the Donor is admitted for transplant. There is no waiting time for liver transplant and it is immediately done after all clearances (medical and legal). The Donor is kept for 3 days in ICU thereafter 5 days in Private room. Donor after discharge are required to stay in India for 15 days for follow up visit and checking of parameters by surgeon
Advantages of Liver transplant/benefits
- The major Advantage is the leading normal and longer life.
- Success rate of liver transplant
- Alphine life solutions is associated with best hospitals for liver transplants . Our Associated best doctors for liver transplants are world renowned and have perform over 1000 transplants .The number of surgery performed under Alphine Life Solutions till date have achieved 100% and best success rate for liver transplant .
Cost Of Liver transplant:
World renowned and highly experienced doctors , hospitals with latest technology ,no waiting time and lowest cost for liver transplant makes India today is best destination for liver transplant as compared to liver transplant in Malaysia or liver transplant in Singapore and rest of the world. India is preferred best liver transplant destination as compared to liver transplant in Indonesia, liver transplant in Bangladesh,liver transplant in Saudi Arabia,liver transplant in oman,liver transpant in Africa,liver transplant in Iran,liver transplant in veitnam,liver transplant in Uzbekistan because the low cost and latest technology available in India.
Guidelines for Live Donor Liver Transplantation ( LDLT )
Recipient’s evaluation:
- You can send Following reports via email or post to confirm the requirement and cost of a Liver Transplant.
- Urine protein creatinine ratio and Urine routine/microscopy
- Anti HCV, HIV I & II, Liver Function Tests (LFT), P time / INR, Urea ,Creatinine, CBC / Hemogram, Sodium , Potassium, AFP, HbsAg
- Triple phase CT angiography of the liver (Patients with normal ceratinine levels, urea and no contrast allergy can get this test done safely)
- Your Medical Summary prepared by your doctor carrying information about your past medical history / symptoms.
- Recent Upper GI endoscopy report
All these reports are required to confirm the requirement and cost of a Liver Transplant.
Nevertheless, once the patient reaches the preferred hospital in India.The liver transplant candidate would be examined again and would have to undergo certain other essential tests such as ABG, PA pressure measurements, PFT, Stress Echo for checking his fitness before undergoing the transplant surgery.
Evaluation of Donor:
1. He/She should be a relative of the patient and should be happy to donate his liver on selfless basis.
2. It is preferable that the donor must be between the age group of 18 and 45 years. He/she should be fit, strong and have a matching or compatible blood group:
| Patient blood group | Matching donor groups |
| A+ or A- | A+/ A- /O+ / O- |
| B+ or B- | B+ / B- / O+ / O- |
| AB+ or AB – | Any blood group acceptable |
| O+ or O- | O+ / O |
- Though liver looks like a single organ but in reality it consists of 8 different lobes and thus can be separated into these lobes. Generally the donor’s right half of the liver is donated during an adult – to – adult liver transplant. Liver’s bloodless division into right and left has now become possible because of latest techniques and gadgets. A living donor can now easy donate his liver safely as the remaining left side grows back to around 80 percent of liver’s original size in few weeks and quite close to the original size within few months. The ratio of risk in liver donation is even lower than 1:200.
- It is mandatory that the donor should be a psychologically-sound adult who is well aware to take any sort of decision.
- If the transplant is being done by an unrelated liver donor for financial reasons, it is illegal and punishable under Indian laws. No queries in this regard would be entertained.
- In case, you want to start the evaluation of the donor on an immediate basis, you can get done the Level I and Level II tests in your own country and send the reports to us by mail:
Level I: Blood group HBsAg, HbA1c, Anti HCV, HIV I & II CBC / Hemogram, Creatinine, P time / INR, LFT, Urea
After 14 hour Fasting, Serum T3, T4, Lipid profile and TSH
If the reports are fine, go on to Level II
Level II: Triple phase CT Liver Angio (donor protocol) along with a plain scan for looking at Liver Attenuation
You can courier or mail us the reports or bring along a CD in DICOM format
This scan is a crucial part of the donor work up
Level III: MRCP
Level IV: Stress Echo, Chest X-ray, ECG, Lung Function Tests USG breast & pelvis, Mammography ( less than 40 yrs ), , CA 125, HLA tissue typing, PAP smear ( married ladies), Blood group antibody screen
- Tests at Level III and IV for the donor and all tests for the patient can be done within 48 hrs of arrival at a hospital in India. If the test reports are fine, liver transplant can be done quickly once permission from Government of India Transplant Authorisation Committee is taken. All this might take a week’s time
Necessary Formalities And Assistance in Visa Formalities
- Step1: Obtaining No Objection Certificate from the respective embassy . Furnish the following documents at the Embassy:
- A letter on the hospital’s letter head telling that the patient is undergoing the treatment
- Old medical reports and health records
- A small summary of the case or medical history of the patient (if referred)
- An affidavit from the local government authority stating that the patient and the donor are relatives (mandatory for all Foreign Patients).
- 10 photographs each (patient and donor)
- Salary slip or bank statement of both patient and donor as the Income proof
- The consent from the next of kin of donor on a stamp paper that should carry donor’s and kin’s photograph, duly pasted. In case the donor is a cousin, it is necessary for the next of kin to be present at the Transplant Authorization Committee.
- Birth certificate or marriage certificate etc as proof of relation
Step 2: The patient is required to go to the SDM office along with the donor and the relative for getting the affidavit of donor, attested by him. Following documents are needed at the SDM office:
- A letter on the hospital’s letter head telling that the patient is undergoing the treatment.
- NOC from the Embassy
- Affidavit patient
- Affidavit donor
- Affidavit relative
Step 3: Notary attests the affidavits of the patient and the relative. This takes a time of a day or two.Please note if the documents are in patients local language of country of residence .The same has to be translated in English and get the translation notarised by local authority from patients country of residence.
Step 4: After the affidavits get attested, these documents are taken to the Authorization Committee of the hospital for approval. At the same time, the concerned doctors conduct some important tests on the patient and the donor. All this takes around 2 week’s time.
