Guidelines for Liver Transplant

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

3. 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.
4. It is mandatory that the donor should be a psychologically-sound adult who is well aware to take any sort of decision.
5. 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.
6. 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

7. 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.

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