April 26,2019

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Facts About Liver Transplant and Surgery in India that Liver Patients Must Know

Very recently one of the leading English tabloids in India, ‘The Hindu’ carried an article on the surge in non-alcoholic liver diseases in the country in recent times. This is not the only documented piece of literature in mass media or medical science research to make such claims on liver diseases in India.

Data published by the World Health Organization shows that deaths due to liver diseases in India have touched 259, 749. This translates into 2.95% of the total deaths in India. While treatments for many liver diseases are available, there are several cases of acute liver diseases that call for a liver transplant procedure. A paper published in the MAMC Journal of Medical Sciences asserts that while 20 people per million of the population in India are in need of a liver transplant surgery, only 1.2 persons per million are actually able to get a liver transplant done.

This being the scenario despite liver transplant surgery in India being relatively affordable as compared to other nations, points towards two takeaways.

First, the diversity in the economic profiles of patients suffering from liver diseases and their families means that all such patients in need of a liver transplant surgery are unable to afford it.

Second, liver transplant centers in India, medical practitioners and healthcare institutions offering liver transplant surgeries are unable to reach out to the last man standing in the queue. Given the twin dimensions of the challenge, the solution envisaged must ideally seek to address two things: first, fund raising initiatives to facilitate financial aid for liver transplant surgeries of individual patients and second, holistic reforms to the liver transplant ecosystem in India through better interface and coordination among all the stakeholders, i.e. patients, liver donors, hospitals and liver transplant centers in India.

In this piece we take you through the details of what a liver transplant is, statistics on survival chances after undergoing liver transplant, types of liver transplant possible, the risks involved and finally how NGOs like The Pravin Agarwal Foundation are navigating India towards better fund raising for patients and reforming the liver healthcare ecosystem in India.

What is a Liver Transplant?

A healthy liver is essential to the longevity of the human life because it is the liver that is responsible for filtering blood, removing toxins from the body and secretion of bile juice for digestion of food. Liver transplant is a lender of the last resort in the sense that a liver transplant becomes necessary when the liver of a person on account of being affected by chronic and severe acute diseases stops working.
A liver transplant is also referred to as hepatic transplant. Any person living or deceased with a healthy liver can become a liver donor and help in saving the life of a person in need of a liver transplant.

Liver Transplant Survival Statistics

According to a study people undergoing a liver transplant have an 89% probability of surviving after one year and have a 75% probability of surviving after five years. There are few cases where the transplanted liver fails or there is a recurrence of the original disease. Therefore doctors suggest that it is necessary to monitor a recovery for long after the liver transplant has taken place to detect threats that may persist. This calls for undergoing blood tests on a regular basis and taking anti-rejection medications lifelong if necessary.

Types of Liver Transplants

Not all liver transplants are the same. Liver transplants may be classified into three types as follows:

1. Orthotopic Liver Transplant: Orthotopic liver transplant is one where the whole liver of a deceased donor is transplanted. The donor usually is required to pledge his or her organs for voluntary donation prior to death. The liver of the donor is required to be bereft of illnesses and/ or cancers prior to being transplanted into the recipient.

2. Living Donor Transplant: A living donor transplant is one in which the donor is alive. Either the left or right live of the donor’s liver is removed and transplanted into the recipient.

3. Split Type Transplant: A split type transplant is one in which the liver from a deceased donor is split to be transplanted partly into two individuals.

Why Liver Transplants Are Done?

In the context of liver transplant surgeries, it makes enormous good sense to understand the need for liver transplants,i.e. why liver transplants are done? The following points are relevant in this regard:

•  By nature human livers are regenerative, i.e. human livers can regenerate on their own without the need for external medical intervention.
• There are cases where the liver functions are damaged beyond repair and the liver fails to regenerate itself. Liver diseases, tumors and generalized diseases can lead to liver failure.
• It is under these medical conditions of liver failure that liver transplant becomes an absolute necessity. Again, the reasons behind a liver transplant vary with the age of the patient and the extent of damage to the liver done by the disease.

Possible Risks and Complications of a Liver Transplant

Despite the overwhelming quantum of evidence pointing towards prospects of successes found through liver transplants, there are risks associated with the procedure. These risks are outlined as follows:

• One of the foremost risks associated with the operation is transplant failure. In such cases, the body of the recipient rejects the new liver and unfortunately doctors cannot trace the reasons objectively.
• Second, a liver transplant also imposed a significantly high risk of infection.
• Further, there are risks that play out over a length of time such as bleeding, damage to the bile ducts, blood clots and after effects emanating from medications that are administered to enable the recipient’s immune system will accept the new liver and the possibility of a surge in blood sugar levels emanating from the use of steroids.

Tips to Maintain Liver Health

Given the centrality of the role that the human liver assumes and the challenges associated with being inflicted with liver diseases, it makes enormous good sense to be proactive and adopt preventive and precautionary measures to consistently maintain great liver health. Some of the basic measures that people can take to maintain sound liver health are as follows:

• Maintain a healthy weight consistently
• Take a balanced diet
• Follow a disciplined exercise regimen
• Keep drinking habits at moderate levels
• Stay away from illicit drugs
• Stay away from contaminated needles
• Seek medical counsel when exposed to blood
• Do not share items of personal hygiene
• Maintain discipline in sexual life
• Wash hands before food and after using the loo
• Read directions for all medications
• Get vaccinated for hepatitis A and B

How Can You Get a Liver from TPAF?

Given the challenges to liver transplant in India prevailing at both the institutional and individual levels, patients especially children seeking liver transplants and their families find the going to very rough. The Pravin Agarwal Foundation (TPAF) is a non-government organization that is dedicated to making liver transplant in India affordable and accessible. A philanthropic initiative taken by Pravin Agarwal,Chairman of Sterlite Power Transmission Limited and Vice-Chairman of Sterlite Technologies Limited, TPAF is working on thrust areas:

• Financial Assistance for Liver Transplant Surgery

TPAF collaborates with diverse fundraising platforms to either sponsor or externally procure financial aid needed by patients and their families for liver transplant surgery. TPAF provides direct financial aid to children who are in need of urgent liver transplant and also helps raise additional funds through collaborations with crowd-funding platforms like Milaap.

• Hospital Assistance for Liver Transplant Surgery

TPAF is committed to making holistic changes in the ecosystem for pediatric liver transplant surgery in India. To this extent, TPAF partners with liver transplant centers and works directly with them to rationalize costs of surgeries and make liver transplants more affordable for patients.

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Patients in need of support for their liver transplant surgery procedure can reach out to TPAF on the web at www.tpaf.in, subscribe to the TPAF newsletter or write to info@tpaf.in.