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Liver Transplant

Liver Transplant

The liver is alargereddish brown organ placed on the right side of the belly. It is protected by ribs and has four lobes of unequal size and shape. Weighing 1.4,1.6 kg (3.1,3.5 lb), a human liver is the largest internal organ (the skin being the largest organ overall) and the largest gland in the human body.

The human liver is connected to the hepatic artery and the portal vein that are two large blood vessels. The hepatic artery carries blood from the aorta, while the portal vein carries blood from the small intestine and the descending colon, this blood contains digested nutrients. All these blood vessels are further divide into capillaries, which then travel to a lobule. Each lobule consists of millions of hepatic cells which function as the basic metabolic cells.

Function of Liver

Liver has many important functions to play in the body. It produces many essential chemicals required for the body to function normally. Liver breaks down and detoxifies substances in the body and it also functions as a storage unit. Most importantly, it produces bile which plays a vital role in excreting waste from the body. Blood passes through liver while leaving the blood and is processed by the liver. Liver also breaks down the nutrients and drugs into simple forms that can be usedeasily for the rest of the body.

Liver Diseases

  • Alcoholic Liver Disease
  • Alpha-1-Antitrypsin Deficiency
  • Haemochromatosis
  • Hepatitis D
  • Hepatitis E
  • Liver Cancer
  • Biliary Atresia
  • Liver Diseases & Pregnancy
  • Chronic Hepatitis
  • Primary Biliary Cirrhosis
  • Cancer of the Gallbladder and Bile Duct
  • Cirrhosis
  • Liver Abscess
  • Liver Adenoma
  • Drug Induced Hepatitis
  • Hepatitis A
  • Hepatitis C
  • Autoimmune Hepatitis
  • Hepatitis B

Liver Cirrhosis

Cirrhosis is an abnormal liver condition marked by scarring of the liver and poor liver functioning. In this condition normal liver cells are permanently damaged and replaced by scar tissue. The increase in scar tissue in liver decreases the amount of normal liver tissue and affects the normal functioning of the liver. Since liver is one of the most important organs in a human body, Liver cirrhosis can be very dangerous.

The blood flow gets blocked and it no longer performs its usual functions. The signs and symptoms of this ailment are not observed in the early stage and the damage to liver is irreversible. The liver almost stops working as the disease grows. Cirrhosis also causes a number of other diseases such as variceal bleeding, ascites and hepatic encephalopathy.

Symptoms of Cirrhosis

The most common symptoms of Liver Cirrhosis are listed below:

  • Weakness
  • Loss of appetite
  • Fatigue
  • Exhaustion
  • Nausea
  • Weight loss

Major Causes of Cirrhosis:-

There are a number of factors responsible for the development of Cirrhosis such as:

  • Excessive intake of alcohol
  • Viral infections initiated by chronic viral hepatitis (types B, C and D)
  • Metabolic diseases such as alpha-1-antitrypsin deficiency, galactosemia and glycogen storage disorders
  • Inherited ailmentslike Wilson's disease and hemochromatosis
  • Biliary cirrhosis caused by diseases such as primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC)
  • Toxic hepatitis caused by severe reactions to recommended drugs or elongated exposure to environmental toxins
  • Recurrent bouts of heart failure with liver congestion

Diagnostic Procedures of Cirrhosis

Following steps are included in the diagnosis of cirrhosis

  • Identifiable symptoms
  • Ultrasound
  • Radioisotope liver/spleen scan
  • Physical examination
  • CAT scan (computerized axial tomography)
  • ERCP
  • Liver Biopsy
  • LFT
  • MRCP

Treatment is recommended as soon as liver disease is diagnosed through these medial examinations.

Who needs Liver Transplant?

Absolute indications for liver transplant

Ascites (Fluid in the Belly):- Repeated collection, non-responsive to diuretic medicines or frequent removal by needle

GI bleed:- Frequently Vvmiting blood or passing blood in stool

SBP:- Spontaneous infection in the fluid in the belly (Polymorph cell count >250/cc)

Coma:- Repeated admission to hospital for loss of orientation and conscious state

Serum Albumin:- Measurement constantly below 3.5 Gm/dl

Prothrombin Time:- Measurement in patient sample 5 seconds above the control lab value (or INR>1.5)

Total Bilurubin:- Serum total bilurubin>6 mg/dl, especially in patients with bile outflow problems like- PSC & PBC

Liver Donor Requirements

Anyone in the blood relation including family, parent, sibling, child, and spouse can donate their liver. The donor can be any volunteer. Following are the major points considered as criteria for liver donation:

  • The donor should be in good health
  • The blood group of donor must match or be compatible with the recipient's
  • Volunteer donation with no financial motivation in the process of donation
  • Age should be between 18 and 60 years old
  • The liver size should be similar or bigger than the recipient's

Before accepting liver from a living donor, the individual is carefully examined to ensure that the person is fit. CTscans or MRIs are also performed in some cases to image the liver. Mostly the process takes 2-3 weeks.


Some of the major centres in India perform living donor surgery. In very rare cases does the individual require any blood transfusions during or after surgery. The potential donor must be informed that there is 0.5 to 1.0 percent chance of death though the procedure is safe. Other risks of donating a liver include bleeding, infection, painful incision, possibility of blood clots and a prolonged recovery. Most donors take 2-3 months recover fully after the liver donation surgery.

Paediatric Transplantation

Living liver donor transplantation has become a common and accepted practice in children. The number of infants who would have otherwise died waiting for a transplanthas reduced due to the accessibility of adult parents who want to donate a piece of the liver for their children/infants. It is also morally and emotionally better for both child and parents since both parents can help each other emotionally.

Benefits of Living Donor Transplantation

There are various advantages of living liver donor transplantation over cadaveric donor transplantation, such as:

  • Transplant can be done on an elective basis because the donor is readily available
  • There are less possibilities for complications and death while waiting for a cadaveric organ donor

Arrangement of Donor for Transplants

We at IMH do not take responsibility of providing a living donor for liver transplantation. The receiver has to arrange for the donor on his own as the human organs transplant acts are very strict. No monetary exchanges are accepted in the entire process of Liver donation. Involvement of money is illegal.

Therefore, the receiver will have to take it upon himself to arrange for the donor who is voluntarily willing to donate. The person should preferably be someone in the first blood relation.

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