Deceased Donor Liver Transplantation
Deceased donor liver transplantation (also known as cadaver liver transplantation) involves transplanting a healthy liver from an individual who has died in the ICU because of irreversible brain injury. The cause of death is usually head injury sustained in a road traffic accident or a fall from height. Brain stroke can also lead to irreversible brain damage. These patients can also donate their organs. The treating team will do a series of internationally standardized tests to confirm that the brain damage is irreversible and there is no chance of the patient recovering. Then the family of the patient is approached and counselled regarding organ donation. If the family is agreeable, then our surgical team will carefully remove the organs in the operation theatre and place them in a special cold preservative solution while they are transported back to the hospital by road or air.
Wait-listing for Deceased Donor Liver Transplantation
For patients with serious liver disease who do not have a suitable family donor, waiting for a suitable cadaver liver is the only option. Once the patient is considered suitable for transplantation, he/she is registered on the official state-wise waiting list. Offer of a donor liver is based on the blood group and the time for which the patient is on the waiting list. Considerations such as relative size of the patient and the donor, quality of the donor liver and condition of the patient are also taken into consideration when deciding on the best match.
Life on the Waiting List
Being on the waiting list can be difficult and frustrating period. The key is to maintain the patient’s health in the best possible condition so that when ultimately a liver becomes available, transplantation can proceed. The patient should continue on the prescribed liver medications and be under regular follow up with the treating liver physician, so that any problems or complications can be treated early.
Your Health While on the Waiting List
In some patients, the transplant team may do regular investigations of the heart and lungs to identify any new problems that can impact the safety of liver transplantation. Patients may have intermittent infections and deterioration of liver function on the waiting list needing hospital or even intensive care admissions. The aim of treatment is always to treat the complication and stabilize his/her condition so that transplant can proceed when the organ becomes available. If the patient gets admitted in a local hospital for any medical problem, this should be informed to our transplant team. This will help us in communicating with your local doctor regarding the best treatment for the illness.
What Happens When You Get the Call?
When a suitable donor liver becomes available, the surgical team will check to see if the liver is compatible for the patient. If so, the patient will be contacted immediately and advised to come to the hospital immediately. The call may come at any time during the day or night and the patient usually has about 6 hours to come to the hospital. Hence it is advisable for them to look at their transport options beforehand (contact numbers of taxis, flight timings etc). We advise patients from outside the city to stay in Chennai when they reach the top of the waiting list to avoid losing an opportunity due to travel related issues. The patient should always be contactable while on the waiting list. It is important that the transplant team is informed if the patient changes their contact telephone, email ID or address.
How Long Does It Take to Get a Donor Liver?
Donor livers are allocated based on the time spent on the waiting list. The average waiting time is around 6 – 12 months. The waiting time is variable and depends on multiple factors including the patient’s blood group. For example, patients with blood group AB may have to wait less than those with blood group O. The problem with the transplant waiting list is that unfortunately, not every one will get a liver transplant. Some of the patients will deteriorate while waiting for a new liver and will become too sick to have a transplant. In Western countries, the risk of patients dying before they get a suitable liver is around 10%. In India, because cadaver donors are much less in number, the risk of dying on the waiting list can be as high as 50%. This again underlines the importance of looking after your health carefully during the waiting period. We advise our patients to continue to explore the possibility of a family donor during this period, as that will ensure a timely transplant.