Transforming Lives: Deceased Donor Liver Transplantation in Bangalore

Deceased Donor Liver Transplant (DDLT)

When a patient does not have a family member who can donate a liver, the only option way to obtain a liver is through a deceased or brain death (cadaveric) donor. This type of transplant is referred to as a Deceased Donor Liver Transplant (DDLT).

In Deceased Donor (Cadaveric) Liver Transplant liver comes from people who have died suddenly, usually from an accident or bleed into the brain. Their heart is still beating,

but their brain has stopped working so they’re considered legally dead. The donor is usually in an intensive-care unit. These individuals are usually been relatively healthy before their death. These people have previously expressed to their families a willingness to donate their organs, or their families have made the decision to donate their organs so that someone else will have a chance to live a better life.

After consent from relatives, retrieval procedure is performed in operation theatre. After removal from the donor (a process called liver retrieval), the liver can safely preserved outside the body in special preservation solutions for 6- 8 hours, which is why recipients are often called to the hospital at short notice based on availability of organ. All donors are screened for hepatitis viruses and the HIV to ensure that they don’t pose a health threat to the recipient.

Waiting List for Liver Transplant

Patients have to register themselves at Individual centers/NOTTO for cadaveric organ allocation in India. Once a liver is available and matches the patient’s blood group, they are called for a transplant based on their MELD score. Currently, India houses a state-based regulation for organ allocation based on the MELD score & waiting list.

What is a Deceased Donor Liver Transplantation

Deceased Donor Liver Transplantation in Bangalore, spearheaded by renowned Liver transplantation doctor in Bangalore Dr. Rajiv Lochan, is a life-saving surgical procedure performed to replace a diseased or failing liver with a healthy liver obtained from a deceased donor. This type of transplantation is typically considered when a patient’s liver function has severely deteriorated due to conditions such as liver cirrhosis, liver cancer, or acute liver failure, and other treatment options have been exhausted.
The process begins with the identification of a suitable deceased donor whose liver matches the recipient’s blood type and other compatibility factors. Once a suitable donor is found, the liver is procured through a meticulous surgical procedure while maintaining its viability.

The liver is then preserved and transported to the transplant centre for transplantation into the recipient. Before the transplant surgery, the recipient undergoes thorough evaluation to assess their overall health and suitability for the procedure. During the liver transplant surgery, the recipient’s diseased liver is removed, and the healthy donor liver is implanted. Following the surgery, the recipient requires lifelong immunosuppressive medication to prevent rejection of the transplanted organ. Deceased Donor Liver Transplantation offers a chance for patients with end-stage liver disease to regain normal liver function and significantly improve their quality of life. However, it is a complex procedure with potential risks and complications, requiring close monitoring and ongoing medical care post-transplantation.

Types of deceased donor

1. Brain Dead Donors:

These donors have suffered irreversible brain damage, leading to cessation of brain function while the heart continues to beat with the support of mechanical ventilation. Organs such as the liver, kidneys, heart, lungs, and pancreas can be retrieved from brain dead donors.

2. Donation After Cardiac Death (DCD) Donors:

In DCD, organ donation occurs after the heart has stopped beating, usually following the withdrawal of life-sustaining treatment. While DCD donors typically donate organs like kidneys, lungs, and pancreas, advances in surgical techniques have enabled the retrieval of livers from some DCD donors.

3. Donation After Brainstem Death (DBD) Donors:

In DBD, brainstem function is irreversibly lost, leading to cardiac arrest. However, vital organs such as the heart, liver, kidneys, and pancreas remain viable due to the continued circulation of blood and oxygen. DBD donors are the primary source of organs for transplantation.

4. Donation After Circulatory Death (DCD) Maastricht Category III:

In this type of deceased donation, organ retrieval occurs after the heart has stopped beating for a predetermined period following the withdrawal of life support. This category involves a more prolonged period of cardiac arrest compared to standard DCD, allowing for the retrieval of organs such as the liver.

5. Extended Criteria Donors (ECD):

These donors may be older or have certain medical conditions that make their organs less suitable for transplantation into standard recipients. However, their organs may still be viable for transplantation into carefully selected recipients, often those with urgent medical needs.

Deceased Donor Liver Transplantation: Overview and Process

Donor Aspects:

Criteria for Deceased Donor Selection: -

Donor eligibility based on medical history, age, cause of death, and organ function. – Screening for infectious diseases and other contraindications. – Compatibility with potential recipients based on blood type and immunological factors.

Organ Procurement Process: -

Identification of potential donors through hospitals, organ procurement organizations, or donor registries. – Consent from the donor or their family for organ donation. – Surgical retrieval of organs, including the liver, in a timely manner to maintain viability.

Preservation and Transport of the Liver:

Immediate cooling of the liver after retrieval to slow metabolic activity. – Preservation solutions to protect the organ during transport. – Timely delivery to the recipient hospital while maintaining optimal conditions for transplantation.

Recipient Aspects:

4. Recipient Evaluation and Selection:

Assessment of medical history, severity of liver disease, and overall health status. – Compatibility with the donor liver based on size and immunological factors. – Evaluation of psychosocial factors, including support systems and adherence to post-transplant care.

Post-Transplant Care:

Immunosuppression Therapy: -

Administration of immunosuppressive medications to prevent rejection of the transplanted liver. – Tailoring of drug regimens based on individual patient factors and risk of rejection. – Monitoring for medication side effects and adjustments as needed.

Post-Transplant Care and Monitoring:

Intensive care in the immediate post-operative period to monitor for complications. – Ongoing monitoring of liver function, immunosuppressant levels, and overall health. – Long-term follow-up to address complications, optimize medication regimens, and promote overall wellness.

Outcome and Future Aspects:

Outcomes and Success Rates:

Evaluation of graft survival, patient survival, and quality of life post-transplant. – Assessment of factors influencing transplant outcomes, including donor-recipient matching, surgical techniques, and immunosuppressive therapy. – Comparison of outcomes with national and international transplant registries to benchmark success rates.

Challenges and Future Directions:

Addressing organ shortage and improving access to transplantation. – Minimizing complications and optimizing long-term outcomes through advancements in surgical techniques, immunosuppression, and patient care. – Research into alternative therapies, such as regenerative medicine and bioengineering, to expand treatment options for patients with end-stage liver disease.

It’s only knowledge purpose and crucial to consult with a healthcare professional for proper diagnosis and treatment recommendations tailored to the individual’s specific condition.