What is Scenario of Liver Transplantation in India?

Is extending criteria for donors a reasonable solution for donor shortage in a liver transplant?

The process of replacement of Healthy liver with a diseased liver is known as liver transplantation. Patients suffering from acute liver failure and chronic liver failure undergo liver transplantation. Some of the causes of liver disease include viral hepatitis, alcoholic liver disease, metabolic liver disease, autoimmune liver disease, genetic liver disease, vascular liver disease, and hepatocellular carcinoma.

Liver Transplantation in India

Who are not the eligible candidates for liver transplantation?

-Severe, irreversible medical illness that limits short-term life expectancy

-Severe pulmonary hypertension (meaning pulmonary artery pressure greater than 50mmHg)

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-Cancer that has spread outside of the liver

-Systemic or uncontrollable infection

-Active substance abuse (drugs and alcohol)

Unacceptable risk for substance abuse (drugs and alcohol)

-History of non-compliance, or inability to adhere to a strict medical regimen and Severe, uncontrolled psychiatric disease.

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It is imperative to understand the eligibility criteria of the patient to reduce the level of risk in the procedure. Presently some marginal donors are being used for example elderly donors, steatotic grafts, non-heart-beating donors, hepatitis C virus-positive (HCV+) or hepatitis B core antibody-positive donors. These so-called marginal or extended-criteria donors were used initially in high-risk or urgent recipients; however, the number of marginal grafts has significantly increased, forcing the transplant community toward their more rationale use to maintain excellent results of liver transplantation.

The optimization in the liver transplantation in India as outcomes is observed because of improvement in a surgical procedure, techniques, immunosuppression, and post-transplantation patient care. To bridge the gap between the donors and patients waiting for liver transplantation various alternatives are adopted by Healthcare professionals to identify new sources. Early survival gets significantly reduced when steatosis grafts are used in the recipients with high Model for End-stage Liver Disease (MELD) scores. Moreover, a decreased survival has been observed among high-risk patients receiving organs from marginal donors. No benefit seems to exist when high-donor risk index grafts are transplanted into recipients with low MELD Scores. The recognition of various donor groups according to their quality and the need for good donor and recipient selection must lead us to define new policies for organ allocation of marginal grafts that may come into conflict with current policies of organ allocation according to the risk of death among patients awaiting a liver transplantation. According a recent research done on 63 liver transplant patients, 8 of the 63 (13%) patients developed biliary complications; however, the incidence was not different between the Standard and Extended groups. Seven early deaths occurred, four and three in the Standard and Extended groups, respectively. Recipients of DCDs beyond conventional acceptance criteria have equivalent early outcomes to standard DCD grafts. With careful selection of donors and recipients, these grafts can be safely used to expand the donor pool.

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Left lateral segment (LLS) or left split grafts have mainly been transplanted into children, and right split or Right Tri Segment (RTS) grafts into adults, with excellent outcomes. Rogiers, reported on 100 livers that were split in situ, yielding 190 grafts for transplantation. LLS grafts were transplanted to pediatric recipients and RTS grafts were transplanted to older children and adults. Patient and graft survivals were equal to those in 1086 recipients who received the whole liver from deceased donors.