Best Liver Transplant Surgery in India

Liver transplant program in India 

Indraprastha Apollo hospital in India successfully carried out India’s first liver transplant in 1998. Since then, India has emerged as a global leader in solid organ transplants and over 2000 liver transplants are performed here annually. Nearly 3,200 patients from over 50 countries got their liver transplant done from the Apollo Institute of Liver Transplant in New Delhi, India.

Apollo’s Solid Organ Transplant Program is the world’s largest program and remains so for the last six consecutive years since 2014. The institute holds expertise in performing ABO incompatible and liver & kidney transplant together.

What is liver transplant?

An adult liver transplant is a surgical procedure that involves replacing recipient’s recipient liver with the liver of a healthy donor.

When is liver transplant needed?

Common indications for liver transplant are cirrhosis, acute liver failure, metabolic diseases, liver cancer, biliary atresia etc.

When should liver transplant be performed?

When a liver is unable to perform its normal function resulting in complications such as coma, bleeding, and jaundice due to liver failure.

What is the success rate of liver transplant surgery in an adult?

It depends on how early the transplant surgery is performed. Generally, 94% success rate can be achieved.

Does a patient need lifelong medication after the liver transplant?

Yes, patient will need anti-rejection medicines lifelong, otherwise patient’s own immunity system will reject the donor liver.

Where does liver graft come from?

The most feasible option is to get the graft for liver transplant from a live healthy family donor. On rare occasions, the patient can get liver graft from a brain-dead patient.

How much liver will be taken out from the donor?

After matching the liver size with that of the recipient:

• 35%, in case where left side is chosen as the graft liver
• 60-65%, in case where right side is chosen as the graft liver

What are the risks for the liver transplant donor?

There’s risk of death in 0.02% cases where there is infection. There is also a risk of injury in bile duct, leakage of bile, bleeding, etc.

What are the criterions for a matched living donor in liver transplant?

• The most important condition for a liver transplant donor is that s/he should come forward voluntarily without any coercion.
• It must be clearly understood that there is a 10% risk of complication arising in the event of surgery.
• Statistics suggest that there is a five-percent chance on recipient’s non-survival after liver transplant.
• Donor should understand that there will be no financial gains for him/her.
• The liver transplant donor has all the rights reserved to withdraw his / her consent from the liver transplant surgery at any point of time without assigning any reason whatsoever.

Do liver surgeries for both the donor and the recipient occur at the same time?

Yes, the surgery is planned like that, in case the liver donor is alive. However, in case of a deceased donor, the liver transplant surgery can only be started once the liver is made available in the hospital where the surgery is scheduled to take place.

Do both donor and recipient require ICU stay after surgery?

Yes, both will be shifted in the special liver transplant ICU. Generally, 3-5 days of stay in ICU is sufficient for the donor and recipient, respectively.

When can a liver recipient get discharged from the hospital?

Patient needs to stay in hospital for three weeks until the newly transplanted liver starts functioning properly and patient is strictly monitored for any complications that may arise.

When can a patient start eating normally?

Soon after the surgery, the patient is put on a liquid diet. Once the liver starts giving indications that the liquid diet is well received, the patient would be switched to solid foods as the new liver starts to work appropriately.

What is the meaning of ‘rejection of liver’ and what are ‘anti-rejection medicines’?

‘Rejection of liver’ occurs when one’s body immunity system recognizes the new liver as a foreign body and starts damaging it as a natural defense mechanism. In order to avoid this rejection, doctors prescribe the patient with ‘anti-rejection’ or immunosuppressant medicines that should be consumed lifelong along with the anti-bacterial and viral medicines to prevent the rejection caused by low immunity.

What could cause risks to a new liver after the transplant surgery?

• Return to alcohol, infections, or non-compliance of anti-rejection medicines may lead to graft failure
• Primary and delayed graft non-functioning
• Graft failure due to sepsis, recurrent disease
• Return of liver cancer
• Kidney failure
• Bleeding in abdomen

As a patient of liver transplant, how can I take care of my health after surgery?

You should see your physician regularly to monitor functioning of the new liver. This will include blood tests, ultrasound and other routine tests. Patient should eat healthy food, exercise and avoid alcohol, especially when alcohol was the initial cause of liver failure. Another important precaution is to avoid crowded places to minimize chances of infection. In case of infection, report to your treating physician immediately.

When can I resume my daily activities after liver surgery?

This depends on how unwell you were before surgery, but yes, most patients go to work and resume normal daily activities. Your transplant doctor will guide you on recovery phase based on the findings of the performed clinical tests.

What dietary precautions do I have to consider post liver transplant?

There is a possibility for the patient to gain weight or develop diabetes due to transplant medicines. Hence, it is advisable to take low-fat balanced diet to be able to stay fit.

How long should a patient from foreign country stay in India for the liver transplant?

Liver transplant requires a minimum of two-month stay in India. The process of all types of solid organs’ transplantation in India is governed by an ‘Act’ and surgery can only be carried out once the Authorization Committee grants the written permission for the same. It takes minimum 15 days to seek this kind of approval from the committee in an ideal situation when all the statutory requirements are fulfilled. The patient is recommended to stay for atleast a month post-transplant to monitor the functioning of the newly transplanted liver so that the patient can travel back to their home country without hassle.

How long should a liver donor from foreign country stay in India?

The donor could fly back to his / her home country after 10 days of surgery if the donation went uneventful.

 Step-by-step process for undergoing liver transplantation

Top doctors in India offering liver transplant surgery in India 

1. Dr Arinder Singh Soin, working as Chairman Liver Transplant Unit at Medanta the Medicity, experience 28 years.
2. Dr Prof Subhash Gupta, HOD Liver Transplant and Hepatobiliary unit at Max Super Speciality Hospital, Experience 22 years.
3. Dr Vivek Vij, Head Liver Transplant Department at Fortis Group of hospitals, experience 20 years.
4. Dr Neerav Goel working as senior consultant liver transplant and hepatobiliary unit at Indraprastha Apollo Hospital New Delhi, experience 15 years.
5. Dr Shailendra Lalwani, Director Liver Transplant at Manipal Hospital ,experience 15 years

Top hospitals  Offering liver transplant surgery in India 

1. Indraprastha Apollo Hospital
2. Medanta The Medicity
3. Manipal Hospital
4. Max Super Speciality Hospital
5. Fortis Memorial Research Institute, Gurugram

What is the cost of ABO Compatible Liver Transplant Surgery in India?

Cost of CIS (Uzbekistan, Tajikistan, Kyrgyzstan etc.) countries is less than the rest of the world due to its high volume of patients. Following is the cost of LTP in top hospitals.

Rest of the world

The above package will include the following:

1. 21 days hospital Stay  for recipient
2. 07 to 10 days hospital stay for donor
3. Initial Workup and investigations (Only related to Liver Transplant)
4. Liver Transplant Cost
5. Surgery Team Fee (Only related to Liver Transplant)
6. Drugs, consumables and consultant visits

The above package strictly covers only the Liver Transplant Procedure and will not include

1. Stay beyond the above-mentioned period.
2. Any other disease/ complications
3. Use of special drugs/ consumables if not part of Liver Transplant Package
4. DNA test if needed
5. Legal Documentation before transplantation

Unmatched blood group patients (ABO incompatible) will have to undergo plasma exchanges cycles (plasmapheresis). Generally it will cost around 10000 USD extra.

Cost of robotic liver transplant surgery to take out donor’s graft is USD 5000.

ABO incompatible LTP will additionally cost you around 10000$ as patients needs to undergo plasmapheresis therapy that too depends of antibody titer. 

What all documents needed prior to organ transplant in India ?

In India, solid organ transplantation is regulated by a law known as Transplantation of Human Organs Act, 1994. This Act is enacted to prevent medical ethics and commercialization of human organs. All major Indian hospitals like Fortis, Apollo, Max, Medanta, Artemis and BLK have statutory licenses to carry out human organs transplantation in accordance of the Act. This acts permits transplants only when donor and recipient meet certain criterion, monitored by transplant Authorisation committee set up by Govt. of India. The Patients are advised to go through the table below very carefully, properly compile all duly attested documents before traveling their home country /coming to India. The Authorization Committee may not grant permission to carry organ transplant surgery in case of any discrepancy observed by the Authorization Committee in your documents. Other set of documents are compiled by the hospital legal cell on your arrival.

Who is close relative donor?

It means grandparents, parents, spouse, sibling, children and grandchildren of donor only. In case of married donors, close relative donor would mean husband or wife.

Who is 1st degree related donor?

1st Degree Related means grandparents, parents, children, siblings and grandchildren only.

Who is distant relative or unrelated donor?

Distant Relative means cousin, In laws, Niece, nephew, brother/sister in law, All others fall in unrelated donor category.

Suitability of Donor would be decided by transplant surgeon as per the Transplantation of Human Organs Act, 1994 (THOA), the donor should be above 18 years of age.

If the donor is unmarried then one consent form is to be made in prescribed format from mother and father of donor duly attested by the concerned Embassy/High Commission (Annexure -1 ), In addition to their ID card and documentary link. If the Donor is married, the consent affidavit needs to be provided by both the spouse (husband/wife as applicable) AND parents (either father or mother) along with photograph attested by the concerned Embassy/High Commission (Annexure -1), In addition to their ID card and documentary link.

Donor & Recipient Identity Proof

Donor & Recipient Family Proof

Donor & Recipient Income Proof

Note:

• Husband and wife fall in spousal category
• It is compulsory that all the above documents are attested by your Ministry of External/Foreign Affairs before you leave your country. Upon arrival in India, these documents will again need to be attested by your country’s Embassy/High Commission in New Delhi, India. Please bring all the original documents along with you, which will be required to produce before the Authorization Committee in the hospital.
• Other affidavits, psychiatric clearance and forms would have to be made in India.
• Presence of donor, recipient and donor close relative is essential

*** Additional documents needed in case of UNRELATED DONOR

The other family members apart from the first degree members fall under the category of unrelated donors. They should carry the below mentioned additional documents in addition to the documents mentioned in the General Check List.

1. Self-attested family tree, depicting all the first degree family members mentioning blood groups along with the supporting documents with reasons for their unsuitability to donate the organ.
2. Self-attested family tree showing the relationship between the patient and the donor.
3. An explanation of the link between the donor and the recipient and the circumstances which led to the offer being made.
4. Reasons why the donor wished to donate.
5. Documentary evidence of the link, e.g. proof that they have lived together etc.
6. Old photographs/albums showing the donor and recipient together.
7. Educational certificates of the Donor.
8. Job/employment details of the donor.

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