Liver Transplant In India: An Overview

Liver transplantation or hepatic transplantation is the replacement of a diseased liver with the healthy liver from another person or from a deceased donor. Liver transplantation is a treatment option for end-stage liver disease and acute liver failure. In this specific article, we would be talking about various aspects involving liver transplants. The sub-topics would include types of liver transplants, when the need for a liver transplant arises, the benefits of a live donor, costs involved with the transplants and the various avenues to get financial help for liver transplants.

Types of liver transplants:

Liver transplant in India can be broadly divided into two categories: (a) adult and (b) pediatric.

When do people want to go for a liver transplant?

A liver transplant is considered when the liver no longer functions adequately. Liver failure can happen suddenly (acute liver failure) as a result of viral hepatitis, drug-induced injury or infection. But it can also be the end result of a long-term problem. The following conditions may result in chronic liver failure:
• Chronic hepatitis with cirrhosis.
• Primary biliary cholangitis (previously called primary biliary cirrhosis, it is a rare condition where the immune system inappropriately attacks and destroys the bile ducts)
• Sclerosing cholangitis (scarring and narrowing of the bile ducts inside and outside of the liver, causing the backup of bile in the liver)
• Biliary atresia (a rare disease of the liver that affects newborns)
• Alcoholism
• Wilson's disease (a rare inherited disease with abnormal levels of copper throughout the body, including the liver)
• Hemochromatosis (a common inherited disease where the body has too much iron)
• Alpha-1 antitrypsin deficiency (an abnormal buildup of alpha-1 antitrypsin protein in the liver, resulting in cirrhosis).

Liver transplant in India can be done via two processes i.e from a live donor and from a cadaver

Here are some of the benefits of liver transplantation from a live donor:

Transplanting liver from a live donor is a very transparent activity in India. It is a well-organised process with the recommendations and clearance required from the specialists concerned.
For donations done apart from the first-degree relations one needs to get clearance from the state-appointed authorization committee.
If a foreign patient needs to donate or get a transplant done, the necessary approval from the embassies concerned along with the state clearance certificate is a mandate.
The donor risk is discussed and the success of the recipient operation is also explained to all patients.

How to be a living liver donor?
Donating a liver has become very safe. A surgery is performed to remove a part of liver from the donor used for transplant. Within a time span of 2-3 weeks the donor recovers completely well as the liver regenerates itself.
There are certain criteria for becoming a live donor, which includes:

The donor should be within the age limit of 18-55 years and willing.
To eliminate any risk of fatty liver the person donating the liver should not be more than 85 kgs or the respective BMI (<25)
The donor should either possess the same blood group as of the recipient or universal donor ‘O’.

The donor is then thoroughly checked for complete screening tests like - CBC, PT, LFTs, Serum creatinine, HBsAg, HCV antibody, HIV I,II, Chest X ray, ECG and Ultrasound of the abdomen.

In India, the availability of deceased donor organs are very less and sporadic. As a result, in most cases, a patient requiring liver transplant would almost certainly die before an organ could become available. In India where historical and cultural issues create a major roadblock for the ready availability of cadaveric organs for donation, at least currently, LDLT is the only realistic option.

Costs involved with the transplants

The costs of a transplant and the related costs vary depending on whether they are living transplants or deceased donor transplants. While the reason for a disparity is obvious between a government and private hospital, often the difference between different private hospitals may also be quite significant.
The direct costs are that of pre-transplant recipient evaluation, living donor screening and evaluation, deceased donor transplant waiting list registration, pre-transplant medications (mostly significant for ABO-incompatible transplants), deceased donor maintenance and retrieval, donor and recipient surgery, post-operative care and drugs and follow-up investigations and medications.
Most often transplants are offered as a package at private hospitals, either fixed or open. The costs for living transplants range from somewhere between 15-20 lakhs depending on the hospital, city, surgeon among other factors.The indirect costs typically involve that of pre-transplant medical treatments and care such as dialysis, LVAD, maintenance of acute liver failure patient in ICU, etc. which may be very high.
The costs of a liver transplant in government hospitals ranges between 4 lakhs to 10 lakhs.
Costs of the patient and family staying in another city waiting for a deceased donor organ or in the post-operative period for close follow-up can also be significant. The patient is not able to go to work during the illness and that contributes to the financial difficulty, especially if the patient is the primary bread earner in the family. The uncertainty of any complications and associated costs can upset any financial plans for the transplant.

Here are some of the major avenues to get financial help for liver transplants

Prime Minister's National Relief Fund: Apart from relief to families of those killed in natural calamities like floods, cyclones and earthquakes etc, assistance from PMNRF is also given to meet the expenses partially for medical treatment like heart surgeries, kidney transplantation, cancer treatment, etc.
Chief Minister Medical Assistance fund: Many states have Chief Minister level similar welfare programmes for medical expenses like heart surgeries, kidney transplantation, cancer treatment etc.
Rashtriya Arogya Nidhi (RAN): Financial assistance is provided by Department Of Health & Family Welfare under Rashtriya Arogya Nidhi-RAN to the patients below poverty line and suffering from major illness (related to heart, liver, kidney and cancer cases) at any listed Government Hospitals or Institutions, to defray a part of the expenditure on hospitalization and treatment.
There are several NGOs that help the needy to go forward with a liver transplant who do not have the required amount of money to spend.
Crowdfunding has also become a viable option for those in need these days.
Tamil Nadu is one of the major states in India that is known for its superb transplant facilities in the country. While transplantations are done free of cost in government hospitals, patients who undergo transplants in private hospitals are covered under the Chief Minister’s Comprehensive Health Insurance Scheme. Under this scheme, patients are provided with financial support of up to Rs 30 lakh, the highest in any state in the country.
Tamil Nadu government took major steps to build coordination between itself and non-profit organisation and public and private hospitals. Key to these efforts have been entities like the Multi Organ Harvesting Network (MOHAN) Foundation and the National Network of Organ Sharing (NNOS), which help hospitals strengthen the secondary and tertiary activities around organ transplantation, and are involved in such activities as training transplant coordinators, grief counselling for donors’ families, educational programmes for hospital staff and so on.
Other states which have schemes for liver transplants in this country are Telangana and Assam.