1. What is transplantation?
   
   When an organ from one person is surgically removed and placed into another person it is known as organ transplantation. In situations where a person’s organ has failed due to illness or injury, the only option they have to recover is to undergo organ transplantation.
   
   
2. What are the organs that can be donated?
   
   Solid organs that can be transplanted include: Heart, lung, liver, kidneys, pancreas and intestine.
   
   Tissues that can be transplanted include: Cornea, bone, cartilage, skin, vein and heart valves.
   
   
3. Liver Transplant
   
   
1. What are the conditions for which liver transplant is done?
   
   
   1. Irreversible cirrhosis with at least two signs of liver insufficiency
      
      
   2. Fulminant hepatic failure: coma Grade 2
      
      
   3. Unresectable hepatic malignancy confined to the liver that is less than 5 cm in diameter
      
      
   4. Metabolic liver disease that can be treated by liver replacement
      
      
   5. MELD score of 12 or higher
      
      
   Other specific indications include Budd-Chiari Syndrome, benign hepatic tumor and autoimmune liver diseases. In addition, there should be no alternative forms of therapy and no contraindications for the procedure. Finally, the patient and family members should be able to accept the procedure and provide for its costs.The most common indication for liver transplantation however is end-stage chronic liver disease, accounting for approximately two-thirds of all patients.
   
   Factors that increase the risk of liver transplantation include the following:
   
   
   1. Advanced age
      
      
   2. Advanced chronic renal failure
      
      
   3. Cholangiocarcinoma
      
      
   4. Chronic Hepatitis B virus infection with high viral counts
      
      
   5. Hepatocellular carcinoma beyond Milan Criteria
      
      
   6. Hypoxemia from intrapulmonary shunts
      
      
   7. Massive ascites
      
      
   8. Portal vein thrombosis
      
      
   9. Prior portosystemic shunt surgery
      
      
   10. Prior biliary tract surgery
       
       
   11. Severe malnutrition
       
       
   12. Severe abdominal atherosclerosis
       
       
2. Patient Selection for Liver Transplantation
   
   Minimum Listing Criteria for Liver Transplantation
   
   
   1. CTP score > 7 (CTP Grade B)
      
      
   2. MELD = 12
      
      
   3. Life expectancy < 85% at 1 year without liver transplantation
      
      
   4. Evidence of Clinical Decompensation in Chronic Liver Disease
      
      
3. Contraindications to Transplant
   
   Contraindications to liver transplantation can be divided into those that are absolute and those that are relative, i.e., are expected to complicate and increase the risk of transplantation. Absolute contraindications to liver transplantation include:
   
   
   1. AIDS or HIV positivity
      
      
   2. Irreversible brain damage
      
      
   3. Multi-system failure that is not correctable by liver transplantation
      
      
   4. Malignancy outside the liver (except skin cancer)
      
      
   5. Infection outside the hepatobiliary system
      
      
   6. Active alcohol or substance abuse
      
      
   7. Advanced cardiopulmonary or other systemic disease
      
      
   8. Moderate to severe uncorrectable pulmonary artery hypertension
      
      
   9. Completely occluded porto-mesenteric venous system
   
   
4. How is a patient evaluated prior to Liver Transplant?
   
   The majority of pre-transplant evaluations can be completed on an outpatient basis over a two-three day period. Candidates for transplantation are typically seen by the transplant surgeon, transplant hepatologist, social worker, nutritionist/dietitian, financial counselor and other consultants as appropriate. The transplant coordinator is the key contact person who facilitates the pre-transplant evaluation.
   
   Once the pre-transplant evaluation is completed, the patient’s profile is presented to the selection committee for categorization and prioritization
   
   
4. Living Donor Liver Transplant
   
   
   1. What is living-donor liver transplantation?
      
      A living-donor liver transplantation, or transplant, is when a live person donates a part of his or her healthy liver. The donated part then grows to full size in the person who receives it (the recipient). After the transplant, the donor’s liver also grows back to full size over a very short period of time, usually days or weeks. Sometimes, however, it can take up to several months. The donor may be a family member, such as a parent, sister, brother, or adult child. The donor can also be a husband or wife.
      
      
   2. Who can become a donor?
      
      People who want to donate their liver go through a complete medical exam to make sure their liver is healthy and that it is safe for them to donate. Safety is important for both the donor and the recipient. The risk of death is real. Talk about the risks with your doctor. In general, liver donors must:
      
      
      1. Be at least 18 years old
         
         
      2. Be in good health with no major medical or mental illnesses
         
         
      3. Be a non-smoker for at least 4 to 6 weeks before surgery
         
         
      4. Be able to understand and follow instructions before and after surgery
         
         
      5. Have a compatible blood type
         
         
      6. Have an emotional tie with the recipient
         
         
      7. Not have a selfish motive for donating
         
         
      8. Have a similar body size
         
         
      9. Be able to go through certain medical tests like blood work, radiology studies, and a liver biopsy
         
      
      A person should feel no pressure to donate part of his or her liver; nor should any money be given or received. It is against the law for people to sell their body parts.
      
      
   3. What are the major risks of donating?
      
      Most donors recover fully after the operation and can do normal activities within a few months after the surgery.However, as with any major surgery, there are risks.
      
      A donor may develop some problems during or right after the operation; they might also experience problems months or years later. Removing more than half of the liver is a major operation that has some risks. Some of the risk involves specific problems that can occur in and around the liver after surgery. These problems include bleeding, infection, bile leaks,or damage to the bile tree (the ducts that run through the liver). Bile is a digestive juice made by the liver.
      
      Other risks can come from anesthesia and general surgery. You could have a reaction to the anesthetic, or you could get pneumonia. You could have problems because of the tubes that will be inserted in your mouth, arteries, and veins. Your blood pressure could change during the operation. There is also a risk of blood clots in your legs. Although there is a 10 to 25% chance a donor could have complications from the surgery, the most common problem is a bile leak. In rare cases, a donor may die as a result of the operation. Or, if the remaining piece of the liver is damaged,the donor may also need a liver transplant. The estimated risk of dying from the transplant operation is about 1 in 500.. One of the most common problems is stomach pain and bulges around the scar. The bulges can usually be fixed with surgery.
      
      During your medical exam, ask the transplant team about these risks. You may also want to talk to a donor who has already gone through the surgery and can talk about his or her experiences.
      
      
   4. What happens during the donor medical evaluation?
      
      A person who wants to donate part of his or her liver must go through a complete medical evaluation for two basic reasons:
      
      
      1. To make sure the donor does not have any health problems, like diabetes or heart conditions, that could increase the risks of problems during and after the surgery.
         
         
      2. To make sure the donor has a piece of liver that is the right size and shape for the recipient.
         
         
   5. What happens during transplant surgery?
      
      The donor's liver is split into two parts. One part is removed for the transplant. The surgeon then closes the wound with sutures or staples. These are later removed at a follow-up visit to the surgeon's office. The remaining liver begins to heal and grow new tissue. It takes about 6 to 8 weeks for the liver to grow back to normal size.
      
      
   6. How long does a donor usually stay in the hospital?
      
      Donors stay in the hospital from 4 to 7 days after surgery, longer if problems occur. You will usually spend the first night after surgery in the intensive care unit (ICU). The next day, you may be moved to the general surgical floor .
      
      
   7. How long will a full recovery take?
      
      For the most part, it takes about 4 weeks to recover from surgery. For a month after leaving the hospital, you will go to the clinic for frequent check-ups. Most people get back to work within 8 to 10 weeks, but this differs from person to person. The medical staff will say when it is safe to return to normal life. Federal employees can get a special leave for being organ donors. Other employers have similar programs, so check with your boss to see if your company offers special leave.
   
   
5. Cadaver Liver Transplant
   
   Cadaver liver donation is possible from a brain dead person whose family wishes to donate the person's organs before discontinuing life support. This situation arises only in a hospital ICU in a person after brain injury in an accident or in someone who has suffered fatal brain hemorrhage etc. In these circumstances, the whole liver can be used for an adult, and a part of it for a child. After removal from the donor (a process called liver retrieval) the liver can safely be kept preserved outside the body in special preservation solutions for 12-15 hours. Allocation of such organs is strictly according to blood group which must match, time on waiting list and urgency of requirement.
   
   
6. Brain Death and Organ Donation
   
   The general idea of death is that it occurs when the heart stops beating and breathing ceases.
   
   When brain death occurs it is different. Though there is irreversible loss of all brain function and the patient is clinically and legally dead, the appearance of life continues. This is only because of a breathing machine (ventilator), which is an artificial means for delivering enough oxygen to the heart to keep it beating. Through this mechanism, the heart, lung, liver, kidney and pancreas can be kept alive for a few hours.

For any queries call our Transplant Coordinator @ 94446 62495