In a first, liver used from patient after cardiac death

Liver transplants in India are typically conducted from brain-dead donors, where the blood circulation is intact, cells are normally perfused and organs are still functioning at the cellular level.

Written by Kaunain Sheriff M | New Delhi | Published:July 11, 2017 1:20 am

A 45-year-old patient has successfully undergone a liver transplant at a Delhi hospital — after receiving the organ from a 60-year-old man post ‘cardiac death’. According to available data, there has been no case of liver donation after cardiac death (DCD) recorded in the country before this.

Liver transplants in India are typically conducted from brain-dead donors, where the blood circulation is intact, cells are normally perfused and organs are still functioning at the cellular level. However, in case of DCD, blood supply to the organ is briefly absent, causing tissues to become starved of oxygen, a condition known as ischemia, which makes the procedure particularly complex.

“This should be the first reported case of liver transplant in India where the donation has taken place after cardiac death. As per available data, there are reported cases of DCD of kidney, reported from PGI, Chandigarh, but none for liver. The degree of complexity involved in this case — as against kidney transplant — makes it more challenging,”

Dr Sanjay Singh Negi, senior consultant and director, department of HPB surgery and liver transplant at BLK Super Specialty Hospital, said.

According to doctors, the donor was a 60-year-old from Delhi, who was admitted to the intensive care unit and suffered cardiac arrest.

“The recipient is from Ghaziabad and was suffering from cirrhosis — chronic liver damage that leads to scarring and liver failure. The recipient had also suffered a stroke,” Dr Negi said.

Specialists said the liver transplant took place in under four hours — a record. “In case of DCD, blood supply to the organ is briefly absent, causing the tissues to become starved of oxygen, a condition known as ischemia. Unlike kidneys, which have a long ‘warm ischemia time’ of about two hours, the challenge in liver transplant is a shorter ‘ischemia time’ of 30 minutes, which requires the graft to be re-perfused very fast,” Dr Negi said.

DCD is commonly carried out in western countries, but in India, DCD — especially in cases of liver transplant — is yet to take off due to reluctance of families of possible donors. “A lot of families are reluctant to donate organs after a cardiac arrest. This is the main challenge in DCD,” the specialist said.

“DCD can help bridge the wide gap between demand and supply of organs. In India, less than 5,000 kidney transplants are carried out annually against an estimated requirement of over 175,000. Similarly, only 1,000 liver transplants are performed every year in a country where over 50,000 die due to end-stage liver disease, mostly related to preventable causes like hepatitis B and hepatitis C. But the rate of organ donation is as low as 0.3 per million population (PMP),” Dr Negi said.

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