Workup and Evaluation of patient and donor on OPD basis
Patients of liver diseases who are referred to specialist liver units are evaluated for the cause and status of liver disease and need and fitness for liver transplant. This evaluation can be done on Outpatient basis if the patient is stable or after admission if he is sick or had any recent decompensation. The admission is done both for stabilization of patient’s condition and evaluation. The standard time for patient’s evaluation is 2-3 days.
The potential donor for liver too is simultaneously evaluated to assess his medical condition and fitness to donate mostly on an outpatient basis. The usual time for donor evaluation is 2-3 days.
Preparation of Legal File and Authorization Committee approval
In the meanwhile when the patient and donor are being medically evaluated, simultaneously the liver coordinators prepare the legal file of the patient for the ethical committee. The file consists of identity cards and other documents (like photos, income proof and HLA typing if required) of patient and donor to establish their relationship and rule out any possibility of illegal trafficking. These also includes various affidavits and NOCs from competent authorities.
Once the medical fitness is done and legal file is completed, the patient’s file is submitted to the hospital ethical committee for approval. The ethical committee studies the case based on documents and personal interviews and approves the case for transplant if satisfied with the presented details.
Operation and Post operative Course
After approval from the ethical committee the case can be scheduled for operation based on the available date and/or the medical urgency depending upon the patient’s condition.
The standard operation can take around 6-10 hours (or more) depending upon the complexity of the case. Both the donor and patient’s (recipient) operation go sided by side by two different operating teams. Once the graft is taken out from the donor it is then placed into the patient’s body. The standard donor surgery last for about 4-6 hours (or more) depending upon the complexity of the case.
Both patient and donor are shifted to the Liver Intensive care unit after the operation. The donor is mostly fully awake after the operation while the recipient is mostly kept sedated on ventillator for next 12-18 hours only to be extubated the next morning of surgery. The donor and patient has many invasive tubes and needles on their body like nose, neck, belly and urethra for medical monitoring which are gradually removed according to protocols. Similarly the diet is gradually started by 2nd or 3rd day depending upon condition.
Patient and donor are usually allowed to move out of bed by around 4-6th day.
During the whole course of stay and then after patient and donor ‘s condition is monitored with frequent blood tests and Ultrasonograms
Discharge and Follow-up
The donor stays in the ICU for 2-3 days and recipient for 5-7 days. If all goes well majority of donor and recipient can start eating full diet and walking along by around 5-7 days. Majority of donors are discharged from the hospital by 7-10 days while recipients by 2-3 weeks.
After discharge patient and donor are asked to report to outpatient department with weekly blood tests for first 4-6 weeks. If the team is satisfied with the progress patient can return to home town or country after 2-3 months from original date of operation.
Process of Deceased Donor Liver Transplant
Work up and Evaluation of Patient for Transplant: Patient’s evaluation for a deceased donor or cadaveric liver transplant is done in the similar way as patient of living donor on either an outpatient basis or after admitting and stabilization depending upon the patient’s condition.
Registration for Diseased Donor Liver Transplant
If found fit ,patient is then registered for a cadaveric liver transplant on the online portal of the national/regional organ transplant registration, allocation and distribution organization. One patient can register only from one hospital in a state or region.
Follow up after registration: Post registration patient had to comply with the prescribed follow-up with the registering unit depending upon the condition and disease status. Any issue or event in health condition happening has to be reported and updated to the registering hospital.
Call for Transplant: Whenever an organ is made available, the patient or family will receive a call regarding the same and he has to report to the hospital at the earliest. As a deceased donor transplant is always an emergency, these calls may be received at odd hours and requires urgencies in travel and financial logistics. Reporting to the hospital on call may not necessarily guaranties a liver transplant as the process may be halted at various levels because of unavoidable circumstances.
Operation and Post operative Course: Operation for a deceased donor liver transplant lasts about 6-8 hours. Patient is shifted to the Liver Intensive care unit after the operation. Patient may be kept sedated on ventillator for next 12-18 hours only to be extubated the next morning of surgery or may be brought to awake state immediate after surgery depending upon patient’s condition and protocol followed. Patient has many invasive tubes and needles on his body like nose, neck, belly and urethra for medical monitoring which are gradually removed according to protocols. Similarly diet is gradually started by 2nd or 3rd day depending upon condition.
He is usually allowed to move out of bed by around 4-6th day after operation.
During the whole course of stay and then after patient’s condition is monitored with frequent blood tests and Ultrasonograms.
Discharge and Follow-up
Patient stays in the ICU for 3-5 days. If all goes well majority patients can start eating full diet and start walking alone by around 5-7 days. Majority of patients can be discharged within 2-3 weeks.
After discharge patient is asked to report to outpatient department with weekly blood tests for first 4-6 weeks. If the team is satisfied with the progress patient can return to his home town or country after 1-2 months from original date of operation.
Department of Liver Transplant, HPB and GI Surgery, Venkateshwar Hospital, Sector 18, Dwarka, New Delhi - 110075
