The largest internal organ in the human body, the liver is an important component of the digestive system. It is located below the diaphragm on the right side of the abdomen. It performs a variety of functions, including the production of bile, which helps in absorption of fats, fat-soluble vitamins and cholesterol, detoxification of the blood, processing of nutrients, and producing proteins which aid in blood-clot.
Liver transplantation is a treatment of last resort, a surgical procedure carried out for end-stage liver disease, also known as Cirrhosis or chronic liver disease with decompensation. It involves the removal of the entire liver, to be replaced with that of a healthy donor. The process depends on many factors, such as the severity of the condition, medical history of the patient, overall physical condition, and other medical conditions that the individual might have. However, if a person is afflicted by cancer or heart problems, in such cases liver transplant is not carried out.
Some of the common diseases affecting the liver which may warrant transplantation are: Hepatitis infection such as hepatitis A, B, C, and E. Hepatitis A causes acute liver failure, and B and C causes chronic liver failure. Other causes include alcoholic liver disease and non-alcoholic liver disease which is also known as fatty liver disease leading to cirrhosis. Other causes are Auto-immune liver disease, Sclerosing cholangitis, liver cancer and some hereditary factors such as Wilson’s disease or copper accumulation in the liver and Haemochromatosis or accumulation of iron in the liver. In children, liver failure can occur due to blockage of bile duct and glycogen storage.
Hepatitis C is an infection which spreads through blood, due to blood transfusions are done in the past before epitaxy screening was done in the blood samples before the transmissions and due to the usage of unsterilized or improperly sterilized needles used in the past for injections. These are some of the common reasons for the prevalence of Hepatitis C in India and other South Asian countries.
Hepatitis C can be diagnosed by a simple blood test to ascertain the presence of Hepatitis C antibodies. After the confirmation of that test, a confirmation test called the PCR test is carried out to detect the type and quantity of virus present in the blood. These two tests are complementary and once these are done, treatment should be taken depending on the clinical condition.
The treatment for Hepatitis C has evolved quite rapidly in the last four to five years. Earlier, there were medicinal injections, which had a success rate of only about 40% to 50%. But now, there are medicines available which can give a cure rate of about ninety-five percent. According to some estimates, if effective treatment is carried out for Hepatitis C infections, the world will be free of this infection by 2030.
Hepatitis B is another major reason for liver failure which in turn requires a transplant. Once diagnosed with this disease, it is important to immediately consult a specialist. Even if the Hepatitis B is inactive, regular follow-up must be carried out because there are chances of it getting reactivated in the future. Also, people affected with Hepatitis B related disease are prone to getting liver cancer and even liver failure in the future. So, a routine and regular follow-up is a must for all those affected with Hepatitis B.
It is especially important for pregnant women to undergo the tests for detecting Hepatitis B, as there is a risk of passing it on the unborn child, although it is easily preventable. In case the mother has an active infection, she should be given medications to decrease the amount of virus in the blood. The new-born child must also be given both active and passive immunization to prevent the occurrence of the infection.
Liver cancer occurs in a liver which is already damaged due to some other causes, usually due to hepatitis infection or alcoholic abuse. In rare cases, liver cancer might also occur in a normal healthy liver. It is one of the leading causes for liver transplantation.
Fatty liver disease, or non-alcoholic liver disease, is a condition which is extremely common in India due to the prevalence of diabetes and an unhealthy lifestyle. If the population of patients getting admitted to a particular hospital is closely examined, the incidence of the fatty liver disease is almost 40%. In the case of diabetics who are on long-term medication and a host of other reasons, the incidence rate is close to 70% to 80%. In the years to come, fatty liver disease and liver failure are predicted to be the leading causes of liver problems and related complications in our country.
There are no evidence symptoms of fatty liver. The symptoms of liver failure occur quite late in the disease process, so having a fatty liver alone will not produce any symptoms or signs that can be diagnosed. This is possible only during a routine health checkup, or if a person undergoes a blood test or scans for some other purposes.
Fatty liver is directly related to long-term diabetes and being overweight. Currently, there are no medications which can cure fatty liver disease.
Therefore, the preventive measures for this disease involve changes in lifestyle. The body weight must be maintained in proportion to the height. Regular exercising, following a healthy diet and avoiding alcohol are some of the main ways by which fatty liver can be prevented.
Alcohol abuse or consumption is another major cause of liver failure. Alcohol needs to be metabolized by the liver to convert it into non-toxic substances which are harmful to the body. But, in the process, the liver itself gets damaged. When this happens continuously over a period of time, there is bound to be liver damage.
There have been studies done in western countries which say that there is a limit of alcohol consumption below which the liver is safe and does not get damaged. However, it depends on other factors such as genetic make-up. As far as Indian population is concerned, there have been no such studies conducted. Therefore, it is advisable to stay away from alcohol, or take it very sparingly and in minimal quantities, if at all.
Liver transplantation is a relatively new procedure; it was first performed in 1967. It entails the removal of the old cirrhotic liver, which is affected with chronic liver disease, and completely replacing with a new, healthy liver which can come from either a diseased, brain-dead donor or a living donor giving up sixty percent of his/her liver. Liver transplant is a complicated procedure. It requires the patient to be evaluated and once the person is registered in the list, he/she needs to wait till a suitable liver is found. In case of a cadaveric donor, after the surgery, it takes about two weeks for the recovery, with the initial 3-4 days in the ICU. In case of living donor, the transplant is a planned procedure in which one of the relatives donates a part of their liver, usually up to 60%. The unique aspect of liver is that it is the only internal organ capable of regeneration. That means, the part of the donor liver which is transplanted into the recipient, and the part which is remaining in the donor, grow to their normal sizes in two to four weeks’ time.
Once the decision for a transplant is made, an evaluation process is carried out. The transplant team consists of a surgeon, a hepatologist, nurse, psychiatrist/ psychologist and other members such as a dietician and anesthesiologist. The evaluation process includes blood tests, diagnostic tests such as X-rays, ultrasounds, colonoscopy, heart and lung tests and dental exams. A psychological and social evaluation is also carried out.
A person can easily lead a normal life after the liver transplantation. He/she can resume the normal day-to-day activities and work. But heavy exertion in work and sports must be avoided.
MYTHS AND FACTS ABOUT LIVER TRANSPLANT
Being well aware about the facts and myths regarding liver transplant can help a person make an informed decision before opting for a liver transplant procedure. The liver is an irreplaceable organ because, unlike a kidney whose functions can be performed by a dialysis machine, albeit temporarily, it cannot be replaced by an artificial device. Therefore, in case of a liver failure, a transplant is the only: y option. Therefore, it is important to clear the air regarding this procedure by exploring the common myths and facts associated with it.
- Myth: I will have to depend on lots of medication for the rest of my life.
Fact: After a transplant, medication is necessary to protect the new liver because there are chances of rejection of the new liver by the host body. But, the frequency and quantity of medicines decrease as time elapses and the immune system becomes accustomed to the new liver.
- Myth: If I am an alcoholic suffering from liver cirrhosis, I cannot qualify for a liver transplant.
Fact: There are certain caveats. An alcoholic needs to be sober for at least a year to be eligible for a deceased donor liver transplant. But, if a person is ineligible for this option, he/she can still opt for a living donor liver transplant.
- Myth: If I agree to be a donor, I might have to donate my whole liver and I’ll die.
Fact: The entire liver will never be taken out of the system. The liver is unique because it is the only internal organ capable of regeneration. Therefore, only a part of the liver will be removed. Gradually, the livers in both the donor and the recipient will regenerate themselves.
- Myth: A living donor liver transplant is better than a deceased one.
Fact: This is not true. Usually, when the death of a person is inevitable, he/she might prefer to donate the liver before it becomes infected so that it can be of use to someone else. A living donor liver transplant is very rare.
- Myth: Transplant is a cure.
Fact: Any transplantation for that matter is akin to taking a risk. There is always a chance that the new liver might get rejected by the recipient body.
- Myth: If I agree to donate my liver, saving my life will not be a priority in case I am admitted to a hospital.
Fact: When any person is admitted to the hospital, saving his/her life is the sole priority and objective of the medics attending to him/her. It is only when the death is inevitable that the topic of donation is even brought up. Moreover, the medical personnel in charge of a particular patient are entirely different from the team which will oversee and carry out the transplant, should the opportunity arise.
- Myth: My religion prevents me from becoming a donor.
Fact: Most of the world’s major religions support organ donation as they view it as an act of generosity and love towards fellow human beings, which also happens to be the essence of all the major religions.
- Myth: I am too old to be a donor.
Fact: Age is no barrier for donating the organs after an individual’s death. The factors considered for donation are the condition of the organs, waiting time period and the urgency of requirement. In fact, there have been many cases where people aged above 80 and even 90 have successfully donated their organs.
- Myth: People who are rich or famous will get preference for receiving organs.
Fact: The only factors considered for blood donation are the severity of illness, crucial medical information, waiting time etc. A person’s caste, colour, gender, financial and social status is absolutely irrelevant.
- Myth: I and/or my family will have to undergo a lot of formalities if my liver is donated.
Fact: There are costs incurred in the transplant process for the donor and there are no stringent rules to register for a donation.
- Myth: Will I get a healthy liver?
Fact: Yes. Only healthy liver is transplanted during a transplant. A diseased liver is never considered for a transplant.
To conclude, let us go over some of the important things to remember regarding the liver and the ways to ensure its longevity.
- The liver is responsible for filtering the blood and purifying it of toxins such as pollutants, harmful chemicals, alcohol and drugs.
- Cirrhosis is the accumulation of scar tissue in the liver. It is an irreversible condition caused by alcohol abuse, right-sided heart failure, hepatitis etc.
- Hepatitis C is not always fatal. There are many factors which have a say in how the disease progresses in the person’s body, such as the overall health status, strength of the virus infecting the person, alcohol consumption and the remedial measures taken for liver wellness.
- Hepatitis B is readily transmitted through sexual intercourse, whereas Hepatitis C is not so easily spread through intercourse.
- A high-protein diet may be dangerous for people with liver disease as the liver lacks the ability to properly metabolize the proteins and eliminate the waste products.
- An inherently strong immune system can fight the progression of a liver disease more effectively.