Liver Transplantation Evaluation

For Patient:

As most of the patients are coming from outside city and also from other countries, the medical history is reviewed, video consultation is done, the investigations are reviewed. The severity of the disease is determined by symptoms, blood investigations and Ultrasound abdomen, which would guide if patient can be managed with medication alone or would be more benefited by liver transplantation. Once ensured that patient deserves liver transplant, patient and family members are counselled regarding the evaluation and are guided appropriately by team to plan further to make a personal visit to the hospital. They are guided about the measures to identify potential donors among their relatives/family members. They are also conveyed about the expected length of stay in India, nearby the hospital, expected expenses involved.

The final decision for going ahead for transplant is made after their meeting with Dr Punit Singla, everything is reviewed and a physical examination is done. The planning for the patient evaluation would be as follows, which guide not only about current status but also to optimize the condition of the patient.

• Detail blood investigation to determine functionality of other body organs, like kidneys, thyroid, to determine vitamin and mineral deficiencies
• Ultrasound/ MRI/ CT scan of abdomen to evaluate status of the liver, any liver cancer and vascular anatomy
• Echocardiogram and stress test to ensure proper functioning of the heart and valves Ultrasound of abdomen
• Chest X-Ray and pulmonary function tests to determine status of the lungs
• Mammogram and Gynaecology checkup for women

For Donor:

• Every single donor undergoes extensive investigations, to ensure safety of the donor and patient
• Initial history and physical exam to ensure no identified medical problems are present
• CT scan in order to determine the quality of the liver
• CT Triphasic to determine portion of liver that can be safely transplanted, the adequacy of remnant liver, anatomy of blood vessels and surgical planning.
• MRCP to determine biliary anatomy
• Psychiatry consultation to ensure the donor is able to handle the physical and emotional changes that may come with the donation
• Extensive blood tests to determine the presence of any transmittable diseases, underlying liver disease or other medical conditions
• Echocardiogram and stress test to ensure proper functioning of the heart and valves
• Chest X-ray and Pulmonary function test to determine lung function
• Mammogram and Gynaecology checkup for women
• Liver biopsy may be required in a few donors to assess liver quality and to ensure disease free liver

Both of them, donor and recipient undergo thorough checkup by superspecialist in respective fields, i.e. Cardiology for heart, Pulmonologist for chest, Transplant Anesthetist; who guide them about optimizing their health conditions.

After the complete evaluation and assessment, both cases are reviewed and discussed among the core team members. They re-determine the requirement of the liver transplant, evaluate the risks involved and possible optimizable factors, make surgical planning and counsel the patient and family about the case, treatment plan, the risk factors and expected prognosis.

Every transplant can be done only after permission by authorization committee as per THOA 1994 act.

Cadaveric Listing

Once approved for transplant, if no living donor is present, the patient will be placed on the national waiting list. The wait may be anywhere from less than a month to five years, depend on the severity of the patient’s condition and availability of donors.