Dr. Sanjay Singh Negi
Sr. Consultant and Director
BLK Centre for HPB Surgery
& Liver Transplant
BLK Super Speciality
Hospital, New Delhi

THE CASES

A 45 year old patient, Atul Saluja, underwent successful Liver Transplant at BLK Super Speciality Hospital, New Delhi. What made it a milestone case was the fact that the patient received the liver from a donor post his cardiac death, making it a classic example of ‘Donation After Cardiac Death’ or DCD. As per the available data, there are reported cases of DCD of kidney in India but none for liver. The degree of complexities involved in this case as against Kidney Transplant, makes it more challenging and special. The success of this case also demonstrates the growing capabilities and expertise of the surgeons in India.

What went in favour of Atul Saluja was the readiness of the family of the deceased ― a 60-year-old man who suffered a cardio-respiratory arrest and was surviving on mechanical support. After much consideration, the family agreed to go in for the donation. The donor had a history of Hypertension, Diabetes and Coronary Artery Disease. He had suffered one cardio-respiratory arrest already and was awaiting another.

THE PROCEDURE

Organ Transplants in India are usually done from brain dead donors where the blood circulation is intact, cells are normally perfused and organs are still functioning at the cellular level. In case of DCD, blood supply to organ is briefl y absent, causing the tissues to become starved of oxygen, a condition known as ischemia. Unlike kidneys which have long warm ischemia time of about 2 hours, the challenge in Liver Transplant is shorter ischemia time of 30 minutes requiring the graft to be re-perfused very fast.



Since time was of critical significance, the team did not lose any moment and the complex transplant operation was swiftly accomplished. The critical care team led by Dr. Amit Singhal, Associate Director, HPB Surgery & Liver Transplantation, Anaesthesia and Critical Care at BLK Super Speciality Hospital, played a pivotal role through the turbulent intra-operative and post-operative period.

THE RESULT

Atul’s body received the donated organ quite well and under the supervision of the doctors, he recovered fast and had since been discharged. He has been advised to take his medicines on time and to lead a near normal life.

DISCUSSION

While Western countries have used DCD for a long time, somehow India has been lagging behind due to reluctance of families to donate organs. Donation After Cardiac Death 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 diseases, mostly related to preventable causes like Hepatitis B and Hepatitis C. The annual requirement of hearts is estimated to be around 50,000 and lungs about 20,000. But the rate of Organ Donation is as low as 0.3 per million population (PMP).

BLK Super Speciality Hospital has been at the forefront of Organ Donation. Through its Recycle Life initiative, the hospital has been carrying out campaigns to encourage people to come forward and learn about many aspects of Organ Donation. In India, due to lack of knowledge about Organ Donation, many people ignore to register for Organ Donation with the national registry maintained by National Organ & Tissue Transplant Organisation.

Other factors like myths and misconceptions discourage potential donors from making the decision to donate organs or tissues after death. If more and more people come forward and take the pledge to donate their organs, it can end up saving a lot of lives.


Patient Atul Saluja post surgery