A liver transplant is often considered a last but life-saving option for individuals suffering from severe or end-stage liver disease. Although the journey can seem overwhelming, gaining a clear understanding of the process—from evaluation, meeting eligibility requirements, and donor matching, to the surgical procedure and recovery—can provide reassurance and confidence. With medical advancements and proper post-transplant care, many patients go on to lead healthy, productive lives after transplantation.

What is a Liver Transplant?

A liver transplant is a surgery to replace a damaged or diseased liver with a healthy one. The healthy liver can come from a deceased donor or a living person who donates a portion of their liver. The unique thing about the liver is that it can regenerate—both the donor’s and recipient’s liver will grow back to normal size within a few months. This makes living donor liver transplants possible and successful.

Who Needs a Liver Transplant?

People are considered for liver transplantation when their liver stops functioning effectively. This could happen due to chronic illnesses or sudden acute damage. Common reasons include:

• Cirrhosis: Permanent liver scarring due to long-term damage from alcohol use, hepatitis, or fatty liver disease.
• Liver Cancer: Especially when the tumor is confined to the liver and has not spread.
• Acute Liver Failure: A sudden and severe liver malfunction, often caused by drug overdose or viral hepatitis.
• Inherited Liver Diseases: Such as Wilson’s disease (copper build-up) or hemochromatosis (iron build-up).
• Biliary Atresia in Children: A rare condition where bile ducts are blocked or missing.

Liver Transplant Criteria

To qualify for a transplant, a patient must meet certain medical and psychological criteria:

• MELD Score (Model for End-Stage Liver Disease): This score, calculated using lab tests, helps determine how urgently a transplant is needed.
• Absence of Uncontrolled Conditions: Conditions like severe heart or lung disease may prevent safe surgery.
• No Widespread Cancer: Liver cancer confined to the organ may be considered; cancer that has spread is usually not eligible.
• Substance-Free for a Period: In alcohol-related liver disease, patients often need at least 6 months of abstinence.
• Commitment to Aftercare: Patients must agree to long-term follow-up, lifestyle changes, and medication.

These liver transplant criteria help ensure that the patient will benefit from the surgery and manage the responsibilities afterward.

Liver Transplant Requirements

Before being listed for a transplant, a thorough evaluation is done. This includes:

• Blood Tests: To check liver function, blood type, and overall health.
• Imaging Tests (CT, MRI, Ultrasound): To look at the liver, blood vessels, and rule out spread of disease.
• Cardiac Evaluation: The heart must be strong enough to handle surgery.
• Psychiatric and Social Evaluation: Mental health and a strong support system are critical for recovery.
• Financial Planning: Transplant and post-operative care are expensive and long-term.

Meeting these liver transplant requirements ensures the patient is a suitable candidate for the surgery and can cope with post-operative demands.

Liver Transplant Donor Criteria

A liver donor can be deceased or living. Here’s what is required for a deceased donor:

• Brain Death Confirmed: The donor is legally and medically declared brain dead.
• Healthy Liver: No cancer, infections like hepatitis B/C (unless matched), or fatty liver disease.
• Matching Blood Type: Must be compatible with the recipient.
• Age and Organ Condition: Generally under 70 years of age with good organ function.

These liver transplant donor criteria ensure the liver is healthy and suitable for transplant.

Living Donor Liver Transplant Requirements

In some cases, a living person—often a family member—can donate a portion of their liver. Requirements include:

• Age 18–55 Years: Should be an adult in good health.
• Compatible Blood Type: Matching the recipient’s blood group is essential.
• Good Overall Health: No serious illnesses, such as heart disease, diabetes, or liver problems.
• Voluntary Consent: The donation must be made freely and without pressure.
• Liver Size Matching: The donor’s liver anatomy and size should suit the recipient’s needs.

How to Transplant Liver: Step-by-Step

Here’s how the liver transplant process typically unfolds, step by step—from patient evaluation to long-term care:

1. Evaluation and Matching

The journey begins with a thorough medical evaluation. Doctors assess the patient’s overall health, liver function, and other organ systems to determine if they meet the liver transplant criteria. Blood tests, imaging, and psychological assessments are done. Once approved, the patient is either listed for a deceased donor liver or prepared for a living donor transplant. A compatible blood type and liver size are essential for a successful match.

2. Surgical Removal of Diseased Liver

During the surgery, the patient is placed under general anesthesia. Surgeons make an incision in the upper abdomen and carefully remove the damaged liver. This is a delicate process, especially since the liver is connected to major blood vessels and the bile duct system. Great care is taken to avoid excessive bleeding and ensure stability during the procedure.

3. Implantation of Healthy Liver

Next, the new liver—either from a deceased donor or a portion from a living donor—is placed in the exact location where the old liver was removed. The liver is positioned and secured, ensuring it fits well within the body and does not cause pressure on surrounding organs.

4. Connecting Blood Vessels and Bile Ducts

The surgeons then connect the major blood vessels (like the portal vein and hepatic artery) to restore circulation to the new liver. The bile duct is also reconnected to ensure bile produced by the liver can flow into the intestine. This step is crucial for the liver to function properly in its new host.

5. ICU Recovery and Monitoring

After surgery, the patient is moved to the Intensive Care Unit (ICU), where they are closely monitored for several days. Doctors watch for signs of complications such as organ rejection, infection, or internal bleeding. Vital signs, liver function tests, and urine output are regularly checked to ensure everything is stable.

6. Post-Transplant Care and Lifestyle

Once stable, the patient is transferred to a regular hospital room and later discharged. However, the journey doesn’t end there. Post-transplant care is lifelong and includes immunosuppressive medications to prevent the immune system from attacking the new liver. Regular follow-ups, a balanced diet, avoiding alcohol, and maintaining a healthy lifestyle are all crucial to long-term success.

Life After Liver Transplant

After a liver transplant, most patients return to a normal life—but with lifestyle changes:

• Lifelong Medications: Anti-rejection drugs (immunosuppressants) are essential.
• Regular Follow-ups: Frequent blood tests and checkups are needed, especially in the first year.
• Healthy Lifestyle: A nutritious diet, no alcohol, and staying active are encouraged.
• Watch for Complications: Early signs of organ rejection or infection should be reported immediately.

Conclusion

Understanding the liver transplant criteria, donor requirements, and the full procedure can make this complex process more manageable. Whether you’re considering living donor liver transplant or seeking information for a loved one, being informed is the first step to healing. With the right care and commitment, liver transplant patients can lead long, healthy lives.

FAQs

• 1. How long can a person live after a liver transplant?
  Many patients live 10–20 years or more after transplant, especially with good care and healthy habits. The 1-year survival rate is about 85–90%.
• 2. Is it safe to donate part of your liver?
  Yes, with modern surgical techniques and proper evaluation, donating part of your liver is safe. The liver grows back within a few months.
• 3. Can children undergo a liver transplant?
  Absolutely. Children with liver conditions like biliary atresia can receive a transplant. Often, a parent donates a portion of their liver.
• 4. What is the recovery time for a liver transplant?
  Initial recovery takes around 4 weeks. Full recovery and return to normal life may take 3–6 months, depending on the patient.
• 5. What is the cost of a liver transplant in India?
  The average cost ranges from ?20 to ?30 lakhs, including surgery, hospital stay, medications, tests, and follow-up care. It varies according to the clinical condition of the patient.
• 6. Can the body reject a transplanted liver?
  Yes. That’s why lifelong medication is needed. With proper treatment, most rejection episodes are manageable.