A human liver performs over 500 functions. The detoxification of blood, chemical and toxic filtering, protein synthesis, and drug metabolism are a few among other parts of its job.
You will require a liver transplant if your liver cells get degraded to a point where the unit’s efficiency drops below ten percent. However, as is with any organ transplant, many factors play an important part in determining your chances at getting a new liver.
Why Would You Need a Liver Transplant?
The hepatocytes(cells that make up the organ) get replaced by scar tissue after they get attacked by multiple injuries for an extended period. This scar tissue prevents the free flow of blood inside the cell network and renders the unit ineffective in carrying out its functions.
After a point, the number of healthy tissue is outnumbered, and the scar tissue takes over, causing liver failure.
The injury could occur because of cirrhosis, hepatitis, biliary cholangitis, biliary atresia, alcohol or drug abuse, sclerosing cholangitis, or Alpha-1-antitrypsin deficiency. Inherited causes of liver failure could be Hemochromatosis, Wilson’s diseases, etc.
Selecting Candidates for Transplant
Replacing a major organ of your body is a decision that requires a good deal of consideration. There are never enough organs to go around while the patient count only increases per day.
A panel of specialists is set up to monitor and evaluate every case. They review the medical history, observe the tests and bloodwork, and compare the reports with other possible candidates to get an idea about the severity of the person’s condition.
Your financial counsellor, social worker, and psychiatrist will work with a team of transplant coordinator, surgeons, and hepatologists to access your status, finances, and mental health.
When They Put You on a Waiting List
After accessing your situation, if the panel finds you to be an active candidate in need of a transplant, they will put you on a waiting list.
Based on the INR, bilirubin, and creatinine levels in your blood, you will be handed a score called as MELD(PELD in children.) As the illness progresses, the score is also adjusted likewise. Patients with acute liver failure whose MELD is highest among others get a new organ for transplantation.
Predicting who may or may not get a liver and when may they get one is difficult. The MELD list goes through many fluctuations because of the changing condition of patients which makes guessing a tough job.
Why Is There a Shortage of Livers for Transplantation Procedures?
The donor liver could come from a cadaver(a brain-dead person) or a living human.
A deceased donor is one who is legally dead with irreversible and permanent brain damage. Their heart may be working, but the brain isn’t. The organ is scanned for any hint of disease, infection, cancer, hepatitis, or HIV. If it’s clean, it is matched with the recipient’s blood type. If everything fits, the organ is approved as a donor's liver.
Living donor transplantation uses a healthy person. After matching their organ with the recipient’s body, the doctors remove a segment of the healthy liver from the donor and implant it into the patient. Since a liver can regenerate to its full size from a minimum 25 percent, the transplanted segment grows into a full liver. The living donor could be a family member or an anonymous unrelated person.
The Doctors Found a Matching Liver- What Now?
Usually, the transplant coordinator notifies people about the availability of a matching donor organ. Before your surgeons could set up the operation, you are given a set of instructions(like don’t drink or eat) and a few tests(like electrocardiogram or X-ray.)
A computed tomography will show the presence or absence of hepatocellular carcinoma in your liver and adjoining areas. An echocardiogram, pulmonary function tests, liver function test and blood test, will also be arranged. X-rays will help determine the condition of your heart and lungs. A Doppler ultrasound will let the doctors examine the status of the blood vessels around the organ.
If the doctors find you in good physical and mental health to handle the surgery, and the donor's liver is suitable for your body, the surgery will be scheduled.
Complications in Liver Transplant Surgery
The chances of post-transplant rejection and infection vary per person.
Your immune system views a foreign organ as an invader and considers it a threat. In an attempt to save your body from this invading, new, and potentially dangerous element, your immune system could attack the donor's liver and destroy it.
A rejection episode could happen anytime within the first 90 days of the surgery. Afterwards, the chances of rejection get reduced a bit but never go away completely. Doctors suggest using immunosuppressants to deal with it. However, you must be careful about the dosage.
These immunosuppressants, as the term indicates, keep your immunity powers at bay. They slow down the resistance response, thus ensuring that the donor's liver stays safe enough to grow into space and to its full size. However, it could make you vulnerable to infections.
Post-Transplant Follow up
Normally, you should be able to get back home in two to three weeks after surgery. It is merely a matter of complications that may keep a patient from getting discharged. The release may take longer if your body is showing signs of rejection in the first week after surgery, for example.
A week or two after you get discharged, the doctor will call you for the first follow-up visit. Afterwards, the frequency of follow-ups will be twice a year for the first year and eventually once every year.
You will be self-administering your medications from there on out. The doctors and the medical team will help you understand how to measure your pulse and blood pressure. They will fill you in on any symptoms that may hint at an infection or a rejection episode.
The surgeons and the hepatologists will extend your medical information before and during the surgery to your primary doctor.
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