In a notable trend, the number of deceased donor liver transplants has exceeded that of living donor liver transplants for three consecutive years in Maharashtra. While the primary reason is an effective organ donation programme, experts said patients, who have a potential donor among their relatives, often prolong their surgeries as they are now more hopeful of getting an organ from a deceased donor.
As per data from the Regional Organ and Tissue Transplant Organisation (ROTTO), Maharashtra, the shift was first noticed in 2016 when the State recorded 110 deceased donor liver transplants and 80 living donor liver transplants. The trend continued in 2017 when 111 deceased and 96 living donor liver transplants were carried out and in 2018, the numbers stood at 125 and 96 respectively. Till May this year, 65 deceased and 54 living donors liver transplants have been performed.
“This shows the cadaver organ donations are rising and thus more organs from deceased donors have been available over the past few years,” Dr. S.K. Mathur, chairperson of ROTTO’s liver sub-committee, said.
Dr. Mathur, who is also the president of the Zonal Transplant Coordination Centre, is positive that the kidney transplants will also witness a similar trend if the number of deceased organ donations keeps increasing.
Hope and expectations
Liver is a unique organ which has regenerative capacity. In a living donor liver transplant, a close relative donates a portion of their liver. The donor’s liver then regenerates to its full size in a few months. In a deceased donor liver transplant, the organ is taken from a brain dead patient, whose family has consented for organ donation. Given that a living donor transplant involves putting a healthy individual under the knife, one feels it is ideal to get an organ from a deceased donor.
With the steady rise in cadaver organ donations in Maharashtra, the number of patients on the waiting list for cadaver liver transplants has also jumped by nearly 82% from 2017 to 2019.
“In reality though, even as the number of cadaver organ donations is increasing, the number of organs available doesn’t match the requirement,” said liver surgeon Dr. A.S. Soin from Medanta The Medicity, Gurgaon.
According to Dr. Soin, the hype around cadaveric transplantation hinders the live transplants to a certain extent. “Ideally, the patients on the waiting list should choose the available living donors and go ahead with the transplant. But there is this false sense of expectation that pushes them to wait even when they have potential living donors.”
Nearly 2.5 lakh people die of liver failure in India. Dr. Soin said a third of these patients can be saved by transplants. “But we don’t get so many cadaver organs. Thus, a healthy mix of living and deceased donor organ transplants is necessary.”
Dr. Ravi Mohanka, chief liver transplant surgeon at Global Hospital in Parel, echoed similar thoughts. “It is a healthy trend if the number of transplants goes up cumulatively, but not if the load shifts on the cadaver transplants,” he said, adding the outcome of both transplants is almost similar.
Global Hospital carries out the highest number of liver transplants in Mumbai. Of these, nearly 75% are living donor transplants and 25% cadaver donor transplants. “But we are witnessing a shift. The cadaver organ transplants are now close to 30%,” Dr. Mohanka said. He also said the waiting list mortality for liver transplants in India is anywhere between 40% and 50%, while it is about 20% in the West.
The cost of liver transplants, depending on the hospital, ranges anywhere between ₹15 lakh and ₹30 lakh. Besides covering the expenses of the patient, living donor liver transplant involves the cost of surgery and hospital stay of the donor as well.
In cadaver donor organ transplant, doctors said, almost similar cost is required for a special preservative solution for the organ. “A litre of this solution costs about ₹25,000. In a living transplant, we need about two litres of this solution. But in cadaver organ transplants, we need 6 to 10 litres of this solution, so the costs almost come up to the same,” Dr. Mohanka said.
In the West, the dependence on living donor organ transplants is less than 10%. “If Maharashtra continues with the pace of organ donations, we will definitely be able to clear the waiting list of liver patients in a few years,” hepatologist Dr. Akash Shukla said.
“Every surgery has some risk. One in 300 liver donors has a life-threatening risk and donors may also have long-term risk like any other surgical procedure. Instead, why not put all efforts to increase cadaver organ donations,” he said.
Dr. Shukla also said there will always be patients in the acute stage who cannot wait and have to depend on living donors, but boosting organ donations can help those who can wait.
