ANDHRA PRADESH

Expert prefers `split liver' transplant to cadaver

Hyderabad Dec. 7. A 21-year-old Lambada youth from Kurnavelli in Khammam district, T. Venkataratnam, died at the doorstep of the Nizam's Institute of Medical Sciences on October 20 with a swollen liver after a few a blood vomits caused by Wilson's disease, having failed to mobilise Rs 20 lakhs prescribed by a Delhi specialities hospital for undergoing a cadaver liver transplantation.

The disease kills the victim by depositing excess copper in the liver and, as a family curse, has so far claimed the lives of Venkataratnam's uncle and his two brothers. All the time, his doctors and he were pinning hopes on a cadaver liver for transplantation, to come from a "clinically (brain) dead'' person.

Tan Kai Chah, world's leading liver specialist, feels that Venktaratnam would have been saved by a "split liver'' transplantation done with live liver donated by mother or kith and kin. Liver survives and grows even when cut to two pieces, he says.

The transplant of a "split liver'' has become such a perfected art under surgeons like Dr Tan that the risk is restricted to a mere 0.03 per cent (three deaths for every 1,000 transplants). The patient can resume normal activity in three-four months. Because of the success rate, doctors and patients are after this technique in the US, Europe and Asia, especially in the past two years.

Dr Tan, now director, Liver Transplantation Programme, Gleneagles Hospital, Singapore, and consultant, Paediatric Liver Transplant Programme, Subang Jaya Medical Centre, Malaysia, was at Kamineni Hospital here recently to give a talk on "Living Donor Transplantation--The Hope for Asia''. He prescribes "split liver'' transplants as the only hope of the world, particularly in Asia where livers are generally fatty with intake of oil.

According to him, those in Asia are vulnerable to irreversible diseases like hepatitis B, secondary biliary cirrhosis, fulminant hepatic failure, metabolic disorders such as Wilson's disease due to a variety of factors, including poor hygienic living conditions, consumption of alchohol which is on the rise in this part of the globe now, and lack of potable water.

Dr. Tan is actively associated with the Living Donor Liver Transplantation (LDLT) programme presently being implemented in the world through several agencies. He has performed about 500 LDLTs so far, including some on children. Parents in London protested against him when he first did LDLT on a child but they also cheered him up when it was sucessful.

In an interview to The Hindu, Dr Tan advocated LDLT, replacing the conventional cadaver ones, insisting on the mother or kith or kin being the donor for better blood suitability.

At Kamineni where a Rs 10-crore Liver Centre is being set up for both cadaver and LDLTs, Dr Tan wants to perform the transplants himself where necessary. It will be easier in Andhra Pradesh because an enactment is already in force here facilitating organ transplant, he said.

About jaundice which is widely prevalent in india, Dr Tan advises against going in for "ring-branding'' the wirst, as done at some places and wants the affected to immediately consult doctor. As a long-term solution, he suggests vaccination, alcohol deaddiction etc.

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