In India we see a rise in the cases of liver diseases over the last 20 years. In 2011, WHO placed it as one of the top 20 ailments in India. To understand more Liver diseases and how is the current stage of Liver transplants Healthcare India spoke to Dr Sumana Kolar Ramachandra, CHIEF OF LIVER TRANSPLANT, COLUMBIA ASIA REFERRAL HOSPITAL, YESHWANTHPUR, Bangalore. Here are some excerpts from the Interview.
Healthcare India: What is the status of liver transplant surgeries in India?
Dr Sumana Kolar Ramachandra: At present, there are around 25000 patients who need liver transplant every year which is approximately 20 per million population and approximately 1200 to 1500 transplant are being done every year in the 3 years. The majority of liver transplants being done in India are Living Donor Liver Transplants. The deceased donor transplants predominantly being performed in Southern India.
Healthcare India: How do you measure success rate and the quality of life after a recipient has received the Liver?
Dr Sumana Kolar Ramachandra: Without a liver transplant, 60-70% of patients with decompensated chronic liver disease will die at the end of 3 years and 90% at the end of 5 years. If the same set of people undergo liver transplant, then 90-92% of them will be alive at the end of 1 year, 83-85% at the end of three years and 79-80 at the end of 5 years in the best of the centers. After the liver transplant, the quality of life improves drastically. With life style modifications and a regular follow-up, the patients get back to their normal life.
Healthcare India: That is indeed remarkable to see the prognosis after a transplant, then what is stopping us from looking at transplants to treat liver disease ?
Dr Sumana Kolar Ramachandra: In my view the key challenges in Liver Transplant are –
- Awareness about liver disease and the treatment options
- Availability of organs for donation
Healthcare India: Can doctors do anything to overcome these challenges?
Dr Sumana Kolar Ramachandra: It is well established that the standard of care for end stage liver disease is liver transplantation, the primary physician should refer the patients with de-compensated liver disease to a transplant center early.
Every clinician should be aware of brain stem death and the process of organ donation. Brain stem death declaration should become mandatory in every ICU and more and more hospitals should become empanelled for brain stem death declaration and organ retrieval.
Healthcare India: How important is a support group in the process of management of Liver transplants?
Dr Sumana Kolar Ramachandra: Support group programs assist patients who have been diagnosed with liver disease and provide education and information on the resources available and also offer emotional support to them and their family members and care givers
In case of post-transplant patients, this group helps each other to understand the importance of medications and other life style modifications needed. They can motivate each other in continuing to care for their new liver and have a regular follow up with the transplant team.
Healthcare India: Maybe preventive care can help, any guidance on preventive measures that can be initiated to manage liver disease?
Dr Sumana Kolar Ramachandra: One way to avoid majority of liver disease is be aware of the liver diseases. Discipline and a healthy life style is of utmost importance to avoid some of the liver diseases. To be specific:
- Drinking alcohol in moderation
- Exercising and healthy eating habits
- Avoid risky behavior
- Get vaccinated
- Use medications wisely and avoid self-prescription
- Avoid contact with other people’s blood and body fluids
Healthcare India: Any best practices that you would like to share for better management of Liver disease?
Dr Sumana Kolar Ramachandra: In the last 40 years, liver transplant has evolved from an experimental procedure to the only definitive treatment option for patients with Acute Liver Failure and End Stage Liver Disease. The only way we can increase the number of liver transplants in our country is by bringing awareness among the doctors and also the general population and secondly by increasing the organ pool.
Brainstem death declaration should become mandatory in all the ICUs and we should have more hospitals empanelled for organ retrieval. We should have better trauma care facilities established in our country.
At present the Liver Transplant Centers are concentrated in the metropolitan cities, there should be more transplant centers across the country so that people have more access to transplant and in turn the cost of treatment will also come down.