New Delhi: Man receives liver in 'donation after cardiac death'

In what is being cited as a rare case of liver transplant after ‘donation due to cardiac death,’ (DCD) 45-year-old Sudip Kumar (name changed) from Ghaziabad received a new lease of life. In India, mostly livers of only brain dead patients are used for the cadaver transplant.

A sixty-year-old man, the liver donor, was wheeled in at BLK Superspeciality Hospital in New Delhi, four months ago. He suffered a cardiac arrest and after all efforts to revive him failed, he was declared dead.

"The kin of the deceased agreed on donating his liver. His kidneys were poor and could not be used," said Dr Sanjay Negi, Director, Department of Hepatobiliary Surgery & Liver Transplant, BLK Super Speciality Hospital, New Delhi. 

DCD is a difficult procedure as the liver has to be retrieved from the deceased’s body in thirty minutes at the most, while in a case of a brain death, a window period of four to six hours can be maintained.

"It is extremely challenging to retrieve liver in such a short period of time. In India, there is great reluctance in removing organs from patients that suffer from cardiac death as the risk involved in surgery is very high," Dr Negi explained. 

As the heart stops beating, blood flow to heart, lungs, liver, kidneys rapidly drops. In the case of a brain death, which occurs due to brain stroke or head injury trauma, the heart continues to beat for a few hours on the artificial support so the organs have a longer window period for retrieval. This is not the case in cardiac death, thus making DCD more challenging. 

"In absence of blood flow from the heart, the liver can stay healthy for thirty minutes at the most,” said Dr Negi. 

After waiting for almost over a year and suffering from two neurological attacks, Sudip finally ended up getting a liver. He was ailing from end-stage liver disease, where the liver had been completely destroyed and the only option left was the transplant.

There was a high risk involved in accepting a DCD organ, said his wife Neha. "Sudip had suffered from the first attack when toxic ammonia had entered his brain, later in second attack his left side of the body was paralysed. The DCD transplant carried a huge risk, but due to the dearth of available organs, we went ahead," Neha told DNA. 

She further said, "I have seen many people die in wait list as they do not get the liver in time. I had never expected that we would get an organ in Delhi, we were looking to travel to Chennai for the transplant."

In the past, a liver transplant with DCD was attempted in 2005 at Sir Gangaram Hospital and later last year at Medanta Hospital in Gurgaon.

"These transplants are very uncommon and challenging. There is uncontrolled DCD such as this case where organs are retrieved after cardiac arrest and then there is a procedure of controlled DCD where life support is withdrawn from a patient and then organs are retrieved. The law does not permit controlled DCD due to the Euthanasia debate. The legal loopholes need to be plugged to increase the DCD transplants," said Dr AS Soin, leading liver transplant surgeon, Medanta Hospital in Gurgaon.

DCD can help bridge the gap between demand and supply of organs. 

50,000 patients die every year due to non-availability of a liver, while only 1000 liver transplants are carried out in India every year, say doctors. In Europe and US, while 80% of cadavers are retrieved from brain dead patients, about 20% are retrieved from cardiac death cases.

"In India, the scenario is very bleak. None of the cadavers from cardiac death have led to successful liver transplants. According to medical literature, this is the first case. Though PGI Chandigarh does do kidney transplants from cadavers obtained post-cardiac death as window period for kidney retrieval is two hours, none for liver have been reported," said Dr Negi.