A technically difficult procedure, Mumbai earlier lacked dedicated full-time surgeons to carry it out
Mumbai, which takes pride in its status as the country's financial capital and a medical tourism centre, was not so comfortably placed when it comes to liver transplants, with patients opting for Delhi or down south for treatment. Worried over the trend, city's private hospitals, including Global Hospital, Kokilaben Dhirubhai Ambani Hospital (KDAH) and Fortis, have been poaching liver transplant experts from Delhi and Chennai. The strategy, sources from city's private hospitals say, has helped reverse the trend.
Experts say one reason why city lost out to Delhi and southern cities in treating liver cases was because performing live liver transplant is technically a difficult procedure, and city hospitals were reluctant in carrying it out. KDAH now has brought in the entire team from Delhi's Sir Ganga Ram hospital, which is famed for liver transplants.
Dr Vinay Kumaran, who heads the liver transplant surgery in KDAH said, "We started the programme in March 2013 and since then we have had 83 liver transplants, of which nine were paediatric cases."
Talking about why Mumbai was lagging behind in liver transplants, he said the problem was Mumbai hospitals didn't have full-time surgeons. "For liver transplant, you need dedicated full-time surgeons. Things are changing now with many city hospitals now addressing the issue," said Dr Kumaran.
Global Hospital in Parel had appointed three leading liver transplant surgeons from Delhi hospitals like Sir Ganga Ram Hospital and Medanta Hospital. In last six months, the Global Hospital has done 35 liver transplants that include the city's first dual lobe liver transplant, one joint kidney-liver transplant and six acute liver transplants.
"Liver transplant is heavily dependent on results. In Delhi, when the programme was started, it had teething problem but the hospitals were determined and persistence paid off. In Mumbai that wasn't the case. The initial setback led to hospitals losing heart," said Dr Ravi Mohanka, head of liver transplantation in Global Hospital.
The hospital soon plans to start a paediatric liver transplant unit. "It should be in place within next couple of months; currently hiring of manpower is in process," said Dr Somnath Chattopadhyay, liver surgeon at Global Hospital.
Apart from live liver transplants picking up in the city, health experts say that end-stage liver disease patient requiring transplant has also got a new hope with more cadaver donations happening. Dr Rakesh Rai, liver transplant expert at Fortis hospital said,
"There was no successful live liver transplant programme. Patients had to go to Delhi and down south for the transplants as the cadaver waiting list was long. The cadaver donation in the city is now picking up and we are feeling positive though it is not enough to match the actual need."
A liver transplant in any private institute costs up to Rs18-20 lakh. KEM Hospital has subsidised the cost to about Rs 5 lakh. While the city sees close to 300 patients suffering from end-stage liver disease, less than 10% of them manage to get an organ in Mumbai, according to liver transplant experts. Another 10% go to Delhi or Chennai, Hyderabad or Vellore in the hope of getting atransplant. Almost 80% die waiting for a transplant as they can't afford surgery. In Mumbai alone, nearly 2000 patients die annually from liver failure or liver cancer, and 300 are waiting for a liver transplant at any time.
For healthy adult, 25 % of liver is adequate for normal function and rest he can donate for a live liver transplant. Liver only solid organ with regenerating ability. Partial livers in donor and recipient regenerate in 4-8 weeks to normal size. For a successful transplant, both donor and recipient should have sufficient liver for 4-8 weeks. #Problems in Live Donor for liver Transplant: One third of potential donors are rejected due to fatty liver, inadequate remnant or graft. The only option is to wait for a cadaveric transplant, for which the disease might be too severe, risk of waiting list mortality ~ 25%
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