Global Health Liver transplant

1. Group: 10
Presented by: Layla Abd Alaziz

3. Part 1
• Discussion on the Scenario and 6 possible recipients for liver
transplant in the context of different countries
Part 2
• How is the organization of liver transplant (or human organ in your
county of study?
l. Is any official organ transplant performed?
 2. If so, how is it organized?
3. How many liver (or human organs in general) are transplanted per year in your country
of study? How high is the demand?
4. Is there any organ tourism or organ trade performed?

4. In India:
You cannot have the transplantation if :
cancer in another part of your body
serious heart, lung, or nerve disease
active alcohol or illegal drug abuse
an active, severe infection
inability to follow your doctor's instructions

5. systemic lupus erythematosus
Old age acquired hepatitis and HIV
Cancer
history of cocaine and alcohol
abuse
severe damage of liver

6. Howistheorganizationoflivertransplant(or
humanorgan)inIndia?

7. Is any official organ transplant performed?
• The Human Organ Transplantation Act was passed in India in 1994
• The first deceased donor liver transplant (DDLT) in India was done in 1995 and
was unsuccessful. This was followed by a few unsuccessful attempts until the
first successful DDLT in 1998
• Shortly thereafter by the first successful Living donor liver transplant (LDLT) in
November 1998

8. Count.:
• The first era -1995 to 2004- saw 131 transplants in total (DDLT and
LDLT) done in 15 centers.
• The second era -2005 to 2015- has seen a progressive increase every
year and a phenomenal growth over the last 2 years with close to
1,200 Liver transplants done in the year 2014 alone.

9. Technical innovations and advancement:
• Age: 18 to 50 years, related voluntary donor
• No co-morbidity like diabetes and hypertension
• Smoking/contraceptive pills: abstinence for 6 weeks
prior to surgery
• BMI <27 for Indian/Asians, 30 for Middle East patients
• Acceptable remnant 30% and above
• LAI of >5: acceptable; less than that: Liver biopsy is done
Criteria for donor suitability:

10. Q3/ How is it organized

11. • 1. National Organ and Tissue Transplant Organization (NOTTO):
• Is a National level organization set up under Directorate General of Health
Services, Ministry of Health and Family Welfare.
• Functions as top center for All India activities of coordination and
networking for procurement, distribution, registry and Transplantation of
Organs and Tissues in the country.

12. • 2. MOHAN Foundation:
• Is a not-for-profit, non-governmental organization started to promote organ
donation in 1997 in Chennai.
• Ensures that every Indian who is suffering from end stage organ failure be
provided with the 'gift of life’ through a life-saving organ.
Public
awareness
Train health care
professionals
counsel families
to donate
Networking with
other
organizations.

13. 3.The Organ Receiving & Giving Awareness Network (ORGAN) India:
Is an initiative that was launched in March 2013 by The Parashar Foundation
to address the miserable state of late organ donation in India.
• Goal – to create widespread awareness on organ donation regardless of
religion, age, sex, caste, or social standing.

14. 4.National Transplant Registry:
Is to collect transplant related data from various centers in the
country and to be able to collate the data from time to time to
derive the following information:
Such as Number of Living and cadaver transplants, relationship in
case of related transplants, and profile of Donors

15. • Government of India has started National Organ and Transplant Program
(NOTP), under which patients below poverty line are supported for the
cost of transplant as well as cost of immunosuppressant after transplant
for one year.
• The Transplantation of Human Organs Act of 1994 makes it illegal to buy
or sell human organs in India.

16. How many liver (or human organs in general) are
transplanted per year in your country of study? How
high is the demand?

17. the need for liver transplantation in India is estimated to be around 20/million
population (or 25,000 LT per year).
The current rate of LT performed in India is around 1.2/million population.
Around 1200 and 1400 LT have been performed in India in the years 2013 and
2014, respectively. The yearly trends in the number of LT in India have been shown.

18. Figure 1: Annual trends in liver transplants in India

23. Is there any organ tourism or organ trade performed.

24. A combination of poverty, a significant level of inequality, and an all
pervading corruption makes India a fertile ground for this trade
there is an abundance of poor people who see the sale of an organ as
a possibility to raise cash,
and at the other end, there are rich patients in need of an organ and
some of the world’s best medical facilities to perform the actual
operations.

25. Specific Question 1:
Who is the most
appropriate case among
these potential cases for
receiving liver transplant?

26. In India, Certain conditions disqualify a person from undergoing a liver
transplantation because a successful outcome is unlikely.
“Contraindications”:
include the following:

27. ContraindicationCase
Advanced age (relative contraindication1
The presence of extrahepatic neoplasia
(usually within the last 5 years).
2
Extrahepatic infection + Hepatitis re-infection due to homosexuality and HIV effect4
Irreversible damage to other vital organs seriously limiting life expectancy and lack
of compliance
+ potential recurrence of liver damage.
5
Chronic liver failure (Alcohol-induced cirrhosis)
Abstinent for a period of at least 3–6 months
Approved to be in the waiting list
3

28. Specific Question 2:
Comment on Case 4 as
potential recipient of liver
transplant.

29. Indications
(HIV) infection is no longer be considered a contraindication to
liver transplantation and Liver transplant centers are now
accepting HIV-infected individuals as organ recipients.

30. 2612 homosexual males:
- 5% were found to be hepatitis-B surface-antigen (HBsAg) positive.
-(56%) of these proved to have chronic active hepatitis or active cirrhosis.
Re-occurrence of liver failure  increased mortality and "waste" of organs

31. Specific Question 3:
Where do donated
livers come from?

32. Liver for transplant can be obtained from two types of donors :-
1) Cadaveric Liver Donation:
From a brain dead person .
Allocation of such organ according to :-
• Blood group match.
• Time on waiting list .
• Urgency of requirement.

33. • Compatible blood group with the recipient.
Con..
2) Living Liver Donation :
Donor Blood Group Recipient Blood Group
O O, A, B or AB
A A or AB
B B or AB
AB AB
• A family member ( wife, husband, mother, father, brother, sister,
son, daughter, grandfather, grandmother, grandson,
granddaughter) or close relative of the patient.
• Not overweight.

34. • Family friends, well-wishers, staff or neighbors are not accepted
as donors
• Age group 18-55 years.
• The donor’s liver should be large enough to provide adequate
volume for the recipient.
• Donor should be undergo a thorough medical and psychological
evaluation.
• Fully understand the risks of surgery.

35. • Alcoholic and people with cancer cannot have
the transplantation
• The donor should have some criteria like being
free from diabetes.
• in India it is illegal to buy or sell human organs.

36. • URL https://www.scribd.com/document/357821920/The-Hindu-Chennai-3-
4-17
Website Title Scribd
Article Title The Hindu Chennai 3-4-17
Date Accessed March 04, 2018
Anon, (2018). Living donor liver transplantation in India. [online] Available at:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4824736/ [Accessed 3 Mar.
2018].
• URL http://www.transplantindia.com/
Website Title transplantindia.com
Article Title Welcome to Indian Transplant Registry
Date Accessed March 04, 2018

37. • URL http://sites.ndtv.com/moretogive/numbers-status-organ-donation-
india-221
Website Title NDTV-Fortis More to Give: Be an Organ Donor
Article Title In Numbers: The Status Of Organ Donation In India | Infographics
Date Published August 22, 2017
Date Accessed March 04, 2018
• Journal Title MAMC Journal of Medical Sciences
Publication Year 2015
Article Title Welcome to MAMCJMS
URL http://www.mamcjms.in/article.asp?issn=2394-
7438;year=2016;volume=2;issue=1;spage=6;epage=11;aulast=Soin

38. CASE1
• A 63 year old managing director of family company in the textile
business, with about 400 employees in Europe and India. He
reformed the company to an example of corporate social
responsibility, on the aspect of sustainability and good employer
practices. He has a wife and three (adult) children. During a visit in
India several years ago he donated some blood for an employee of
the local factory who had no relatives. He acquired Hepatitis B, which
became chronic and he developed a hepatocellular carcinoma. Beside
this, his health is good.

39. CASE 2
• A 37-year-old primary school teacher. She is a mother of four children
(age: 10, 4, 2, and 1). After the birth of her first child, she was
diagnosed having breast cancer. She had a surgical and chemotherapy
and was considered to be cured five years ago. However, a year ago,
she visited her GP because of a swollen abdomen, nausea, anorexia,
and loss of weight. Liver metastasis were found. She receives
chemotherapy to slow down the process. Other metastases have not
been found.

40. CASE 3
• A 26-year-old mechanic, who has a personal history of cocaine and
alcohol abuse, since the age of seventeen. Several attempts of rehab
were futile. However, 18 months ago he was admitted to a clinic and
he is a clean now for 13 months. He started to build up his life again,
which include that he found a job and is involved in a relationship.
However, he developed ascites and other symptoms of a cirrhotic
liver and had to stop working. He has a very low quality of life

41. CASE 4
• A 39-year-old man from South Eastern Asia, working as an interpreter.
He was granted asylum 12 years ago, because he was persecuted for
his homosexuality. During his first years in The Netherlands, he has
been sexually abused, and consequently acquired hepatitis and HIV.
The HIV is under control, but he developed a cirrhotic liver due to the
hepatitis.

42. CASE 6
• Case 6 is not on the waiting list. We do not much of her, but she was
in the same car as our donor. Because of her physical resemblance
she probably a family member (cousin). According to her ID she is 26
years old. She has a rupture and other severe damage of her liver.

43. CASE 5
• A 19-year-old high school student with an aggressive systemic lupus
erythematosus. She had several flares the last four years. Last year,
she developed complications of portal hypertension, cirrhosis, and
hepatic encephalopathy – which are rare in SLE. Her quality of life is
low due to these complications.