A 45-year-old patient underwent a successful liver transplant at BLK Super Speciality Hospital, Delhi. This was the first liver transplant in the country. Dr Sanjay Negi, the surgeon who performed the transplant speaks to Namrata Devikar.
How is ‘Donation After Cardiac Death’ (DCD) different from organ transplant from a brain dead patient?
As soon as patient is declared dead by cardiac attack, the heart immediately stops pumping blood and therefore no blood reaches the organs.
So the chances of organs dying is more. In case of liver, it stops receiving blood within 30 minutes of the death.
But when it comes to the case of a brain dead patient, the heart is still pumping and the other
organs can be retrieved in a longer timespan of an hour or so.
What are the complications of donation after cardiac death for a liver
In case of Donation After Cardiac Death (DCD), blood supply to organ is briefly absent, causing the tissues to become starved of oxygen, a condition known as ischemia.
The challenge in liver transplant is shorter
ischemia time of 30 minutes requiring the procedure to be re-perfused very fast.
The degree of complexities involved in this case as against kidney transplant which has a ischemia time of two hours, makes it more challenging.
The success of this case also demonstrates the growing capabilities and expertise of Indian surgeons.
Can DCD help bridge the wide gap between demand and supply of organs in the Indian context?
In India, less than 5,000 kidney transplants are carried out annually against an estimated requirement of over 1,75,000. Similarly, only 1,000 liver transplants are performed every year in a country where over 50,000 die due to end stage liver disease, mostly related to preventable causes like hepatitis B and hepatitis C. The rate of organ donation is as low as 0.3 per million population. In such a state we can use this procedure to bridge the gap further.
What is the current scenario today of DCD in India as compared to the world?
As per the available data, there are reported cases of DCD of kidney in India but none for liver. While western countries have used DCD for a long time, somehow India has lagged behind due to reluctance of families to donate organs. I feel that by this type of organ transplant, we could pave way for a new trend.