Liver disease, leading to liver transplantation & the medical care
Normally, the onset of liver diseases is gradual and that is why no specific symptoms prompt the affected person to seek medical help. But usual symptoms like weight loss ness, weakness and fatigue may be the only symptoms for this type of disease.
However, yellow skin or jaundice is the uncommon symptom for this problem and needs immediate medical attention.
If abdominal pain, vomiting and fever persist, the call for a doctor becomes imminent.
Tylenol overdose or acetaminophen, intentional or accidental, is responsible for acute liver failure. In this condition, the patient needs emergent evaluation and also the treatment. Antidotes for the protection of liver become essential provided it is used within a few hours of the seriousness of the problem. This intervention is essential because overdose of acetaminophen can cause liver failure and compel the doctor to transplant the liver.
In case the original liver does not function properly or the liver fails completely, the need for liver function comes imminent. The situation may be due to complications or infections in liver for consequences of some long term problem or certain medications.
The reason for liver transplantations is as below:-
When the specialist doctors determine the complete failure of, it becomes mandatory to transplant the liver.
What are the compelling factors for this important transplantation?
• Malformation of the bile ducts (Biliary atresia).
• A common inherited disease, Hemochromatosis, in this condition the body has extraordinary iron.
• Cirrhosis or Chronic hepatitis.
• Narrowing or Scarring of the bile ducts, known as Sclerosing cholangitis detected both inside and outside of the liver that cause the bile’s backup in the liver, leading to liver failure.
• Primary biliary cirrhosis means when our immune system abnormally attacks and also destroys the bile ducts, leading to liver failure.
• Wilson's disease, in this condition abnormal copper is deposited throughout the body, including liver. This is a hereditary disease. The problem leads to liver failure.
• The extraordinary accumulation of Alpha-1 antitrypsin protein within the liver leads to Alpha-1 antitrypsin deficiency and finally causing cirrhosis.
• Liver cancer
How to determine the liver transplantation?
The experts from different medical fields, as a team, need to examine the real necessity of liver transplantation. Interdisciplinary approaches by different medical experts are needed for evaluating and selecting this type of health care situation. The following professionals constitute the medical team.
Hepatologist or Liver specialist
Transplant coordinator, the specialist & registered nurse for the care of liver-transplantation cases. They primarily look after this type of the liver transplantation cases.
Social worker for discussing your support network, involving family, friend and taking care of your financial needs and medical history.
Chemical dependency specialists to study the effects of drug abuse or alcoholism for the particular patient
Psychiatrist to take note of your issues like depression, anxiety etc. which are closely connected with the transplantation issues.
Anaesthesiologist for discussing about the potential anaesthesia risks.
Financial counsellor for liaising between the insurance company and the patient
Tests required for liver transplant
Your total medical history that include your previous doctors’ medical observations, your liver biopsy slides, X-rays and the records of medications are essential before your doctors finalise about your liver transplant. Doctors usually complement or update your previous tests and opt for final diagnostic study by following all the procedures as below:
• Computed tomography, with the help of other imagery tests like X-rays and a computerized liver picture that shows its size and shape.
• Studies of pulmonary functions for determining the ling’s capacity to exchange carbon dioxide and oxygen.
• Echocardiogram for evaluating your heart condition.
• Blood tests for determining the type of blood, bio-chemical status, clotting ability and gauging the functions of liver
• Blood tests are also done for screening hepatitis and AIDS
• Doppler ultrasound to make sure if the blood vessels for receiving and sending blood to & from your liver are open.
• Additional tests are also done if some specific problems are detected
What to know about the waiting list?
In case you are the active candidate for liver transplantation, you may have to wait for the right opportunity. Doctors will check the body size, blood type, medical condition of the donor. Depending on the three simple blood tests i.e. INR, creatinine and bilirubin, priority score board is prepared. The score for the adults is named as model of end stage liver disease or MELD and the score for the children is named paediatric end stage liver disease or PELD.
The serious patients score highest, so they are transplanted first. With the worsening of the health condition, the score will be more and the patient will get priority for transplantation. The sickest patients, who are critically ill, get the highest priority for the transplantation.
The types of donor
There are two types of donors: 1) Living donor and 2) Deceased donor
1) Living donor
As per the case, a living donor can donate some segment of his/her healthy liver for transplanting his/her liver into a recipient’s body. Both the recipient’s and donor’s liver will grow to a normal size during the post operation period. The time of recovery will be between weeks or months, depending upon the age and health factors of the recipient and the donor.
In case the donor is a blood-relative, friend or spouse, he/she has to pass through extensive psychological and medical examination for ensuring the lowest possible risk. The critical factors are body size and the blood type of the incumbent donor.
The recipient must be active during the waiting period. The stability of health is a very important factor before the transplantation, so that transplantation becomes a real success.
2) Deceased donor
The deceased donor maybe either head injury or accident victim. At the time of extracting the working liver, in such cases, the brain must have stopped functioning but the heart must be in still beating condition. This type of person is known as legally dead, because the brain has irreversibly or permanently has stopped working. In these cases the donor is at the intensive care unit. Both the deceased donor’s and the recipient’s identity is normally kept secret.
Liver Transplant Donors & their screening
As mandatory, hospitals will screen all the potential liver transplant donors for knowing about the liver disease, any infection, AIDS, hepatitis, cancer, drug abuse, alcohol etc. If doctors are satisfied that the donor does not have any of such problems, the doctors will match the recipient’s liver, body size, blood type etc. In this matter race, age and sex are not the criteria for consideration.
The transplantation team discusses with you about the options of transplantation at the time of evaluation. It may also be the case that the person in need may contact the transplantation team.
Once the match is found, what the recipient needs to take care of?
The recipient is not to eat or drink anything before going for operation table. The coordinator will also inform the patient about other necessary issues. Further to it, additional blood test, chest-x-ray and an electrocardiogram will be taken. A repeat meeting with your surgical doctor and anaesthesiologist will be needed for better coordination before the operation.
What are the issues during the liver transplant operation?
The time span for the liver transplantation is between 6 to 12 hours. The operation will be for removing your liver and replanting your donor’s liver. Since transplantation is a major procedure, several tubes will be placed within your body. These tubes are auxiliary units for maintaining normal functioning of your body during and after some time of the transplantation.
Need & procedures for Tube placement
Your trachea or windpipe will be connected through a tube via your mouth for helping you breathe during the transplantation operation. The tube will be there for the first and consecutive two days of your operation. The tube will remain attached with a ventilator for expanding your lung in a mechanical way.
Another N/G (nasogastric) tube will be inserted up to your stomach for draining the secretion from your stomach. This will remain attached for a few days till your bowel operation becomes normal.
Catheter, another tube will be attached with your bladder for draining out your urine. Again this is for a few days till your urine system is coming back to normal condition.
Your liver will be attached with three more tubes for draining blood to and from. This will remain attached for a week, in ideal condition.
A special tube may be attached in your bile duct. The name of the tube is T-tube. This is for draining your bile into a small pouch outside of your body and the extract will be measured many times in a day. This is not mandatory for all the transplantation cases. If it is there, it will be for 4 to 5 months. The tube will not cause any disturbances for the patient.
The liver transplantation means a new life for the recipient. If the donor is a live-donor, he/she will also have a new life of satisfaction.