Psycho - Social Issues
In India it depends on the socio-economic strata of the patient and the cause of liver disease. Nearly 35% of patients needing LT suffer from self-inflicted conditions such as alcoholism or ingestion of toxins. These patients seldom get good family support and are often financially dependant on other wealthy members in the family. Depression and lack of self worth is seen commonly which makes motivation for Liver Transplant difficult. Most centers will demand complete discontinuation of alcohol intake for a minimum period of six months before listing for Liver Transplant. Finding motivated living donors for patients with alcohol induced liver failure is a difficult task. Most of the live donations for these conditions take place under social duress and family obligations. Pre-transplant counselling and conditioning of both the recipient and the live donor as the case may be forms an important aspect of pre-transplant workup. Acute liver failure resulting from ingestion of toxins places the family in extreme psychological stress. They are expected to accept the serious state of their ward and arrange for finances (there is no insurance coverage for liver transplant in India) as well as a suitable living donor from the family within a very short time span. Various other factors such as post operative complications, re-operations and outcome has a bearing on the psycho-social state of the family. Since there is no insurance coverage for liver transplant in India, most families will weigh the cost benefit ratio of going in for a liver transplant (especially if patients are in the extremes of age group or of female gender). Since liver transplant is new in India, job prospects after prolonged absence for liver transplant and social rehabilitation of the recipient could pose problems. However most patients go back to self employed occupations after liver transplant.
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