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Sunday, January 27, 2008

Where to have Liver Transplant

Where to have liver transplant. Essential Steps.
Essential formalities to enlist and proceed for a liver transplant:

a. E-mail the medical records along with the current medical reports to the author (particularly- albumin level and prothrombin time).
b. After e-consult arrange an appointment to meet the doctor with records and the patient.
c. Overseas patients should send their pp details, if they need any assistance with the visa to enter India.
d. After examination and counseling, a standard evaluation is essential for the patient and the donor if living donation is planned. (evaluation is for assessing suitability, judging prognosis and outcome as well as to exclude contraindications for liver transplant)
e. Overseas patients should take the advice of the author for living related donor choice and getting appropriate documentation required for the legal process prior to live donation.
f. Organization and deposit of finance as per advice and quotes.
g. Choose to enlist for a cadaver waitlist or proceed for a living donor transplant as and when suitable.
h. Elective date is chosen for live donor liver transplant depending on the patient's condition and the team's choice.
i. Approximate hospital stay for the donor is 10 days and 3-4 weeks for the recipient.
j. Plan should be in place to stay for 4-6 weeks of post transplant follow up after discharge from the hospital.
k. Regular blood tests and follow up by the transplant team is essential after the transplant. Patients from abroad are advised to e-mail all reports and take periodic advice on follow up.

At the authors center at New Delhi more than 40 successful liver transplants have been carried out, making it the only successful, ongoing liver transplant programme in India till date. At the authors center in India the liver transplant therapy will cost approximately half the amount from other countries. Transplantation in Europe and the USA will cost 150 and 300,000 USD respectively. The waiting time in most western centers for foreigners is in order of 12 months. It is also common practice in most centers to offer livers rejected by local transplant centers as sub-optimal, to foreigners on the waitlist. So patients with adequate financial resources and ample time to wait can seek liver transplant service outside India. Unfortunately patients from India in middle-class and upper middle-class financial setting end up going abroad from poor guidance. Most of these patients will either die while awaiting a transplant or return to India in a morbid state after exhausting their finances. Remember there are more patients dying on the waitlist as compared to those who succeded in getting a suitable good liver! Hence live related donation is an important option for every patient facing the end stage liver disease state. This facility is now available at your door step at Delhi.

There are very few active liver transplant centers in Asia. Apart from author's centres in India, there are centers in Singapore, Ritadh, Istanbul, Bangkok, Seol, Tokyo, Kyoto and Taiwan. Most of these centers in Asia suffer from the same malady of non availability of cadaver organs. They all tend to have large waiting lists of local citizens and few have time to take on foreign patients. Centers in Tokyo, Kyoto and Seol, exclusively carryout live donor liver transplants. The cost of liver transplant in Asia, outside author's centres will be more than 100,000 USD for a straight forward cadaver liver transplant. This of course will not include costs related to transportation, waiting, evaluation, accomodation and food.

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