If deem suitable, the hospital will identify the brain-dead patient as a potential donor. This is the commonly performed transplant procedure in which the liver is procured from a patient after brain death is certified. The recipient will be the most suitable patient on the top of the SOTTO list, prioritized by the medical urgency and waiting time.
In Living donor liver transplant, a relative (as per THOTA 2011), can be considered as potential donors. The most appropriate donor will be selected, counselled and undergo a series of pre-transplant assessments to ensure their suitability. This can be performed for all patients including foreign patients. Living donor transplant provide an alternative for patients as there is a shortage of deceased donors.
A liver transplant, like all major surgery, has possible serious risks such as bleeding, infection, vascular issues, biliary problems and complications from anesthesia. In addition, people who have a liver transplant may have side effects from the immunosuppressive drugs they need to take. This means that a patient may be at increased risk of developing infections. Some of the immunosuppressive drugs can also cause high blood pressure and cholesterol, diabetes, and weaken the bones and kidneys. Regular health checks with the transplant team are important after a liver transplant.
Liver transplantation is generally very successful. Most people are able to return to their daily routine within a few months after the transplant. Transplant success depends on a number of variables, including health status, age, timing of the transplant since advised and nature of disease. The overall survival of patients at 1 and 5 years is above 90% and 70% respectively. Without the transplant, many patients will not survive for more than 3 months due to severe decompensations.
A common cause of organ failure following a transplant is due to patients not following the prescribed immunosuppression medication regimen. Careful attention to medication schedules, lifestyle changes, diet and close follow-up with the transplant team and primary care physician is important.
Living donation significantly decreases the time a patient has to wait for a liver on the waiting list, prior to the worsening of the patient’s condition. Livers from living donors are usually of excellent quality because donors are carefully evaluated prior to donation and are only allowed to donate if they are in good health. This way of liver transplantation is very handy for uncommon blood groups i.e. A and AB The average waiting time for an available deceased organ is about 5-6 months (except in A and AB blood group where it is even more) vs. 15 days for a living donor liver transplant once a donor is deemed suitable.
All potential living donors will be informed and well counselled about the donation process, possible outcomes, risks and post-donation care.
The transplant team is not allowed to find a donor on behalf of the patient. Anyone who is involved in the buying or selling of organs can be prosecuted by law.
Yes, a person can choose who the intended recipient is, as long as the assessments have deemed that the person is healthy and a match to the recipient, and a completely voluntary decision is made without force or financial promises. Once the evaluation is complete and cleared, the application will be reviewed by the Transplant Ethics Committee (TEC) under the auspices of the Ministry of Health(MOH) to ensure it is appropriate. The transplant surgery can go ahead after the TEC’s approval.
A donor can withdraw from organ donation any time, for any reasons and the decision will be kept confidential.
Hepatitis B carriers who have blood relatives diagnosed with liver cancer have a higher risk of developing liver cancer themselves. They should be screened regularly by a liver surgeon.
Yes, if picked up early, surgery offers the best chance of cure, either with removal of the tumor (liver resection) or liver transplantation. Unfortunately, while some may be diagnosed at advanced stages, these patients can still benefit from good control of the disease with the various treatments, e.g. locoregional, systemic or radiation therapy.
The term “traditional” or “herbal” remedies or Ayurveda medicine can represent thousands of compounds, many of which are not well known. Unfortunately, most are not rigorously tested or well regulated by the companies that produce them. Some are likely safe but many more may be very harmful. More importantly, there is no current evidence of any of these “remedies” work for liver cancer. It is recommended that patients considering these alternative forms of medication discuss this with their liver surgeon.
Liver cancer surgery, like any major surgical procedure, carries certain risks, which vary depending on the type of surgery, the individual's overall health, and more. Risks associated with liver cancer surgery include
>Bleeding:
Infection: As with any surgical procedure, there is a risk of developing an infection at the wounds or within the abdomen.
Liver Failure: In extensive surgeries, there is a risk of insufficient remnant liver function leading to liver decompensation and failure, especially if the remaining liver tissue cannot regenerate sufficiently.
Bile Leakage:
Damage to Nearby Organs or Structures: Given the liver's proximity to other organs and blood vessels, there is a risk of injuring nearby structures during surgery.
Delayed Recovery: Recovery from liver cancer surgery in the minority of cases be lengthy and challenging, and some people might experience slow wound healing or prolonged recovery periods. Minimally invasive liver surgery can ameliorate many of these short-term issues.
Recovering from Liver Cancer Surgery Liver cancer surgery is a major operation and can take several weeks for full recovery. To ensure a smoother recovery, be sure to follow these advice
Follow Medical Guidance: Adhere to post-surgery instructions regarding medication, wound care, diet, and activity levels.
Pain Management & Monitoring: Take prescribed pain relief, watch for signs of infection, and know when to seek medical attention.
Gradual Activity Resumption: Slowly reintroduce daily activities and follow the advice of your liver cancer doctor.
Healthy Lifestyle: Maintain a balanced diet, stay hydrated, engage in light exercise, and avoid alcohol and smoking.
Attend Follow-up Appointments: Attend your scheduled follow-ups to monitor your recovery progress. Enhanced Recovery approach Patients undergoing major surgery have been shown to benefit from measures and prehabilitation prior to and early after surgery to improve their physical condition and better tolerate and recover from the surgery. This multimodal perioperative care pathway starts a few weeks prior and immediately after the surgery, designed to achieve early recovery for patients undergoing major surgery and minimise complications. These include
-> Excerises to improve strength and mobility – physiotherapy, prehabilitation
-> Lung excerises- deep breahting and incentive spirometry
-> Diet optimisation – nutritional supplements to boost immune system and provide an optimal diet to boost physiological reserves especially in patients who has loss of weight and appetite
-> Others e.g., - Preoperative smoking and alcohol cessation, medications review, Anti-thrombotic prophylaxis
-> Post-operative- Early mobilisation, early oral intake, nutritional supplementation, nausea and vomiting (PONV) prophylaxis, judicious fluid and pain management etc.
“Many people with liver cancer do well and survive the disease. Here, our goal is to cure your cancer and help you have best possible quality of life. At every step, we will work with you to determine the best treatment approach. Our team has vast experience and expertise in treating liver cancer and work together with other experts to achieve a comprehensive and personalized treatment strategy for the best outcome for you.”
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