A 44-year-old man recently underwent a one-of-its-kind liver transplant. Nearly three months later, he is back to his normal self, said his wife Sakthi Devi.
M. Ram Prabhu, who had liver cirrhosis, was listed for transplant in the State’s transplant registry for a year. The pandemic made it difficult to procure a cadaver organ for him. On two occasions, an organ was available from Chandigarh and Kolkata but the logistics of procuring it posed a hurdle. In March, when a patient admitted to MGM Healthcare died and his blood group (AB) matched with that of the donor, doctors prepared Mr. Ram Prabhu for transplant.
But the donor liver’s condition was unstable owing to administration of high doses of blood pressure support drugs. A biopsy revealed that the liver had a fat content of 40%, said Thiagarajan Srinivasan, director of the Institute of Liver Diseases and Transplantation, MGM Hospital.
“We kept it (the organ) in a dynamic cold perfusion for six hours. Normally, a liver, after retrieval from a brain dead donor, is perfused by static ice cold preservative solution,” he said.
The surgeon used a hypothermic oxygenated perfusion (HOPE) liver pump that helped repair and improve the quality of the organ by pumping preservative fluid into the organ at a temperature of 4-6 degrees Celsius, and oxygen was further added to the fluid through a membrane oxygenator,” he said. The patient was prepared for surgery, and the organ was transplanted. Dr. Thiagarajan said around 20% of the liver was discarded because of its poor condition.
He suggested that the State government set up perfusion centres in Chennai, Coimbatore and Madurai. These centres could help improve the quality of retrieved organs. Such organs can be perfused for as long as 24 hours. He said in western countries, hospitals retrieved donor organs and perfused them before finding a recipient. The cost of perfusion is around ₹3 to ₹4 lakh.
Though some transplant centres in India had tried normothermic perfusion (using human blood to improve the quality of donor organs), the prohibitive costs had forced them to abandon the procedure, said Karthik Mathivanan, associate director of the institute.