Living Donor Liver Transplant in UAE: Procedures, Risks, and Benefits
21 Jul, 2024
Healthtrip TeamIn the United Arab Emirates (UAE), liver transplant surgery has become increasingly sophisticated, with a growing emphasis on living donor liver transplants. This approach offers hope to patients suffering from end-stage liver disease and other severe liver conditions. Unlike traditional deceased donor transplants, living donor liver transplants involve a healthy individual donating a portion of their liver to a recipient. This blog delves into the procedures involved, the associated risks, and the benefits of living donor liver transplants in the UAE.
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1. Pre-Transplant Evaluation
The pre-transplant evaluation is a critical step in ensuring the success of a living donor liver transplant. It involves a thorough assessment of both the donor and the recipient to determine their suitability for the procedure. This evaluation process is designed to identify potential risks, ensure compatibility, and prepare both parties for the surgery. Here’s a detailed breakdown of the components involved:
A. Medical Assessment
i. Donor Evaluation:
a. Medical History: A comprehensive review of the donor’s medical history is conducted to identify any pre-existing conditions that could impact their ability to donate a portion of their liver. This includes evaluating overall health, past surgeries, and any chronic illnesses.b. Physical Examination: A thorough physical examination is performed to assess the donor’s general health and identify any potential concerns that could affect the surgery or recovery.
c. Laboratory Tests: Blood tests are conducted to check liver function, blood type, and other crucial markers. This includes tests for hepatitis, HIV, and other infectious diseases.
d. Imaging Studies: Imaging techniques such as ultrasound, CT scans, or MRIs are used to evaluate the liver’s anatomy and function. These studies help determine the size, location, and condition of the liver segments that will be removed.
e. Liver Biopsy: In some cases, a liver biopsy may be performed to assess the liver’s health and ensure it is suitable for donation.
ii. Recipient Evaluation:
a. Medical History: Similar to the donor evaluation, the recipient’s medical history is reviewed to understand their liver disease, previous treatments, and overall health status.b. Physical Examination: A physical examination is performed to evaluate the recipient’s health and assess their readiness for surgery.
c. Laboratory Tests: Blood tests are conducted to determine liver function, check for infections, and assess compatibility with the donor. This includes crossmatching tests to ensure that the recipient’s immune system will not reject the donor's liver.
d. Imaging Studies: Imaging studies are performed to evaluate the recipient’s liver condition, including the extent of liver damage and the presence of any complications. This helps in planning the surgical procedure.
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B. Psychological and Social Assessment
i. Psychological Evaluation:
a. Mental Health Screening: Both the donor and recipient undergo psychological evaluations to ensure they are mentally prepared for the transplant process. This includes assessing their understanding of the procedure, coping mechanisms, and emotional readiness.b. Counseling: Psychological counselling may be provided to address any concerns, anxieties, or fears related to the transplant. This helps in preparing both parties for the emotional aspects of the surgery and recovery.
ii. Social Assessment:
a. Support System: Evaluating the support system available to both the donor and recipient is crucial. This includes assessing the availability of family members or caregivers who can provide assistance during the recovery period.b. Lifestyle Evaluation: An assessment of the donor’s and recipient’s lifestyles is conducted to ensure they can adhere to the post-transplant care regimen, including medication adherence, dietary changes, and lifestyle modifications.
C. Compatibility Testing
a. Blood Type Compatibility: Ensuring that the donor and recipient have compatible blood types is essential for preventing rejection of the transplanted liver.b. Immunological Testing: Advanced immunological tests are performed to check for compatibility and assess the risk of organ rejection. This includes tissue typing and crossmatching to ensure that the recipient’s immune system will accept the donor's liver.
D. Multidisciplinary Team Review
a. Team Meetings: A multidisciplinary team consisting of surgeons, hepatologists, transplant coordinators, psychologists, and other specialists reviews the evaluations and tests. This team collectively assesses the donor and recipient's suitability for the transplant.b. Decision-Making: Based on the evaluations, the team makes a decision regarding the eligibility of the donor and recipient. If approved, the team will proceed with scheduling the surgery and preparing both parties for the transplant.
The pre-transplant evaluation process is a comprehensive and crucial step in ensuring the success of a living donor liver transplant. It involves detailed medical, psychological, and compatibility assessments to determine the suitability of both the donor and recipient. By thoroughly evaluating all aspects of their health and readiness, the healthcare team aims to minimize risks and enhance the chances of a successful and smooth transplant procedure.
2. Donor Surgery
The donor surgery is a pivotal component of the living donor liver transplant process. It involves a series of meticulous steps designed to ensure the safe removal of a portion of the donor's liver and its successful transplantation into the recipient. Here’s a detailed overview of the donor surgery process:
A. Preoperative Preparations
i. Fasting:
a. Purpose: The donor is required to fast for a specified period before the surgery to ensure an empty stomach. This helps minimize the risk of complications during anaesthesia and surgery.b. Duration: Typically, fasting begins the night before the surgery, but specific instructions may vary depending on the hospital’s protocols.
ii. Administration of Anesthesia:
a. Anaesthesia Types: General anaesthesia is administered to ensure that the donor remains unconscious and pain-free throughout the surgery. The anesthesiologist carefully monitors and adjusts anaesthesia levels during the procedure.b. Preoperative Medications: The donor may receive medications to help manage anxiety, prevent infection, or address other preoperative needs.
iii. Preparation for Surgery:
a. Preoperative Checklist: The medical team reviews the donor’s preoperative checklist, including verifying identity, surgical site, and any allergies or medical conditions.b. Surgical Marking: The surgical site is marked to ensure precise and accurate incision placement.
B. Surgical Procedure
i. Accessing the Liver:
a. Incision: The liver is accessed through a surgical incision. The choice between laparoscopic (minimally invasive) surgery and open surgery depends on factors such as the donor’s anatomy and the surgeon’s assessment.
- Laparoscopic Surgery: Involves several small incisions through which specialized instruments are inserted. This approach typically results in less postoperative pain and faster recovery.
- Open Surgery: Involves a larger incision to directly access the liver. This approach may be chosen if laparoscopic surgery is not feasible or if the donor’s liver anatomy requires it.
ii. Removal of Liver Portion:
a. Dissection: The surgeon carefully dissects and isolates the portion of the liver to be removed. The liver is a highly vascular organ, so careful attention is given to controlling blood flow during this process.b. Portion Selection: The portion of the liver removed is determined based on the recipient’s needs and the donor’s liver anatomy. The goal is to ensure that the removed liver portion is adequate for the recipient while leaving the donor with a functional liver.
iii. Closure:
b. Incision Closure: The incision is closed with sutures or staples, and sterile dressings are applied.
C. Postoperative Care
i. Intensive Care Unit (ICU):
a. Monitoring: The donor is closely monitored in the ICU immediately following surgery. This includes monitoring vital signs, pain levels, and overall recovery progress.b. Pain Management: Pain management is a key aspect of postoperative care. The donor may receive pain medications through an intravenous (IV) line or oral medications as needed.
ii. Transfer to Regular Ward:
Once stabilized, the donor is transferred from the ICU to a regular ward. Here, they continue to receive care and support as they begin their recovery process.
iii. Gradual Reintroduction of Oral Intake:
a. Diet Progression: Oral intake is gradually reintroduced, starting with clear liquids and advancing to solid foods as tolerated. This helps assess the donor’s digestive function and recovery progress.b. Monitoring for Complications: The medical team monitors the donor for any signs of complications, such as infections, bleeding, or liver function issues.
iv. Rehabilitation and Discharge:
a. Physical Therapy: Depending on the donor’s condition, physical therapy may be recommended to aid in recovery and mobility.b. Discharge Planning: The medical team provides instructions for home care, including wound care, medication adherence, and follow-up appointments.
Donor surgery is a complex and critical part of the living donor liver transplant process. It involves careful preoperative preparations, a precise surgical procedure, and attentive postoperative care. By following these detailed steps, the medical team aims to ensure a successful outcome for both the donor and the recipient, with a focus on safety, effective pain management, and optimal recovery.
3. Recipient Surgery
Recipient surgery is a crucial aspect of a living donor liver transplant, involving the removal of the diseased liver and the implantation of the donor liver portion. This complex procedure requires precise coordination and skilled execution to ensure the best possible outcome for the recipient. Here’s a comprehensive overview of the recipient surgery process:
A. Preoperative Preparations
i. Preoperative Assessment:
a. Medical Review: The recipient undergoes a final medical review to ensure they are in optimal condition for surgery. This includes verifying that all preoperative tests and evaluations are completed and normal.b. Fasting and Anesthesia: Similar to the donor, the recipient must fast before the surgery. General anaesthesia is administered to keep the recipient unconscious and pain-free during the procedure.
ii. Surgical Marking and Verification:
a. Site Marking: The surgical team marks the recipient’s abdomen to confirm the correct site for the incision.b. Verification: The team performs a final verification of the recipient’s identity, the donor liver portion, and the planned surgical procedure to ensure accuracy.
B. Surgical Procedure
i. Removal of Diseased Liver:
a. Incision: The surgeon makes an incision in the recipient’s abdomen. The choice of incision type (e.g., midline, upper right quadrant) depends on the surgical approach and the recipient’s anatomy.b. Access and Dissection: The diseased liver is carefully accessed and dissected from surrounding tissues. This involves clamping and cutting major blood vessels to isolate the liver.
c. Removal: The entire diseased liver is removed from the recipient’s body. This step requires meticulous attention to prevent excessive bleeding and manage any complications.
ii. Implantation of Donor Liver Portion:
a. Preparation of Donor Liver: The portion of the donor liver is prepared for implantation. This includes ensuring that the liver is in optimal condition and matching it to the recipient’s anatomy.b. Anastomosis: The surgeon performs anastomosis, the process of connecting the donor liver to the recipient’s blood vessels and bile ducts. This includes:
- Hepatic Artery Anastomosis: Connecting the hepatic artery from the donor's liver to the recipient’s artery to supply blood.
- Portal Vein Anastomosis: Connecting the portal vein from the donor's liver to the recipient’s vein to facilitate blood flow.
- Bile Duct Anastomosis: Connecting the bile ducts from the donor's liver to the recipient’s ducts to ensure proper bile drainage.
c. Verification of Function: The surgical team verifies the proper function of the newly implanted liver, checking blood flow and bile production.
iii. Closure of Incision:
a. Inspection: The surgical area is thoroughly inspected for any signs of bleeding or complications before closing.b. Closure: The abdominal incision is closed with sutures or staples, and sterile dressings are applied.
C. Postoperative Care
i. Intensive Care Unit (ICU):
a. Monitoring: The recipient is transferred to the ICU for close monitoring immediately after surgery. Vital signs, liver function, and overall recovery are carefully observed.b. Pain Management: Pain management is a key aspect of postoperative care. The recipient may receive pain medications through an intravenous (IV) line or oral medications as needed.
c. Medications: Immunosuppressive drugs are administered to prevent rejection of the new liver. These medications require careful monitoring and adjustment.
ii. Transfer to Regular Ward:
Once stabilized, the recipient is transferred from the ICU to a regular ward. Here, they continue to receive care and support as they recover from the surgery.
iii. Gradual Reintroduction of Oral Intake:
a. Diet Progression: Oral intake is gradually reintroduced, starting with clear liquids and advancing to solid foods as tolerated. This helps assess the recipient’s digestive function and recovery progress.b. Monitoring for Complications: The medical team monitors the recipient for signs of complications such as infections, bleeding, or liver rejection.
iv. Rehabilitation and Discharge:
a. Physical Therapy: Depending on the recipient’s condition, physical therapy may be recommended to aid in recovery and mobility.b. Discharge Planning: The medical team provides instructions for home care, including wound care, medication adherence, and follow-up appointments. This includes guidance on recognizing signs of potential complications and when to seek medical attention.
Recipient surgery is a complex and critical phase in the living donor liver transplant process. It involves the careful removal of the diseased liver and the precise implantation of the donor liver portion. Through meticulous surgical techniques and attentive postoperative care, the goal is to achieve a successful transplant and improve the recipient’s health and quality of life. The process requires close coordination among the surgical team and ongoing support to ensure a smooth recovery and optimal outcomes.
4. Follow-Up Care
Both donor and recipient require regular follow-up visits to monitor liver function, medication adherence, and overall health. Long-term care includes routine check-ups, imaging studies, and laboratory tests.
Risks of Living Donor Liver Transplant
- Surgical Risks: As with any major surgery, there are risks associated with anaesthesia, bleeding, and infection.
- Liver Regrowth: Although the liver has a remarkable ability to regenerate, there is a risk of complications if the remaining liver does not grow back as expected.
- Long-Term Health Effects: Some donors may experience long-term health effects, such as an increased risk of liver disease or reduced liver function.
- Rejection: The recipient’s immune system may reject the new liver, requiring lifelong immunosuppressive medication.
- Infections: Immunosuppressive drugs increase the risk of infections.
- Complications: Postoperative complications include bile duct problems, bleeding, and clotting issues.
Benefits of Living Donor Liver Transplant in UAE
- Reduced Wait Time: Living donor transplants reduce the time spent on the waiting list, which can be critical for patients with severe liver disease.
- Better Outcomes: Studies have shown that living donor liver transplants often result in better long-term outcomes compared to deceased donor transplants.
- Improved Quality of Life: Receiving a healthy liver from a living donor can significantly improve the recipient’s quality of life and overall health
- Personal Fulfillment: Donors experience a profound sense of personal fulfilment from helping a loved one or someone in need.
- Healthy Outcomes: Most donors recover fully and return to their normal lives after a period of recuperation. The liver regenerates quickly, usually within a few months.
Top Hospitals in UAE for Living Donor Liver Transplant
The UAE is home to several top hospitals known for their expertise in liver transplantation:
Mediclinic City Hospital offers a range of personalized cancer treatments, supported by a team of experienced oncologists and genetic counselors. The hospital employs the latest in targeted therapies and immunotherapy, providing patients with cutting-edge cancer care.
- Established Year: 2008
- Location: 37 26th St - Umm Hurair 2 - Dubai Healthcare City, Dubai, United Arab Emirates
About The Hospital
- Mediclinic City Hospital is a state-of-the-art healthcare facility. It is equipped with the latest technology and staffed by highly trained professionals.
- Number of Beds: 280
- Number of Surgeons: 3
- The hospital boasts 80 doctors and over 30 specialists.
- Neonatal Beds: 27
- Operating Rooms: 6, plus 3 daycare surgery units, 1 C-section OT
- Cardiac Catheterisation Laboratories: 2
- Endoscopy suites, fully equipped laboratory, emergency department, labour and post-natal wards.
- Advanced Medical Technology: PET/CT, SPECT CT, and 3T MRI.
- The hospital offers specialist-focused treatment in areas such as cardiology, radiology, gynaecology, trauma, nuclear medicine, endocrinology, and more.
- Mediclinic City Hospital offers specialities in Urology, Neurology, Gynaecology, General Surgery, Gastroenterology, E.N.T, Dermatology, Cardiology, Oncology, Orthopedics, Ophthalmology, Bariatric Surgery, Paediatric Neurology, Paediatric Oncology, and Paediatric Orthopaedics, staffed by top doctors in each field.
Burjeel Medical City is equipped with state-of-the-art technology and a multidisciplinary team of oncologists, radiologists, and geneticists. The hospital offers comprehensive genomic testing and personalized treatment plans. The hospital has specialized programs for various cancers, including breast cancer, lung cancer, and colorectal cancer, utilizing targeted therapies and immunotherapy.
- Established Year: 2012
- Location: 28th St - Mohamed Bin Zayed City - Abu Dhabi - United Arab Emirates, United Arab Emirates
About The Hospital:
- Total Number of Beds: 180ICU Beds: 31 (Including 13 Neonatal ICU and 18 Adult ICU Beds)
- Labour and Delivery Suites: 8
- Operation Theatres: 10 (Including 1 state-of-the-art Hybrid OR)
- Day Care Beds: 42
- Dialysis Beds: 13
- Endoscopy Beds: 4
- IVF Beds: 5
- OR Day Care Beds: 20
- Emergency Beds: 22
- Individual Patient Rooms: 135
- 1.5 & 3.0 Tesla MRI and 64-slice CT scan
- Luxury Suites: Royal Suites: 6000 sq. ft. each
- Presidential Suites: 3000 sq. ft.
- Majestic Suites
- Executive Suites
- Premier & Deluxe Rooms
- Designed to be a hub for tertiary and quaternary oncology treatment.
- Specializes in adult and pediatric subspecialties, long-term, and palliative care.
- Offers immunotherapy and molecularly targeted therapies.
- Provides state-of-the-art diagnosis and compassionate treatment.
- Offers exceptional support services for patients and their families.
- Burjeel Medical City in Abu Dhabi offers advanced care and expertise in cardiology, paediatrics, ophthalmology, oncology, IVF, gynaecology & obstetrics, orthopaedics & sports medicine, a dedicated Shoulder and Upper Limb Unit, Burjeel Vascular Centre, and bariatric & metabolic surgery. This state-of-the-art hospital provides comprehensive, top-quality healthcare services to patients, ensuring their unique medical needs are met with the highest level of care and expertise. Burjeel Medical City is committed to providing high-quality medical care in a comfortable and technologically advanced environment.
- Address: 19th St - Oud Metha - Dubai - United Arab Emirates
- Number Of Beds: 252
- Number of ICU Beds: 43
About American Hospital:
- Premier private healthcare provider in the Middle East
- Part of Mohamed & Obaid Al Mulla Group
- Established to provide world-class medical service since 1996
- First hospital in the Middle East awarded JCI accreditation
- The comprehensive range of medical and surgical specialities across 40 disciplines
Accreditations and Awards:
- JCI accreditation
- Mayo Care Network member
- Ultrasound practice accreditation from AIUM
Specialities and Departments:
Several top hospitals in the UAE have adopted robotic-assisted radiation therapy, providing patients with access to some of the best cancer treatment options available worldwide
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Hear from our satisfied patients
Living donor liver transplants offer a life-saving opportunity for patients with severe liver conditions, with the UAE providing excellent facilities and expertise for these complex procedures. While the process involves careful planning and consideration of risks, the benefits for both donors and recipients are substantial. With advancements in medical technology and the dedicated efforts of healthcare professionals, living donor liver transplants in the UAE continue to offer hope and improved outcomes for many individuals.
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