A liver transplant is an operation that replaces a patient’s diseased liver with a whole or partial healthy liver from another person. This article describes the current indications for liver transplantation in Malaysia, types of donor’s livers, the surgery itself, and the immunosuppression that is required after transplantation.
The liver is an important organ, meaning that one cannot live without it. The liver serves many critical functions including metabolism of drugs and toxins, removing degradation products of normal body metabolism (for instance clearance of ammonia and bilirubin from the blood), and synthesis of many crucial proteins and enzymes (such as factors necessary for blood to clot).
Blood enters the liver from two channels, the hepatic artery, and the portal vein, bringing nutrients and oxygen to liver cells, also known as hepatocytes, and bile ducts. Blood leaves the liver via the hepatic veins which drain into the inferior vena cava which immediately enters the heart. The liver makes bile, a liquid that helps dissolve fat and eliminate metabolic waste and toxins via the intestine. Each hepatocyte creates bile and excretes it into microscopic channels that join to form bile ducts. Like tributaries joining to form a river, the bile ducts join to form a single “hepatic duct” that brings bile into the intestine.
Liver transplantation surgically replaces a failing or diseased liver with one that is normal and healthy. At this time, transplantation is the only cure for liver insufficiency or liver failure because no device or machine presumably performs all of the functions of the liver. People who require liver transplants typically have one of the following conditions.
Acute liver failure
Acute liver failure, also known as fulminant hepatic failure, happens when a previously healthy liver suffers huge injury resulting in clinical signs and symptoms of liver insufficiency. Any number of things can lead to acute liver failure but the most common causes are acetaminophen overdose, viral infections (known or yet unknown virus), ingestion of a toxin such as poisonous mushrooms, or an idiosyncratic drug reaction.
The sign of this condition is the development of confusion (encephalopathy) within eight weeks after the onset of yellowing of the skin (jaundice). Confusion occurs because toxins typically metabolized by the liver accumulate. Unlike patients with chronic liver disease, who can survive weeks to months to years while awaiting liver transplantation, patients with acute liver failure may die within days if not transplanted. These patients are listed at the highest priority, placing them at the top of local, regional, and national waiting lists for a donor’s liver.
Chronic liver failure
The liver has an exceptional ability to repair itself in response to injury. Nevertheless, repeated injury and repair, typically over many years and even decades, scars the liver permanently. The end-stage of scarring is termed cirrhosis and corresponds to the point where the liver can no longer repair itself. Once a person has cirrhosis, he or she may begin to show signs of inadequate liver function. This is termed “decompensated liver disease.” Although medicines can decrease the symptoms caused by liver failure, liver transplantation represents the only permanent cure.
Organ transplantation in Asia has progressed quickly over time. Many countries have moved beyond kidney transplantation and embarked on Heart, Liver, and other organ transplantations. There have also been greater investments in base and personnel without which no progress could be made. The major hurdle continues to be the lack of organs particularly from cadaveric donors. To implement the deceased donor program, the basic requirements start from a law in the country, public awareness, infrastructure, trained personnel, and the required funds. With the easy availability of living donors, particularly for kidney transplantation, some of the Asian countries have become over the prey to unethical practices. For more information visit our official website- http://www.cast2021.my/.