Living donor liver transplant is the most tightly regulated in the book of surgery towards ensuring patient safety today. Experts opine that every single living donor liver transplant in which a family member donates his/her liver is approved by an Authorization Committee appointed by the Central Government.
“There is always a legal permission required in transplant surgeries unlike in any other surgery followed by informed consent with video recording. In case of near relatives like brothers, sisters, husband and wife, the same is also approved by a hospital committee, the authorisation for which is given by the Central government, and is governed under the transplant law,” according to medico-legal experts.
Psychiatric evaluation and counselling are also a part of the modalities for liver transplant surgeries.
Transplantation of Human Organs Act (THOA) 1994 was enacted to provide a system of removal, storage and transplantation of human organs for therapeutic purposes and for the prevention of commercial dealings in human organs. THOA is now adopted by all States except Andhra Pradesh and J&K, who have their own similar laws.
Under THOA, the source of the organ may be near relative donor (mother, father, son, daughter, brother, sister, spouse). Other than a near relative donor, such a donor can donate only out of affection and attachment or for any other special reason and that too with the approval of the authorisation committee.
Deceased donor, especially after brain stem death e.g. a victim of road traffic accident etc. where the brain stem is dead and person cannot breathe on his own but can be maintained through ventilator, oxygen, fluids etc. to keep the heart and other organs working and functional. Other types of deceased donors could be donors after cardiac death.
Brain stem death is recognized as a legal death in India under the THOA, like many other countries, which has revolutionized the concept of organ donation after death. After natural cardiac death, only a few organs/tissues can be donated (like cornea, bone, skin and blood vessels) whereas after brain stem death almost 37 different organs and tissues can be donated including vital organs such as kidneys, heart, liver and lungs.
As of today, only 3,000 liver transplants are done every year when the requirement is 40,000 liver transplants in the country. The latest robotic donor hepatectomy is today the best available technology to the patient performed under the guidance of trained surgeons. With this, the overall surgery and treatment duration has shrunk from 4 to 5 weeks to 3 to 4 weeks.
The features of this unique surgery includes less post operative pain, no infection, painless, scarless, faster recovery, better scar and cosmosis, acceptability and safety as compared to open surgeries.
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