The liver is essential for life. It has a remarkable capacity to recover from injury but there are diseases in which this capacity to recover is lost and the liver fails. In this situation, the only cure is a liver transplant.
Liver failure may be acute or chronic. Acute liver failure may be due to viruses (hepatitis A, E), drugs (drugs for tuberculosis, high doses of paracetamol) or poisons (some types of mushrooms). It can progress very rapidly. Death often occurs due to swelling of the brain. A timely liver transplant is the only cure.
Chronic liver failure develops slowly (over 6 months or more) and is due to continuing slow damage to the liver. This may be due to chronic inflammation of the liver in case of hepatitis B or C or due to regular intake of alcohol. Signs that the liver is beginning to fail include ascites (accumulation of fluid in the abdomen), encephalopathy (drowsiness and confusion), bleeding into the stomach from distended veins in the food-pipe and effects of liver disease on other organs (hepato-renal syndrome and hepatopulmonary syndrome).
There are genetic disorders which affect the liver and result in liver disease such as Crigler-Najjar Syndrome or Progressive Familial Intra-hepatic Cholestasis. There are also genetic disorders which do not cause liver disease but are cured by a liver transplant such as Primary Hyperoxaluria, Familial Amyloid Polyneuropathy, Maple Syrup Urine Disease etc.
In the United States and much of Europe, most liver transplants are from deceased donors. Such a donor is a person who has become brain dead due to injury, bleeding (as in strokes) or swelling (as in brain tumors or brain damage due to lack of oxygen). The organs can be maintained as long as the heart is beating and the lungs are kept ventilated with oxygen using a mechanical ventilator. If the family agrees, the organs can be removed and used for transplantation. Unfortunately this form of organ donation is rare in India and the chances of getting such an organ in time are poor for a sick patient.
Functional reserve of the liver: the liver has a large reserve of function and it is not until more than 80% of functional liver cells have died that signs of liver failure begin to appear. This also means that up to 75% of the liver can be removed and the remaining liver will function and grow to the size of a normal liver. However, in living donor liver transplant we ensure that not more than 70% of the liver is removed for transplantation to ensure a margin of safety.
The liver transplant team at Kokilaben Dhirubhai Ambani Hospital has an experience of more than 630 living donor liver transplants with a success rate of more than 90%.