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Liver Transplant Second Opinion Liver transplant is a treatment option for people who have end-stage liver failure that can’t be controlled using other treatments and for some people with liver cancer. Liver failure can occur rapidly, in a matter of weeks (acute liver failure), or it can occur slowly over months and years (chronic liver failure)Medial Second Opinion from Expert Liver Transplant Specialists helps you in,Become a more educated healthcare consumer – By seeking a second opinion, you gain more knowledge of your condition and your options. You are more equipped to make informed decisions that can have long-term consequences. Confirm that your diagnosis is appropriate – Have all of the appropriate studies and test been completed and interpreted properly? Are there other diagnoses that should be considered? Confirm that the recommended treatment is appropriate – Is the treatment plan correct? Is it providing the desired results? Is the treatment plan complete? Have all of the treatment alternatives been discussed? Compare outcomes of the treatments you are offered – By obtaining a second opinion, you help ensure that you have been diagnosed appropriately and that you will receive the most appropriate and optimal treatment plan. A second opinion may recommend treatments that may eliminate the need for unnecessary invasive procedures or surgery. Ultimately, a second opinion can help you make the best decisions for your health.Determining your position on the waiting list Doctors use results of liver function tests and other factors to determine your prognosis and your place on the transplant waiting list. Your prognosis is sometimes called your Model for End-Stage Liver Disease (MELD) score. The higher your MELD score, the more dire your situation. Organs are allocated based on MELD scores. People with higher MELD scores generally are offered donated livers first. MELD scores range from 6 to 40.Some liver conditions, such as liver cancer, may not result in a person getting a high MELD score. The transplant center can request additional MELD points for people with specific diseases if they meet defined criteria.Waiting for a new liver Your wait for a donor liver could be days, or it could be months. Or a donor liver that’s a good match for you might not become available.As you wait for a new liver, your doctor will treat the complications of your liver failure to make you as comfortable as possible. Complications of end-stage liver failure are serious, and you may be frequently hospitalized. If your liver deteriorates, your MELD score is updated.Living liver donors A small percentage of liver transplants are completed each year using a portion of a liver from a living donor. If you have a family member or friend who is willing to donate part of his or her liver to you, talk to your transplant team about this option.Living-donor transplants have good results, just like transplants using livers from deceased donors. But fewer living transplants are performed because of restrictions on the donor’s age, size and health that make finding a good match difficult. The surgery carries significant risks for the donor. Your transplant team can discuss the risks with you and the potential donor.
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Liver transplant second opinion is of PARAMOUNT IMPORTANCE. It can be a difference between end stage liver failure and a second life. In today’s scenario, Live donor liver transplant is gaining popularity.
Who Needs a Liver transplant?
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 reliably performs all of the functions of the liver. Some diseases in children also warrants a liver transplant.People who require liver transplants typically have one of the following conditions.
Transplant Surgery Transplant Surgery / Kidney transplant/Liver transplant/Pancreas transplantCadaver Liver TransplantFacts about Liver TransplantsLiver transplant involves surgical removal of your diseased liver and implanting a new liver. The liver can come from a cadaver (cadaveric liver transplant) or a living person can donate part of his liver (Living donor liver Transplant).Cadaver Liver TransplantOrgans for liver transplant are obtained from deceased donors, after they or their families have given consent to be an organ donor. A liver transplant is a big step to take, but it can save your life. You will be able to take better care of your new transplant if you understand your illness and your treatment. You will need to reach certain goals in your recovery. It is very important that you understand what you must do to make your transplant work. You must take your medicines as told, keep your appointments, and stay in close touch with your doctors.Some facts about the liverThe liver does several things:It helps digest your food.It clears wastes from your blood.It makes proteins that help your blood to clot.It stores the sugars (glycogen) that are used for energy.It makes proteins that the body must have.It helps use and store vitamins.It makes chemicals that protect the body.It breaks down many toxins. The liver also controls the way your body uses food and the way it works with your immune system. When the liver is badly damaged, it cannot grow enough new liver tissue to heal itself. Severe liver damage with scarring is called cirrhosis (sir o sis). Cirrhosis can lead to two problems:1. Liver failureThis happens when the liver cannot do what it is supposed to do.2. Portal hypertensionThis happens when scarring in the liver stops blood from flowing through it. This causes pressure to build up in the vein that feeds the liver (portal vein). The liver can take a lot of damage, but when most of it is damaged, it will start to fail. Once a person has signs of liver failure, it means there is not much of the liver left for the body to use during sickness and times of need. Signs of liver failure may include:Yellow skin and eyes (jaundice) Forgetfulness, confusion, or coma (encephalopathy) Feeling very tired Muscle loss (muscle wasting) Itching Blood does not clot Other signs of liver disease are too much fluid in the stomach (ascites), infections, and bleeding in the stomach. There is no treatment that can help the liver do everything it needs to do. So when a person reaches a certain stage of liver disease, a liver transplant may be the only way to prolong their life.What will happen before my transplant?First, your doctor will refer you to a transplant specialist.Your General practitioner or a gastroenterologist will refer you for liver transplantation when and if your liver disease begins to get worse, and you show signs of liver failure or portal hypertension. This is a specialized operation, so you will need to go to a hospital where liver transplant is done.Your transplant surgeon will evaluate your health status.We call this evaluation the pretransplant evaluation. It is how we decide if a liver transplant is right for you. During this time, you and your family will learn what you need to know about having a liver transplant. You will have many tests done. This process can take a few days or a few weeks. It depends on how many tests you need to have. Some things that will happen during this evaluation:You will meet with the liver specialist, the transplant surgeon, and other doctors. The transplant coordinator will schedule you for lab tests (blood work) and x-rays. Most patients do not need a liver biopsy. You will receive the usual vaccines. Other tests to expect: X-rays and other imaging testsYou will have regular x-rays taken, such as a chest x-ray. You will also have more specialized imaging tests, like a CT or MRI scan. These tests will give your doctors a detailed view of your liver, its blood supply, and other organs. The tests are also used to look for tumors in the liver. All these images will show the surgeon what he needs to know in order to do your operation.Endoscopy and colonoscopyYou may have an endoscopy test done. During this test, the doctor will run a flexible tube with a tiny television camera on the end of it down your throat and into your stomach. With a colonoscopy, the doctor will run a tube through your rectum and into your large intestine. Both of these tests look for enlarged veins called varices. They are a sign of liver disease or problems with the lower intestine. If you have large varices, the doctor may tie them off with rubber bands. This prevents them from bleeding. You will be given medicine to make you sleepy during your colonoscopy and endoscopy.Heart and stress testsSince a liver transplant is major surgery, it is important to know that your heart and lungs are healthy. We will do a detailed evaluation of your heart. They may do an electrocardiogram (ECG), echocardiogram, and a stress test. If you have been a smoker, your may undergo lung function tests and a blood gas test. If you smoke, you need to quit before you have the transplant.Your emotional health will also be evaluated.Your emotional health is as important to your transplant team as your physical health. For this reason, you will also be seen by a team of health professionals like a social worker, psychologist, addiction specialist. We will schedule a family meeting so everyone can meet the transplant team. At this meeting, will explain what a liver transplant involves and answer any questions. This team can also help you with financial concerns, connect you to hospital services, and give you information on support groups.Finally, your nutritional needs will be evaluated.A dietician will talk to you about your nutritional needs and design an eating plan for you to follow. They will also support you in eating well to you help your body heal after your transplant.Cadaver TransplantIf you are for cadaver transplant then you will be listed on a waiting list. You will be informed when your turn comes and there is a suitable liver for you.The Waiting ListBe sure to notify your transplant center of any change in your medical condition. When a liver is found for you, the transplant team must be able to contact you quickly. Your coordinators will need a current list of names and phone numbers of people who will know where to reach you.Dr.Rakesh Rai has clinic in following hospitals - Fortis Hospital Mulund, Fortis Vashi, Reliance Hospital New Mumbai, PD Hinduja hospital Mahim, Hinduja Hospital Khar. Saifee hospital, Mumbai (Monday 2 to 4 pm)WHAT'S APP CHATLiving Donor Liver TransplantDue to shortage of cadaver liver there is a long waiting list to get a cadaver liver. Many patients are too unwell or have tumour in their liver and they may not be able to wait long for cadaver liver. Many patients die waiting for a cadaver liver.In living donor liver transplant a portion of liver is surgically removed from a live donor and transplanted into a recipient, immediately after the recipient's liver has been entirely removed.Live donor liver transplantation is possible because the liver, unlike any other organ in the body, has the ability to regenerate, or grow. Both sections of the liver regenerate within a period of 4 to 8 weeks after surgery.FREQUENTLY ASKED QUESTIONSWho can be a live donor?The donor preferably is a first degree realtive. If a first degree relative is not suitable for donation then a close relative or friend can be considered. The blood type of the donor must be compatible with the recipient’s. The donor should be in good physical and mental health. The donor should be between 19-60 years old. The decision to be a donor should be made after careful understanding of the procedures, and consideration of the risks and complications involved.What would immediately disqualify me as a donor?• History of Hepatitis B or C • HIV infection • IV drug use • Psychiatric illness currently under treatment • A recent history of cancer • A significant medical conditionIf I am related to the recipient, will he or she have less rejection?The risk of rejection in a live donor liver transplant is low. The same risk of rejection exists when the donor is related or non-related.What are the advantages to live donor liver transplant?The main advantage is the shortened waiting time for the recipient. Depending on their condition, diagnosis, status, blood type and size, patients can be on the waiting list for months or even years. Some patients may develop complications and even die while waiting for a deceased donor organ.Will the recipient be removed from the active transplant waiting list if I’m evaluated?NO. The recipient will remain on the active list until he/she is actually transplanted. Should a deceased liver become available for the recipient, no further testing of the living donor will take place, and scheduled surgery would be cancelled.What is the evaluation process all about?The evaluation process is to determine if the donor’s liver is the right size for the recipient and is healthy. The evaluation also ensures that a potential donor is free from any transmittable diseases or psychiatric illness.What are the possible complications of the donor’s operation?As with any surgery involving general anesthesia, there are possible complications of the anesthesia itself, including heart complications, stroke and blood clot formation in the legs or lungs.There is also a risk that the remaining portion of your liver will fail and you will need an urgent liver transplant yourself. While these complications are very rare, the risks exist, and we will discuss them with you in more detail during the evaluation. The most common complications of this surgery are small bile leaks from the remaining portion of your liver, wound infections, and hernias. Gastrointestinal upsets such as constipation, indigestion, nausea or diarrhea are common; however, usually resolve after a couple of weeks.Should I stop smoking before my surgery?Even a light smoker should stop smoking before surgery. A heavy smoker may not be considered a suitable donor due to increased health risks.Should I stop drinking alcohol?If you are going to be a liver donor, it is best that you stop drinking alcohol. If you have a history of alcohol use, it is very important that you tell our team.Will I require a blood transfusion during my surgery?Blood transfusions during this surgery may be necessary, as with any kind of operation, but are not usual with living liver surgery.Will I have pain after the surgery?It is normal to experience some pain or discomfort after surgery. We use a variety of methods to minimize post-operative pain including intravenous and oral medication.When can I start to drink and eat after my surgery?Usually you will start having sips of water in the recovery room. You will gradually be advanced and you will be eating a normal diet in 4 or 5 days.Will I need to take any medication after I donate a part of my liver?Normally, you would only require pain medication for a short period of time.How long will I need to stay in the hospital?If there are no complications, the usual hospital stay is 7-10 days.How long will I be off work?The minimum amount of time you need to recover is 4-6 weeks. However, even if there are no complications, some donors require a few months before they feel ready to return to work.Will I have a normal life after surgery?We expect that you will return to a totally normal life within 3 months after your surgery, provided you do not experience any complications.When can I lift weights, jog, swim, etc?You will need to avoid any heavy lifting (no weight greater than 15-20lbs, or about 2 grocery bags) for the first 6 weeks, until your abdomen has completely healed. After 6 weeks, if you are feeling well and have not experienced any complications, you may begin to return to your normal activities. Begin slowly and build up gradually. Be cautious with activities that strain abdominal muscles.How long after the surgery will it take before my liver functions normally again?Unless there are unforeseen complications, your liver will function immediately after the surgery. After 6 weeks, your liver will have grown back to almost its normal size.Dr.Rakesh Rai has clinic in following hospitals - Fortis Hospital Mulund, Fortis Vashi, Reliance Hospital New Mumbai, PD Hinduja hospital Mahim, Hinduja Hospital Khar. Saifee hospital, Mumbai (Monday 2 to 4 pm)WHAT'S APP CHATPancreatic TransplantA pancreas transplant is surgery to implant a healthy pancreas from a donor into a patient with diabetes. Pancreas transplants give the patient a chance to stop taking insulin injections.DescriptionThe healthy pancreas is taken from a donor who is brain dead, but is still on life support. The donor pancreas must be carefully matched to the patient who is receiving it.A portion of the first part of the small intestine, called the duodenum, is transplanted with the donor pancreas. The healthy pancreas is transported in a cooled solution that preserves the organ for up to 20 hours. The patient's diseased pancreas is not removed during the operation. The donor pancreas is usually placed in the right lower part of the patient's abdomen. Blood vessels from the new pancreas are attached to the patient's blood vessels. The donor duodenum is attached to the patient's intestine or bladder.The surgery for a pancreas transplant takes about 3 hours. However, the operation is usually done at the same time as a kidney transplant in diabetic patients with kidney disease. The combined operation takes about 6 hours.Why the Procedure is PerformedThe pancreas makes a substance called insulin. Insulin moves glucose, which is sugar, from the blood into the muscles, fat, and liver cells, where it can be used as fuel. In people with type 1 diabetes, the pancreas doens't make enough, or sometimes any, insulin. This causes glucose to build up in the blood, leading to high blood-sugar levels. High blood sugar levels can cause many complications, including:AmputationsBlindnessHeart diseaseKidney damageNerve damageStroke A pancreas transplant can cure diabetes and eliminate the need for insulin shots. Because of the risks involved with surgery, however, most people with type 1 diabetes do not have a pancreas transplant soon after they are diagnosed.A pancreas transplant is major surgery, and people with diabetes have a high-than-normal risk of heart disease and other complications.People who have had a pancreas transplant will need to take several medicines for the rest of their lives. These medicines have serious side effects. Because of these risks, pancreas transplant is rarely done alone. It is almost always done when someone with type 1 diabetes also needs a kidney transplant.Pancreas transplant surgery may NOT be done in patients who also have:A history of cancerHIVInfections such as hepatitis, which are considered to be activeLung diseaseObesityOther blood vessel diseases of the neck and legSevere heart disease (such as heart failure, poorly controlled angina, or severe coronary artery disease)Smoking, alcohol or other lifestyle habits that can damage the new organThe doctor may also recommend against a pancreas transplant if the patient is not able to keep up with the many follow-up visits, tests, and medications needed to keep the transplanted organ healthy.RisksThe risks for any surgery are:BleedingBreathing problemsHeart attack or strokeInfection or abscessReactions to medicationsScar formationThe risks for pancreas transplant include:Blood clots (deep venous thrombosis)Clotting (thrombosis) of the arteries or veins of the new pancreasDevelopment of certain cancers after a few yearsInflammation of the pancreas (pancreatitis)Leakage of fluid from the new pancreas where it attaches to the intestine or bladderRejection Outlook (Prognosis)If the transplant is successful, you will no longer need to take insulin shots, test your blood-sugar daily, or follow a diabetes diet. There is evidence that the complications of diabetes, such as diabetic retinopathy, may not get worse -- and may even improve -- after a pancreas-kidney transplant.More than 95% of people survive the first year after a pancreas transplant. The risks for organ rejection are about 1?ch year.The quality of life after a pancreas transplant has improved. Almost all patients find that managing daily life is a lot easier and more satisfying.Kidney TransplantThe kidneysThe kidneys are two bean-shaped organs located on each side of the body, just beneath the ribcage. Their main role is to filter waste products from the blood before converting them to urine.If the kidneys lose this ability then waste products can build up, which is potentially dangerous and can be life threatening. Loss of kidney function is known as end stage chronic kidney disease or kidney failure, which is the most common reason for a kidney transplant. When an individual's kidneys fail, three treatment options are available: hemodialysis, peritoneal dialysis and kidney transplantation.Many patients feel that a successful kidney transplant provides a better quality of life because it allows greater freedom and often is associated with increased energy levels and a less restricted diet. In making a decision about whether this is the best treatment for you, you may find it helpful to talk to people who already have had a kidney transplant. You also need to speak to your doctor, nurse and family members.What is a kidney transplant?A kidney transplant is the transfer of a healthy kidney from one person (the donor) into the body of a person who has little or no kidney activity (the recipient).Are there different kinds of kidney transplants?Yes. There are two types of kidney transplants: those that come from living donors and those that come from donors who have died (non-living donors). A living donor may be someone in your immediate or extended family or your spouse or a close friend. A person only needs one kidney to survive. Therefore, unlike other types of organ donation, such as heart, a living person can donate a kidney. Ideally, this will be a close relative. Receiving a donation from a close relative means there is less risk of the body rejecting the kidney.How do I start the process of getting a kidney transplant?Your doctor can discuss the transplant process with you or refer you to a transplant center for further evaluation.What is rejection?The most important complication that may occur after transplant is rejection of the kidney. The body's immune system guards against attack by all foreign matter, such as bacteria. This defense system may recognize tissue transplanted from someone else as "foreign" and act to combat this "foreign invader."You will need to take medications every day to prevent rejection of your new kidney. Most patients need to take three types. The major one is usually cyclosporine or tacrolimus or sirolimus. In addition, you will most likely be taking some type of steroid and a third medication, such as mycophenolate mofetil or azathioprine. Additional treatment may be needed if a rejection episode occurs. Regular checkups at your transplant center will ensure early detection and treatment of rejection.What are the side effects of the anti-rejection medications?Anti-rejection medications have a large number of possible side effects because the body's immune defenses are suppressed. Fortunately, these side effects usually are manageable for most patients. If side effects do occur, changing the dose or type of the medications will usually take care of them. Some of the most common side effects include high blood pressure, weight gain and a susceptibility to infections and tumors. You may also require additional medications to maintain blood pressure and prevent ulcers and infections.What are the chances that a transplanted kidney will continue to function normally?Results of transplantation are improving steadily with research advances. In the event that a transplanted kidney fails, a second transplant may be a good option for many patients.Will I need to follow a special diet?Kidney transplants, like other treatments for kidney failure, often require following special diet guidelines. If you were on dialysis before, you may find this new diet less restricted. The length of time you must follow the special diet varies. Your progress will be followed closely, and your doctor and dietitian will change your diet as needed.What else can I do?You should inform yourself fully by reading and talking to doctors, nurses and patients who already have kidney transplants. You can also see the National Kidney Foundation publications listed below. If you would like more information, please contact us.RisksA kidney transplant is a major surgical procedure with a wide range of potential risks. In the short term, rejection, infection and blood clots are a risk. Long term risks are usually related to the medication needed to reduce the chance of rejection (immunosuppressants). Because of this people who have had a kidney transplant require regular check-ups for the rest of their life.Living with a transplantHaving a healthy lifestyle goes a long way to minimising these types of risks. It’s recommended that you:quit smoking if you smokeeat a healthy dietlose weight if you are overweight or obese; ideally you want to achieve a body mass index of less than 25.OutlookThe outlook for a person who receives a donated kidney will depend on a number of factors. These include:whether the donation was a living donation or not (living donations usually have a slightly better outlook)whether the donation was from a close relative or someone with the same tissue type (this lowers the risk of the body rejecting the kidney)the age of the person receiving the donation (the younger the person, the better the outlook)the overall health of the person receiving the donation (the healthier a person is, the better the outlook)The kidney survival times for living donations are:1 year - 90-95%5 years - 80%15 years - 60%Where kidneys are donated from someone who has recently died, the kidney survival times are:1 year - 85-90%5 years - 70%15 years - 50%
ACUTE LIVER FAILURE
Acute liver failure, also known as fulminant hepatic failure, occurs when a previously healthy liver suffers massive 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, ingestion of a toxin such as poisonous mushrooms, or an idiosyncratic drug reaction.
The hallmark 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.
CHRONIC LIVER FAILURE
The liver has a remarkable 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 medications can decrease the symptoms caused by the liver failure, liver transplantation represents the only permanent cure.
Alcoholic Liver Disease
Metabolic Liver Disease
Autoimmune Liver Disease
Genetic Liver Disease
Vascular Liver Disease
The first successful human organ transplant occurred more than 60 years ago. Since that time, transplant has evolved significantly and become an integral part of standard medical care. If you’ve been told you can’t get one, it might be time for an organ transplant second opinion.
The reason: Today, more patients are eligible for organ transplant than ever before. That’s because of recent advances in technology, improved clinical treatments and new medications and approaches to care. These have helped chip away at the barriers that have kept some patients from receiving the organs they desperately need to improve and extend their lives.
FREQUENTLY ASKED QUESTIONS: ORGAN TRANSPLANT
Which organs can surgeons transplant?
Some of the most common organs include the:
Who is eligible for organ transplant surgery?
Not every patient is an appropriate candidate for this complex procedure. Physicians and multidisciplinary care teams carefully weigh many factors, including a patient’s age and health status, to determine who should be placed on the waiting list to receive a donated organ.
Patients who are elderly and frail or medically unstable may be ineligible. Cancer or infection may also prevent a patient from being considered a viable candidate for organ transplantation. But we’ve made a lot of progress in recent decades to make organ transplants available to more patients.
Which previously ineligible patients are now candidates for transplant?
Morbidly Obese Patients
In the past, surgeons considered patients who were morbidly obese to be too high risk to undergo kidney transplant surgery. Their doctor required them to lose the weight prior to surgery to decrease the risk for infection and other complications.
The problem, of course, is that weight loss could take years, especially for those patients on dialysis for kidney failure. The delay in treatment increased the risk of death not just for a few, but many; approximately 20 to 30 percent of patients needing a kidney transplant are obese.
Because of the evolution of minimally invasive surgery, kidney and pancreas transplants can now be done with smaller incisions and robotic tools. These improve surgical precision and make the procedure safer for the patient. Once the patient is healthier, they can work to lose the weight.
HIV and Hepatitis Patients
Until the late 2000s, the organ wait list also excluded patients with HIV [human immunodeficiency virus] and hepatitis. However, when new drugs made these conditions more manageable or even curable, physicians advocated for a change in organ allocation and acceptance criteria.
Now, patients with HIV can, if they wish, receive an organ from an HIV-positive donor. Patients with hepatitis B or hepatitis C can donate and receive an organ as well; they may donate to another hepatitis-infected patient or, in cases involving hepatitis C, could even donate to someone without hepatitis. This is possible because hepatitis C is now curable with medication.
COULD YOU BENEFIT FROM AN ORGAN TRANSPLANT SECOND OPINION?
Cancer would also typically disqualify a patient. However, there are two types of liver cancer that surgeons can now treat successfully with liver transplant. If the cancer is confined to the liver, removing the organ and replacing it may cure the patient.
Patients with liver cancer may get a whole liver from a deceased donor or, because the liver regenerates, they can also receive a partial organ from a living donor. Living liver donation is more common today, so these patients have a better chance of receiving an organ.
Is it true that some patients might not be able to get a transplant due to social or financial limitations?
This is one element of organ transplant that we often overlook. Having organ failure and going through a transplant procedure is very overwhelming, especially for patients who lack support or who have limited financial means.
In the past, these patients may have been considered poor candidates for transplant, but now we have programs in place to remove these barriers for patients. At UVA, we have a strong team of social workers and others who work to support patients. No financial or social reason should impede a patient’s ability to get a transplant.
What other advances in the field of transplant medicine do you feel are significant?
There are many exciting things happening. UVA physicians are now transplanting islet cells from the pancreas to help restore a diabetic patients’ ability to regulate blood sugar levels, essentially curing the disease. If the success of this procedure is any indication, in the future, we may not transplant entire organs at all, but only the cells necessary to repair a defective organ.
We’re also making significant progress in lung transplantation. Lungs are easily damaged, so often, donated lungs must be discarded, or there are complications after surgeons transplant the lungs into the patient.
UVA is one of the leaders in the use of new technology called ex-vivo lung perfusion (EVLP). Basically, this device allows us to improve the quality of the lungs by pumping blood or other liquid through them outside of the body prior to transplant.
In the future, we may use this same technology to resuscitate organs while they’re still inside a deceased donor. A lot of patient education will have to occur – and we’ll have to get beyond the ‘creepy’ factor – but this would allow families to fulfill an organ donor’s last wishes and give another patient an opportunity to receive a healthy organ.
If a patient is told he is ineligible for organ transplant, should he seek a second opinion?
Yes. At UVA we feel it is our duty to the community to ensure access to transplantation for all Virginians. If a patient has been told they are ineligible for transplant at an outside center, we encourage them to contact the Charles O. Stickler Transplant Center for a second opinion.
When is SECOND OPINION IN LIVER TRANSPLANT important ?
- second opinion in LIVER TRANSPLANT is important when your doctor doesn’t have the required surgical super specialist knowledge for your condition.
- second opinion in LIVER TRANSPLANT – is important when different surgeons have given you different recommendations and you are not able to take a call.
- second opinion in LIVER TRANSPLANT – is important when you haven’t received a clear cut diagnosis or treatment recommendation.
- second opinion in LIVER TRANSPLANT is important when your doctor has recommended a major surgical procedure .
- second opinion in LIVER TRANSPLANT is important when you feel you have incomplete information about your planned treatment.
- second opinion in LIVER TRANSPLANT is important when the suggested treatment promises no significant improvement to your condition.
- second opinion in LIVER TRANSPLANT is important when you want to find out if there are other treatment options you can pursue.
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Dr Vivek Vij
MBBS MS MRCS (Ed.) DNB
Dr. Subhash Gupta
MBBS, MS (General Surgery), FRCS, FRCSE
Dr. Arvinder Soin
MBBS, MS, FRCS, FRCSE
Dr. Neerav Goyal
DNB (Surgery) DNB (G.I. Surgery), MNAMS
Dr. Anand K. Khakhar
MBBS , MS - General Surgery , DNB
Dr Manish C Verma
Fellowship, Massachusetts General Hospital, Boston, USA Fellowship, DNB, MCh, MS, MBBS,
Dr Jayanth Reddy
MBBS, MS, DNB, MRCS, MCh (GI),
Dr. Mohamed Rela
MS, FRCS, DSc
Dr. Ajitabh Srivastava
Fellowship, DNB, MS, MBBS
Dr. Thiagarajan Srinivasan
MBBS, MS - General Surgery, DNB - Surgical Gastroenterology
01. Organization !
We are a group of surgeons from different surgical specialities and not a intermediate/ middleman medical website company just in the business of giving second opinion.
02. Our principles !
We want to re-establish the dwindling lack of trust between the doctors and patients with our honest second opinion.
03. No financial expectation bias !
For your second opinion, We choose surgeons who practice in a city away from your place, so they won’t have any expectation that you would be coming to them for surgery – so no bias of financial expectation
04. We are not a Hospital !
Lot of Hospitals give second opinion. Their opinion cannot be unbiased as they would definitely be benefited if they advise surgery and they would expect you to be coming to them as patients. Whereas we are not a hospital.
05. Surgeons preferred by other doctors !
We choose the surgical panel team very carefully –after taking suggestion from other fellow doctors as to whom they would prefer if someone of their own family requires a surgery.
What happens during a liver transplant?
Liver transplant surgery requires a hospital stay. Procedures may vary depending on your condition and your provider’s practices.
Generally, a liver transplant follows this process:
- You will be asked to remove your clothing and given a gown to wear.
- An IV (intravenous) line will be started in your arm or hand. Other tubes (catheters) will be put in your neck and wrist. Or they may be put under your collarbone or in the area between your belly and your thigh (the groin).These are used to check your heart and blood pressure, and to get blood samples.
- You will be placed on your back on the operating table.
- If there is too much hair at the surgical site, it may be clipped off.
- A catheter will be put into your bladder to drain urine.
- After you are sedated, the anesthesiologist will insert a tube into your lungs. This is so that your breathing can be helped with a machine (a ventilator). The anesthesiologist will keep checking your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
- The skin over the surgical site will be cleaned with a sterile (antiseptic) solution.
- The doctor will make a cut (incision) just under the ribs on both sides of your belly. The incision will extend straight up for a short distance over the breast bone.
- The doctor will carefully separate the diseased liver from the nearby organs and structures.
- The attached arteries and veins will be clamped to stop blood flow into the diseased liver.
- Different surgery methods may be used to remove the diseased liver and implant the donor liver. The method used will depend on your specific case.
- The diseased liver will be removed after it has been cut off from the blood vessels.
- Your surgeon will check the donor liver before implanting it in your body.
- The donor liver will be attached to your blood vessels. Blood flow to your new liver will be started. The surgeon will check for any bleeding where you have stitches.
- The new liver will be attached to your bile ducts.
- The incision will be closed with stitches or surgical staples.
- A drain may be placed in the incision site to reduce swelling.
- A sterile bandage or dressing will be applied.
The Liver transplant evaluation process
If your provider thinks you may be a good candidate for a liver transplant, he or she will refer you to a transplant center for evaluation. Transplant centers are located in certain hospitals throughout the U.S.
You will have a variety of tests done by the transplant center team. They will decide whether to place your name on a national transplant waiting list. The transplant center team will include:
- A transplant surgeon
- A transplant provider specializing in treating the liver (a hepatologist)
- Transplant nurses
- A social worker
- A psychiatrist or psychologist
- Other team members such as a dietitian, or an anesthesiologist
The transplant evaluation process includes:
- Psychological and social evaluation . Many different issues are assessed. They include stress, financial concerns, and whether you will have support from family or friends after your surgery.
- Blood tests . These tests are done to help find a good donor match and assess your priority on the waiting list. They can also help improve the chances that your body won’t reject the donor liver.
- Diagnostic tests . Tests may be done to check your liver and your general health. These tests may include X-rays, ultrasounds, a liver biopsy, heart and lung tests, colonoscopy, and dental exams. Women may also have a Pap test, gynecology exam, and a mammogram.
The transplant center team will review all of your information. Each transplant center has rules about who can have a liver transplant.
You may not be able to have a transplant if you:
- Have a current or chronic infection that can’t be treated
- Have metastatic cancer. This is cancer that has spread from its main location to 1 or more other parts of the body.
- Have severe heart problems or other health problems
- Have a serious condition besides liver disease that would not get better after a transplant
- Are not able to follow a treatment plan
- Drink too much alcohol
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