Dr Arvinder Singh Soin, Chairman Institute of Liver Transplantation and Regenerative Medicine, Medanta – The Medicity talk about liver transplant scenario in India
How far has India progressed on the treatment of liver disorders and diseases?
Advanced Indian centres like Medanta Liver Institute are equipped with the state-of-the art treatments for all types of liver diseases in adults and children. While Hepatitis B, Hepatitis C are easily cured with effective drugs in the early stages, they often progress to decompensated cirrhosis and liver cancer later. Giving up alcohol can often control alcoholic fatty liver and even early cirrhosis. NAFLD is now the commonest liver disease. Besides controlling lifestyle, diabetes and hypercholesterolemia, a few centres like Medanta have access to a new class of drugs called FXR agonists that can reverse NAFLD and even early cirrhosis.
Tell us about the current therapeutic guidelines in Liver Surgery and Transplantation available to India?
Advanced cirrhosis and liver cancer stages one to three can be cured with liver transplantation. In addition, there are some metabolic disorders that happen due to lack of a certain enzyme in the liver (for example hyperoxaluria) that affect multiple organs of the body. They can also be cured with liver transplant.
Liver surgery where the diseased part of the liver is removed, is undertaken when there is a benign or malignant tumor in one part of the liver or in the bile duct near or within the liver.
What are the latest advancements in this discipline?
Liver Transplantation: Conventionally, only donors with matching blood group to the patient can donate for liver transplants. However, over the last ten years, we have developed two revolutionary concepts which have changed this dogma. First is swap transplant, wherein two patients can exchange their donor organs. Second, where the mismatched blood group donor liver can be used successfully by treating these patients with special medicines and plasma exchange prior to transplant.
Liver surgery: Dr Soin and his team developed key hole liver surgery nearly six years ago, and now they routinely do successful liver surgeries using this method by robotic and conventional laparoscopic techniques which causes minimal pain and scarring.
What is your opinion on the organ transplant policy in India? What are the loop holes in the current policy and how can we fix them?
The Human Organ Transplant Act was first passed in 1994, after which several amendments – the last one being in 2014 have made it pretty sound. The implementation of the act and its amendments however, is suboptimal. Andhra and J&K have still not adopted it. Besides, important amendments allowing small centres with ICUs to serve as donation centres, as well the concept of required request (mandatory request to family of all those who become brain dead in ICU) are still not followed.
There should be strong rules on all aspects of the act, and regular audits to ensure its compliance.
How much is organ transplant a part of medical tourism in India?
Medical tourism with organ donation is well developed in India. While 80 per cent of all liver transplants at Medanta are for domestic and 20 per cent for foreign patients, these figures at some other private hospitals are 50/50. One thing needs to be clarified – no Indian donors donate to foreigners. They all with their own family donors for these transplants.