Although liver transplant is considered as the last option for patients with end-stage liver disease, it nevertheless offered patients hope for 2nd life. There are 3 types of liver transplantation that are widely practiced in the world. They are cadaveric, live donor and split-liver/ resection transplant.
Cadaveric Liver Transplantation
Liver transplanted from a deceased donor is known as cadaveric transplant. The majority of livers that are transplanted come from brain dead organ donors where consent is available. A liver transplant from a brain dead donor (cadaver) needs to occur within 12 hours after the liver is removed from the donor for the organ to remain viable. During this time, the surgeon will do a final assessment of the donor liver to ensure it's healthy and a good match.
Due to personal, religious, unawareness, many people do not come forward to be an organ donor. This causes shortage of liver for transplantation and many have died waiting for a compatible liver.
Split-Liver Transplantation
As the name suggests, a cadaveric adult donor’s liver is divided and transplanted into two different recipients – an adult and a child. Due to a shortage of paediatric cadaveric donors, paediatric cases saw a higher mortality rate than the adults. With a better understanding of reduced-liver transplant a small portion of an adult donor’s liver was given to infants and children in addition to an adult recipient. This drastically reduced the number of deaths among children since then and with the introduction of living donor liver transplantation, the percentage was substantially reduced.
Living Donor Liver Transplantation in Asia
With the prevalence of liver disease in Asia, there is an increasing demand for liver transplantation for patients with end-stage liver disease. There is a worldwide shortage of cadaveric livers and every country has a long waiting list.
As such, Living Donor Liver Transplantation (LDLT) has become an important and effective life saving procedure, in particular those with acute liver failure and hepatocellular carcinoma (HCC). The current waiting period for a cadaveric donor liver is much too long to benefit patients with these rapidly progressive diseases. Without LDLT, it is highly unlikely that patients will be transplanted before they develop fatal complication. Besides being an alternative source of donor livers, the other advantage of LDLT over cadaveric organ donation is that it allows scheduling of the procedure. As such, the patient with decompensated liver function can be optimized prior to the operation. In addition, the quality of the graft is better as it is retrieved from a healthy donor and the cold ischaemic time is much shorter. The most important disadvantage of LDLT is the potential for morbidity and even mortality to a healthy donor. There are limitations when faced with living donor liver transplantation. The foremost is finding a suitable compatible donor, who shares the same blood group. The donor can be the next of kin, relatives and even close friends. |
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