New Delhi: In a first-of-its-kind operation in India, doctors at a private hospital in the city reused a liver, transplanted onto a patient who was declared brain dead days after the operation, to save another man’s life, reports Durgesh Nandan Jha.

The new recipient, a 54-year-old man from Delhi, is stable and recuperating well, said Dr Subhash Gupta, chairman of the Centre for Liver and Biliary Sciences at Max Saket. “Only a few such transplants had earlier been done globally, none in India ,” he added. The first recipient of the organ had suffered intracranial haemorrhage, or bleeding in the brain, barely a week after the transplant. He was declared brain dead on October 5.

All but 1 of 21 patients refused ‘used liver’ for transplant op
According to Max hospital doctors, the liver belonged to a 44-year-old woman from Gurgaon who had a history of seizures and hypertension, who was declared brain dead following a brain bleed at Fortis Gurgaon on September 21.

The woman’s family consented to donate her heart, liver, kidneys and corneas. The 44-year-old’s liver was transplanted into a 53-year-old man from Gurgaon who was suffering from liver failure. The recipient was recovering well post-transplant, but he also developed the same problem as his donor — brain bleed (intracranial haemorrhage) on September 28, after about a week of the liver transplant operation.

After taking the opinion of a neurologist, he was declared brain dead on October 5 at about 9.40pm. The family of the 53-year-old insisted that his organs, including the liver, be used to save other lives, following which the National Organ and Tissue Transplantation Organisation (NOTTO) was informed.

An alert was sent out by NOTTO to all hospitals that had the facility for liver transplantation about the availability of a previously transplanted liver, Dr Gupta said, adding that none of the hospitals came forward to accept the reused liver.

“We at Max hospital Saket had about 21 patients waiting for the liver in the same blood group. We contacted all of them. All, but one patient, refused to get the transplant from this liver,” the transplant coordinator at Max Saket said. There is a high risk of rejection in transplant involving a liver that has been used before. Dr Gupta said this was explained in detail to the new recipient, a 54-year-old man from Delhi, but he still wanted to go ahead.

Several precautions were taken to assess the risk of rejection prior to transplant, the doctor said. “First, we checked the quality of the liver by looking at the liver function tests. To our surprise, these tests were pristine. Then, we confirmed that there had been no break in the immunosuppressive therapy after the onset of intracranial bleeding whilst the now recipient-turned-donor had been on the ventilator in the ICU. The coordinators confirmed that no rejection episode had occurred after the transplant and the intracranial bleed was unrelated to the transplant process. This information was obtained by carefully studying the post-transplant medical records,” he said. The liver transplant using the previously transplanted organ was carried out on October 6.

According to the doctors, the first few days are critical for the overall success of the transplant. “Luckily, soon after the surgery, the patient came off the ventilator with mental faculties completely intact. The liver enzymes did go very high, but with infusion of N-acetyl cysteine, we were able to control it. There is a possibility that a severe rejection episode may happen in the next few days. We are prepared to deal with it as all lines and tubes have been removed so that infection does not flare up with increased immunosuppressive therapy,” Dr Gupta said.

The doctor said his team would also be on the lookout for any intracranial bleed. “Blood pressure will be kept under control and no antiplatelet agent will be used,” he said. The success of this transplant opens another door for those waiting for organ transplants, the doctor said. Many organ recipients die from post-transplant cardiovascular events and not from failing grafts, Dr Gupta added.

1st in India: Transplanted liver reused, saves life
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