Please reach us at drsilango@gmail.com if you cannot find an answer to your question.
A transplant is considered when the liver cannot recover and is causing repeat, measurable problems. Families can use the following clear triggers.
If any three or more of these stay abnormal for weeks, a transplant is usually required:
These numbers show the liver cannot maintain basic functions.
Observe these signs:
If the patient has two or more of the following, transplant is likely needed:
These signs reflect advanced cirrhosis.
Look for how frequently these complications occur:
Transplant becomes necessary when any of these patterns appear:
Recurrent complications show the liver has crossed the point of recovery.
Now there are situations where transplant is the only cure.
Transplant is usually required for:
Blood group matters in liver transplant because the donor liver must match the patient’s blood group for the transplant to be safe and successful.
We use the same blood groups everyone already knows: O, A, B, and AB.
Matching works like this:
O patients can receive only from O.
A patients can receive from A or O.
B patients can receive from B or O.
AB patients can receive from AB, A, B, or O.
AB patients have the widest choice, but as per our government rules: AB livers in deceased donor transplantation can receive organs only from an AB donor.
O patients have the longest waiting time because their only possible donors are O.
These rules exist because liver cells carry markers based on blood group. If the donor liver has a different marker, the patient’s immune system may attack it, leading to rejection. Matching prevents this.
The Rh factor (positive or negative) does not matter in liver transplant. Only A, B, O, AB are important.
Mismatched transplants can only be performed in special situations and require specialized treatment. They are not routine. We specialise in doing such liver transplants.
Families should remember: matching keeps the patient safe.
There are two main types of donors in liver transplantation, and each has its own advantages.
Families should understand both because the choice depends on availability, urgency, and medical suitability.
Deceased Donor (Brain-Dead Donor)
This donor is someone who has suffered complete and irreversible loss of brain function but whose heart is still beating with medical support. The liver is healthy and can be donated.
This is called a “cadaver donor” and is the most common source in many countries. Patients are placed on a waiting list, and the liver is offered based on rota in the region, urgency, blood group, and size.
Living Donor
A healthy family member or relative donates a portion of their liver. The liver regenerates in both the donor and the recipient. Living donation reduces waiting time and is lifesaving in urgent situations.
The donor must be healthy, the right blood group, and have a compatible liver size.
There are also special subtypes families may hear about:
Split-Liver Donor
A deceased donor liver is divided into two parts.
One part is given to a child, and the other to an adult. This helps two patients receive life-saving transplants from one donor.
Domino Donor
Rarely, a patient with a metabolic liver disease receives a transplant, and their own liver—which works well for others—is transplanted into a different patient. This is used only in very selected situations.
Donation After Circulatory Death (DCD)
This donor’s heart stops after withdrawal of life support. Their organs are quickly preserved and transplanted. This is common in Western countries but still developing in India.
Each donor type expands the chances of saving lives. Your doctor will decide which option is safest based on urgency, liver condition, blood group, and availability.
A transplant consultation works best when the team has complete information.
Bringing the right documents and items helps the doctors assess your condition quickly and accurately.
All medical records
Bring every report you have, even if old. This includes discharge summaries, clinic notes, biopsy reports, and previous treatment details. These documents show how the liver disease has progressed.
All blood test reports
Carry recent and old tests, especially bilirubin, INR, albumin, creatinine, sodium, viral markers, and any MELD-related reports. Trends over time are very important.
All scan reports and images
Bring ultrasound, CT scan, and MRI reports. If possible, carry them on a CD, pen drive, or through a hospital link. Images provide details that written reports may miss.
Current medication list
Write down all medicines the patient is taking, including blood thinners, diabetes medicines, diuretics, antibiotics, and supplements. This helps the team adjust treatment safely.
Past procedure details
If the patient has had endoscopy, banding, TIPS, paracentesis, or ICU admissions, bring those reports. They show the severity of the disease.
Identity and insurance documents
Bring Aadhaar, PAN, insurance card, proof of address, and any approval letters. This helps the hospital guide you through financial planning.
A family member who understands the case
Bring someone who knows the patient’s history and can help answer questions clearly. Important decisions often need family involvement.
A notebook and questions
Write down your doubts so nothing is forgotten. Liver transplant discussions are long, and having a list helps families understand the plan better.
Emergency contact details
Share the numbers of close family members. Communication is crucial, especially if the patient needs urgent evaluation.
Carrying these items ensures the transplant team can make the safest and most informed plan for the patient’s treatment and timing.
Frailty means the body has become weak, slow, and less able to handle stress.
In liver disease, frailty increases the risk of infections, falls, slower recovery, and poorer outcomes after transplant.
Measuring frailty helps the team understand how strong the patient is and what needs to be improved before surgery.
We use simple physical tests with clear numbers to check frailty.
Hand Grip Strength
The patient squeezes a hand-held device. Lower strength means higher frailty.
Typical cut-off values:
Men: < 26 kg = frail
Women: < 18 kg = frail
Walking Speed (4-Meter Walk Test)
The patient walks 4 meters at a normal pace. The time is measured.
Frailty threshold:
Walking speed < 0.8 meters/second = frail
(Example: Taking more than 5 seconds to walk 4 meters)
Chair Stand Test (5 Sit-to-Stand Test)
The patient stands up from a chair and sits down 5 times, without using hands.
Frailty threshold:
Taking > 15 seconds for 5 stands = frail
If the patient cannot complete the task, that also indicates frailty.
Liver Frailty Index (LFI)
This combines three tests: grip strength, chair stands, and balance. It is now widely used in transplant assessment.
Scoring:
LFI < 3.2 = Not frail
LFI 3.2–4.4 = Pre-frail (moderately frail)
LFI ≥ 4.5 = Frail
6-Minute Walk Test
The patient walks as far as possible in 6 minutes.
Frailty threshold:
Distance < 250 meters = high frailty
250–350 meters = moderate frailty
> 350 meters = good reserve
Albumin and Nutritional Markers (supportive tests)
Low albumin often accompanies frailty.
Albumin < 3.0 g/dL supports frailty but is not used alone.
Why measuring frailty is important
A frail patient has:
Higher risk of ICU stay,
Slower wound healing,
Higher infection risk, and
Longer hospital recovery.
Improving frailty before transplant with nutrition and physiotherapy significantly improves outcomes.
Because a liver transplant is a major surgery, the heart must be strong enough to handle the stress.
The following tests help the team understand how well the heart is functioning and whether it is safe to proceed.
ECG (Electrocardiogram)
This simple test checks the heart’s rhythm and electrical activity. It identifies issues like irregular beats, previous heart attacks, or conduction problems.
Echocardiogram (2D Echo)
This ultrasound of the heart shows how well the heart pumps, how the valves are working, and whether there is fluid around the heart.
It also checks for pulmonary hypertension, which is important in liver disease.
Cardiac Stress Test or Dobutamine Stress Echo
If the patient cannot exercise, medicines are used to “stress” the heart.
This test checks for reduced blood flow to the heart and helps detect hidden blockages.
It is essential for patients over 40 or those with diabetes, hypertension, or smoking history.
Coronary CT Angiogram or Conventional Angiogram
These tests give a detailed look at the heart’s blood vessels.
They help identify narrowing or blockages. Patients with diabetes, long-standing hypertension, or chest pain often need this test.
NT-proBNP Blood Test
This test shows how hard the heart is working. High levels may indicate heart failure or strain.
Right Heart Catheterisation (only when needed)
This is used to accurately measure heart pressures when pulmonary hypertension is suspected. It helps decide whether transplant is safe.
Heart testing ensures that the team can plan the safest approach for surgery and recovery. A strong and well-assessed heart reduces complications and improves transplant success.
All these tests will take 3 days to complete. Without these tests, it is unsafe to proceed with liver transplantation. We advice patients to do the tests in our hospital, so that the proper references for baseline will be readily available.
Please reach us at drsilango@gmail.com if you cannot find an answer to your question.
You may be able to donate part of your liver if you meet certain health, age, and compatibility requirements.
The goal is to ensure the donor’s safety and the recipient’s success.
Living donation is voluntary, safe, and the donor’s liver grows back to full size within weeks. In our program, we ensure the highest safety for our liver donors.
To be a donor, you generally need to meet the following:
Age 18 to 55 years: You must be an adult, physically and mentally capable of making your own decisions.
Blood group compatible with the recipient
Donation requires a safe match:
O gives to O, A gives to A or AB, B gives to B or AB, AB gives only to AB.
Good physical health
Donors must not have major illnesses like heart disease, cancer, uncontrolled diabetes, or severe obesity.
Healthy liver
No fatty liver, hepatitis, cirrhosis, or alcohol-related damage. A CT/MRI scan checks liver size and blood vessels.
BMI usually less than 30
Higher BMI increases surgical risk and may disqualify donation until weight improves.
No significant addiction issues
No active alcohol or drug use. Occasional social drinking is evaluated case by case.
Voluntary, without pressure
Donation must be freely chosen.
These are the first steps in donor selection. We select our donors in a 3- step process to ensure utmost safety for the donor.
The first step in assessing a potential liver donor is a set of simple, safe, non-invasive tests. These tests help determine whether the donor is healthy enough to proceed to the next stage of evaluation. At this point, nothing complicated or risky is done.
The initial screening includes the following:
Basic Vitals and Clinical Examination
Blood pressure, heart rate, BMI, weight, and a full physical check. Ensures no conditions that would increase surgical risk.
Complete Blood Count (CBC)
Checks hemoglobin, white cell count, and platelets.
Ensures the donor is not anemic, not fighting an infection, and has an adequate clotting reserve.
Liver Function Tests (LFT)
Includes bilirubin, AST, ALT, ALP, GGT, albumin, and INR.
Confirms that the donor’s liver is healthy and has no hidden damage or inflammation.
Kidney Function Tests (Renal Profile)
Includes urea, creatinine, electrolytes, and eGFR.
Donors must have normal kidney function for safe surgery and recovery.
Blood Group Testing
Confirms compatibility between donor and recipient.
O-to-O, A-to-A, B-to-B, and AB-to-AB are the usual requirements.
Viral Marker Screening
Checks for infections that can affect donor safety or be transmitted.
Includes HBsAg, Anti-HCV, HIV 1&2 in our program.
A donor must be free from these infections.
Ultrasound (USG) Abdomen
Looks at liver size, liver texture, fat content, and overall abdominal health.
Detects fatty liver, cysts, or structural issues early.
This is a key step because many healthy people may have silent fatty liver.
These tests will be done on the day you consult Dr. Ilango.
When a part of the liver is donated, we must ensure two things:
1. The part given to the recipient is big enough to support their body, and
2. The part remaining in the donor is big enough to keep the donor safe.
We use CT or MRI liver volumetry to measure this accurately. The computer calculates the exact size of the liver and its segments.
Key Measurements and Numbers We Use
Graft-to-Recipient Weight Ratio (GRWR)
This tells us whether the liver piece is big enough for the recipient.
Calculation: graft weight ÷ recipient weight × 100.
Safe thresholds:
GRWR ≥ 0.8%: Ideal
GRWR 0.7–0.8%: Acceptable in selected cases
GRWR < 0.7%: Too small, unsafe for the recipient
Example:
If the recipient weighs 60 kg, the graft should be at least:
0.8% of 60 kg = 480 grams
Future Liver Remnant (FLR) for the Donor
This is the portion of liver left behind in the donor after donation.
Safe thresholds:
FLR ≥ 30% for a healthy young donor
FLR ≥ 35% if the donor has borderline factors (BMI > 28, mild fatty liver)
FLR < 30% is unsafe and donation cannot proceed.
This protects the donor from liver failure after surgery.
Avoiding Small-for-Size Syndrome (SFSS)
If the liver transplanted into the recipient is too small, the recipient may develop complications: jaundice, fluid accumulation, and graft dysfunction.
A GRWR < 0.7% significantly increases this risk.
Matching Donor and Recipient Body Size
Large recipients need larger grafts.
Small donors may not be able to provide enough volume.
Volumetry helps determine whether the match is safe.
Evaluating Fat Content in the Liver
A graft with >10% fat is considered borderline.
A graft with >30% fat is unsafe for donation.
Fat reduces liver function and affects regeneration.
How the Team Decides
Donation is approved only when BOTH conditions are satisfied:
The recipient receives enough liver (GRWR ≥ 0.7%)
AND
The donor retains enough liver (FLR ≥ 30%).
If either number is unsafe, the donation is not allowed.
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