Multi Organ Transplant Hospital

We have done more than 600 + liver transplants .The success rate for liver transplant at our center is 97%.

Liver diseases are divided in to two main categories Acute and Chronic. Acute liver diseases are viral hepatitis (A and E), liver abscess, liver infection which needs medical management. However, chronic liver diseases include cirrhosis of liver, chronic viral hepatitis (B and C), Hepatobiliary malignancies etc which needs aggressive monitoring, medical as well as surgical management including liver transplant. Now a day Nonalcoholic Fatty liver diseases (NAFLD) also called as fatty liver is soaring due to unhealthy lifestyle, obesity and insulin resistance which after few years can causes fibrosis, cirrhosis and sometimes hepatocellular carcinoma (cancer). The only treatment for fatty liver is early detection and evaluation of the disease progress which can help in managing these patients with medication as well as proper dietician consultation if needed.

We have dedicated 8 beds for critically ill liver patients and 7 beds for immediate post liver transplant patients which are monitored and managed by trained liver Intensivist working round a clock. Also we have dedicated high edge technologies in the operation theater required for liver transplant where 12-15 liver transplants are done in a month. We believe in a team work where everyone thinks about best line of treatment including pre and post-transplant patients.

In today’s era liver transplant has gained huge success. The success rate for liver transplant including LDLT and DDLT across all over the world is around 80-85 %. We are able to achieve success rate upto 95 % with great effort and team work. Also these statistics numbers are extraordinary due to patient compliance and regular follow up with stream line communication with the transplant coordinators and doctors.

• Main pancreatic hormone is insulin, which acts to lower blood sugar.
• Maintaining proper blood sugar levels is crucial to the functioning of key organs including the brain, liver, and kidneys. The pancreas contains exocrine glands that produce enzymes important to digestion. These enzymes include trypsin and chymotrypsin to digest proteins; amylase for the digestion of carbohydrates; and lipase to break down fats.
• Even though traditionally it helps in digestion the reason for transplant is for sugar control. The well controlled sugar levels help in the control of diabetes. This helps in halting progression as well as reversal of organ damage that usually occurs in diabetes.

• Type 1 diabetes with end stage renal failuire
• Type 1 DM that cannot be controlled with standard treatment
• Frequent insulin reactions
• Consistently poor blood sugar control
• Severe kidney damage
• Type 2 diabetes associated with both low insulin resistance and low insulin production ( in selected patients only)

• Pancreas transplant alone- People with diabetes and early or no kidney disease may be candidates for a pancreas transplant alone. A pancreas transplant surgery involves the placement of a healthy pancreas into a recipient whose pancreas is no longer functioning properly.
• Combined kidney pancreas transplant– Combined (simultaneous) kidney-pancreas transplants for people with diabetes who have or are at risk of kidney failure. Most pancreas transplants are done at the same time as a kidney transplant.
• Pancreas after kidney transplant – For those facing a long wait for both a donor kidney and a donor pancreas to become available, a kidney transplant may be recommended first if a living- or deceased-donor kidney becomes available.

Patient needs to undergo various tests such as Blood tests, CT Abdomen / Ultrasound abdomen, 2DEcho as a part of the evaluation process. Once they are found to be fit for a transplant, they are registered on the waiting list.

• The recipients are required to undergo periodic checkups with the transplant unit to adjust the immunosuppression. With passage of time, the requirement for immunosuppression comes down and the frequency of follow up reduces.
• The recovery period following a transplant is usually 7-10 days. The recipients are put on immunosuppression and are followed up on a regular basis to monitor the pancreas function. They are expected to resume their normal routine in a months time. There is no restriction on their physical activity or the diet. The physical and mental development is the same as their peers.

• Congenital conditions such as necrotizing enterocolitis.
• Malabsorption syndromes
• Motility disorders in children
• Mesenteric ischemia
• Volvulus
• Invasive mesenteric tumors in adults.

These patients suffer from malnutrition and have progressive weight loss. They need to be started on artificial nutrition which is expensive and is associated with complications such as life threatening infection.

Intestinal transplant is the treatment of choice for these patients with intestinal failure.

• Isolated intestinal (Small Bowel) Transplantation
  In an isolated intestinal transplant, the diseased portion of the small intestine is removed and replaced with a healthy small intestine from a donor. In an isolated intestinal transplant, the disease limited to the small bowel only without liver failure. This procedure can be lifesaving for patients with irreversible intestinal failure that has become life-threatening.
• Combined Liver and Intestinal Transplantation
  Combined liver and intestine transplantation is done for patients with both liver and intestinal failure. IN In this procedure, the diseased liver and intestine are removed and replaced with a healthy liver and intestine from an organ donor. Complications of intravenous nutrition (TPN) are the main cause of liver failure attendant to intestinal failure. Without a transplant, patients with intestinal and liver failure have an expected median survival of 6 – 12 months while continued on TPN.
• Multivisceral Transplantation
  Multivisceral transplantation is performed where two or more intra-abdominal organs (including the intestines) are failing. The transplanted organs may include the stomach, duodenum, pancreas, intestine, and liver. This complex procedure can be life-saving for patients with combined abdominal organ failure resulting diseases such as Gardner’s syndrome (familial colorectal polyposis), a pre-malignant colorectal condition and intestinal pseudo-obstruction (decreased ability of the intestines to push food through).

The recovery period from the transplant takes 2 to 3 weeks. Patients can lead a normal life and consume a normal diet post transplant.

Seventy five percent patients are able to have successful outcomes and can be weaned off artificial nutrition.

• Blood group and HLA typing
• Laboratory tests: automated blood count (CBC), hepatic and renal function tests, coagulation profile
• Serologic tests: CMV, EBV, HIV, as well as hepatitis A, B, and C
• Radiographic evaluation of the entire gastrointestinal tract to determine actual bowel length and function (transit time)
• Duplex Doppler sonography of the intraabdominal vascular system (abdominal aorta, superior mesenteric artery, portal vein, superior mesenteric vein). Conventional angiography (e.g., mesentericography, splenoportography) is not routinely done and only required for selected patients
• Liver biopsy (only for recipient candidates with clinical evidence for total parenteral nutrition-induced liver dysfunction in order to assess the need for a simultaneous liver transplant)
• Assessment for the presence of infectious foci (including dental and ENT consults)
• Additional organ system-specific investigations as dictated by pathologic results of the aforementioned evaluation process (e.g., coronary angiography, pulmonary function tests, creatinine clearance).

Cadaveric (brain dead) donors

• Blood group and HLA typing.
• Laboratory tests and serologies as described above.
• The donor’s weight should range between 20% and 50% of the recipient’s weight.

Living donors

• Thorough history and physical (including detailed family history) to exclude unspecific (e.g., cardiovascular) or specific (e.g., bowel disease) contraindications to living donation.
• Blood group and HLA typing as well as laboratory and serologic tests as described for cadaveric donors.
• Angiography (mesentericography) to assess the vascular supply of the small and large intestine.

1. Severe acute heart attack with major heart dysfunction
2. Severe multi valvular disease with heart dysfunction
3. Congenital heart disease with severe untreatable conditions
4. Severe viral infections of the heart causing myocarditis
5. Dilated cardiomyopathies and other infiltrative diseases of the heart

Any patient who has a heart function of 25 % or lower should meet one Heart failure specialist or a heart transplant surgeon and get a full work up done.

1. Medical treatment which includes salt and water restriction , diuretics ( to increase urine output) , mediations to control heart rate and Special heart failure medications like ARB . treatment of any inciting factor like infection , fluid overload , arrhythmias or drug induced changes.
2. Use of AICD or artificial defibrillator in patients with severe arrhythmias
3. Heart transplantation reserved for patients with refractory heart failure, multiple admissions , severe life threatening arrhythmias and severe hypotension requiring inotrope (blood pressure increasing injections)
4. Mechanical heart devices like Left ventricular assist device ( LVAD ) and Total artificial heart (TAH ) to be used in few patients who are otherwise not a candidate for heart transplant

1. Detailed evaluation of symptoms supported by various investigations to understand the irreversibility of the underlying condition
2. Detailed evaluation of other organ systems to rule any other life threatening disease of organ dysfunction which can reduce life expectancy of the patient due to any other cause
3. Registration with ZONAL TRANSPLANT COORDINATION COMMITTEE (ZTCC)
4. Once a suitable brain dead organ donor is available and allocated by the ZTCC , admission to hospital for the transplant procedure
5. Post-transplant discharge advice and medications
6. Post-operative follow up to evaluate graft function and to identify any early signs of dysfunction
7. Evaluation of general well-being and prevention of infections
8. Making entire family and neighborhood sensitized to the need of organ donation as it is chain reaction to ensure many other patients and families get the benefit of organ transplantation.

All potential recipients for hand transplantation undergo a detailed consultation to understand the complexity and magnitude of the entire procedure. A thorough clinical examination is performed to assess the technical possibility of the procedure. This is followed by detailed investigations and consultation with multiple other specialists involved in the transplantation process. After a detailed psychosocial assessment, the patient is then listed for hand transplantation with the competent authorities of the state government. Following this, we have to wait for a suitable brain-dead donor to donate his hands, which can be attached to the recipient, after appropriate cross-matching. Blood group and HLA cross-match are crucial for the final decision making.

The hand transplant surgery is technically complex and challenging surgery, and it needs a large multidisciplinary team of Plastic and Hand Surgeons, skilled with microsurgical expertise. The transplant surgery needs coordination between all the team members. The average operating time for single hand transplant is 8-10 hours and for double hand transplant is 15-18 hours.

Pre-operative matching of the donor and recipient is performed to ensure compatibility for transplantation. Before surgery, the recipient is started with immunosuppressive medications to avoid rejection of the transplanted hand.

The donor hand is attached to the recipient part by part – bones are fixed first, followed by repair of major blood vessels, tendons, nerves and skin.

Following the surgery, the recipient is closely monitored by the ICU team to ensure smooth hemodynamic recovery. The patient is shifted out of the ICU after 10-14 days. The early physiotherapy and rehabilitation start few days after the surgery and continues throughout the stay of the patient. The patient is usually discharged 3-4 weeks after the surgery.

Hand transplantation is the only procedure which restores a normal physical appearance, with good motor and sensory function, comparable to a normal hand.

No other method of reconstructive surgery or prosthetics can provide a comparable solution or outcome for a hand amputee.

Global Hospitals, Parel, Mumbai is a leading transplant center in Mumbai and Western India. We have the most cutting-edge equipment, carry out innovative new procedures, and follow the best protocols in reconstructive transplantation surgery.

You could not be in better hands to receive this wonderful new opportunity, and live your own life again, on your own independent terms.