Multi Organ Transplant Hospital

Overview

Global Hospitals Mumbai, is Western India’s most comprehensive multi organ transplant centre. With more than 500 Liver and Kidney Transplants and active programs in Hand, Heart, Intestine, Lung, Pancreas and Bone Marrow transplant, the Hospital offers multidisciplinary care for all Transplants under one roof.

The Hospital has been awarded Best Hospital for Multi Organ Transplant in Western India for consecutive 3 years. The team is adept at handling all solid organ transplants including dual organ and multivisceral transplants and also Complex Vascular Composite Allograft (Hand) transplants.

The Hospital is the only one in India to perform a successful Bilateral Hand Transplants in a quadruple amputee and a Bilateral Hand Transplant with a partial hand transplant

Overview of Liver Transplant

Global Hospital, Parel, Mumbai brief about Liver Transplant

Liver is the only organ in the human body which can regenerate. Liver is the vital organ performing important functions of the body. Liver dysfunction can be managed medically, However Cirrhosis or End stage liver disease needs liver transplant as definitive cure. The Global hospital, Mumbai is western India’s leading liver transplant center. Moreover we have a team of 20 doctors dedicated to manage liver transplant patients. Team includes Transplant hepatologists, HPB surgeons, Liver Intensivists, Liver anesthetists, Pediatric hepatologist and interventional radiologist. We deal with various types of liver transplant which includes Living donor liver transplant (LDLT), Diseases donor liver transplant (DDLT), ABO incompatible liver transplant, Auxiliary liver transplant etc. Our center is recognized as one of the best in the country in management of acute liver failure (ALF) and Acute on chronic liver failure (ACLF) patients. Also we have leading edge technologies, research sources, fully equipped ICU and OT which makes Global hospital the health care destination of choice for national as well as international patients.

Milestones

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

Understanding the liver

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.

Infrastructure

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.

Liver transplant facts

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.

Overview of Pancreas Transplant

Who needs Pancreas Transplant?

  • A pancreas transplant is a surgical procedure to place a healthy pancreas from a deceased donor into a person whose pancreas no longer functions properly.
  • Most pancreas transplants are done to treat type 1 diabetes. About 15% of all pancreas transplants are performed in people with type 2 diabetes . Rarely, pancreas transplants may be used in the treatment of pancreatic cancer, bile duct cancer or other cancers.
  • A pancreas transplant offers a potential cure for this condition. But it’s typically reserved for those with serious complications of diabetes.
  • A pancreas transplant is often done in conjunction with a kidney transplant in people whose kidneys have been damaged by diabetes

Functions

  • 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.

Pancreas transplants are done for following conditions

  • 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)

There are several different types of pancreas transplants, including

  • 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.

Pre- transplant Work up

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.

Post Transplant Check up

  • 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.

Overview of Small Bowel Transplant

Intestinal Failure

Intestinal failure is inability of the intestines to adequately digest and absorb the food we eat to meet the nutritional demands of the body. Small bowel transplant is a procedure in which the small intestines are transplanted into a recipient from a deceased or a living donor.

Reasons of Intestinal failure

  • 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.

Types of Intestinal Transplant

  • 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).

Pre- transplant Evaluation

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.

Recipients

  • 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).

Donors

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.

Overview of Kidney Transplant

Global Hospital, Parel, Mumbai brief about Kidney Transplant

The Global hospital began its functioning in August 2012.

The first department in the hospital to be registered for kidney transplant and first kidney transplant was performed in August 2013.

Global Hospital, Parel , Mumbai provides all forms of nephrology (kidney) services. All kinds of kidney diseases are managed in outpatient and inpatient department. As regards renal replacement therapy, all forms of treatment are provided. This includes peritoneal dialysis (CAPD and automated PD), intermittent hemodialysis and hemodiafiltration, slow low efficiency dialysis (SLED), continuous renal replacement therapy. The IRS also does plasma exchange.

Global Hospital ,Parel ,Mumbai has one of the most active kidney transplant program. It is possibly no. one in performing preemptive kidney transplants. It is also one of the most active centers performing ABO incompatible kidney transplants.

The most important activity is patient education by way of weekly kidney workshops. This helps patients in taking care of their kidneys and planning the most appropriate treatment for their kidney disease.

Overview of Heart Transplant

As we all know, Heart and Lungs are one of the most important organs in the body. The heart and lungs work as a single unit for delivery and transport of oxygen to each and every organ and part of the body. Any significant dysfunction of this cardiorespiratory unit can lead to significant and sometimes irreversible changes in other organs like brain, kidney ,liver , intestine and also contribute to general ill-health.

Common symptoms for Heart Dysfunction

  1. Excessive fatigue, low Blood pressure
  2. Swelling of feet, fullness of abdomen with water accumulation
  3. Severe breathlessness even on minimal activity
  4. Blackouts or syncope
  5. Repeated admission in ICU or hospital with above symptoms

Common causes for heart failure

  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.

Options of treatment in heart failure

  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

Overview of Lung Transplant

Lung transplant is usually reserved for patients who have severe restriction of lung function and usually require home oxygen therapy.

Common causes of severe lung dysfunction are COPD (smokers lung) , Interstitial lung disease due to chemicals , dust , industrial exposure to toxins and hypersensitive reactions to some allergens.

Most of the patients complain of shortness of breath with reduction of saturation to below 90 % on simple walking and dependency on home oxygen. Few of them may present with severe carbon dioxide retention requiting a ventilator or Use of ECMO (extra corporeal membrane oxygenation).

Few newer medications like anti fibrotic medications can be used in patients to reduce the progression of symoptoms after diagnosis though they need to be in a close watch of a transplant pulmonologist and Lung transplant surgeon.

Process of Heart and Lung 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.

Overview of Hand Transplant

What is a hand transplant and why is it done?

Hand transplant is a surgical procedure to transplant one or both hands from one human being to another. The donor hand comes from a brain-dead donor.

Hand transplant can be considered for people who have lost one or both hands for any reason (road-traffic accident, industrial or agricultural accidents, electrocution, burns, sepsis, etc). The loss of partial hand or few digits can be managed by reconstructive surgery. However, if all fingers or entire hand is lost, there is no satisfactory reconstruction possible.

There is no good functional prosthesis for the hand, even in today’s advanced computer era. Artificial hands provide very limited function, and are often given up by the hand amputees.

Hand transplant is the only option for these amputees, which can help them to regain useful hand function in order to live an independent life. In appropriately selected candidates, this is the best rehabilitative option.

What is the screening process?

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.

What happens during the procedure?

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.

How long will be the hospital stay?

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.

What are the key benefits of hand transplant?

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.

Why should one choose Global Hospital Parel, Mumbai for hand transplant?

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.

Best Hepatologists in Mumbai

Dr Samir R Shah

MD, DM, (CMC Vellore)

Director - Department of Transplant Hepatology, HPB, Liver Intensive Care

Dr Ameet Mandot

MBBS, MD Internal Medicine, DNB Gastroenterology, Fellowship in Hepatology & Liver Transplantation

Senior Consultant - Clinical Lead Adult Hepatology & Liver Transplant

Dr Uday Sanglodkar

MBBS, DNB Internal Medicine, DNB Gastroenterology

Senior Consultant - Hepatology and Liver Transplant

Dr Alisha Chaubal

MBBS, MD (Internal Medicine), DM Gastroenterology

Consultant - Hepatology and Liver Transplant

Best Liver Transplant, Small Bowel and Pancreas surgeons in Mumbai

Dr Gaurav Chaubal

MBBS, MS(General Surgery), MCh (Surgical Gastroenterology) AIIMS- Delhi, Fellowship in Abdominal Transplant Surgery, Duke University Medical Hospital, USA

Director – Liver, Pancreas, Intestine Transplant Program & HPB Surgery

Dr Aditya J. Nanavati

MBBS, MS, Fellowship in Abdominal Transplant Surgery (Duke University, USA)

Senior Consultant - Liver, Pancreas and Intestine Transplant & HPB Surgery

Dr Rajeev Sinha

MS, FACS, Fellowship (Abdominal Organ Transplant Surgery), Fellowship ASTS (American Society of Transplant Surgeons)

Senior Consultant

Dr Hunaid Hatimi

MBBS, MS, DNB, MCh (GI Surgery), Fellowship in HPB Surgery & Liver Transplant

Senior Consultant - Liver, Pancreas and Intestine Transplant & HPB Surgery

Best Kidney Transplant surgeons in Mumbai

Dr Bharat Shah

MBBS, MD, DNB

Director & Head of Department

Dr Prashant Rajput

MBBS, DNB, DNB

Consultant

Dr Shruti Tapiawala

MBBS, MD, DNB

Consultant

Dr Zaheer Virani

MBBS, MD, DNB

Consultant

Best Cardiologist in Mumbai

Dr Praveen Kulkarni

MBBS, MD, DM

Senior Consultant

Dr Charan Lanjewar

MBBS, MD, DM, FACC (USA), FESC (Europe)

Consultant

Dr Milind Phadke

MBBS, MD, DM

Consultant

Dr Chetan Shah

MBBS, MD

Consultant

Dr Kaushal Chhatrapati

MBBS, MD, DM

Consultant

Dr Saurabh Goel

MBBS, MD, DM, MISCU, FAPSIC (Asia-Pacific)

Consultant

Best heart and lung surgeon in Mumbai

Dr Chandrashekhar Kulkarni

MBBS, MS, MCh, DNB, MRCS (Edin)

Senior Consultant

Best Hand Transplant surgeons in Mumbai

Best Plastic and Reconstructive surgeons in Mumbai

Dr Nilesh Satbhai

MBBS, MS, MCh

Senior Consultant & Head of Department

Dr Vispi Noshir Driver

MBBS, MS, MCH, DNB

Consultant

Best Anesthesiologist in Mumbai

Dr Anil Parakh

MBBS, MD, PDCC in Cardiac Anaesthesia

Head of Department

Dr Vaishali Kulkarni

MBBS, DA, DNB, FCPS

Consultant

Dr Rohit Deshbhratar

MBBS, DA, DNB, PDCC in Regional Anaesthesia and Acute Pain Management

Consultant

Best Orthopedic surgeons in Mumbai

Dr Anup khatri

MBBS, DNB

Consultant

Dr Shreedhar Archik

MBBS, MS, D Orth

Senior Consultant

Dr Neelkanth Dhamnaskar

MBBS, MS, DNB, D Orth

Consultant

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