TN leads in protocol for liver failure

Acute liver failure is a serious condition occurring in both children and adults. It is caused by certain viral infections, medications or congenital problems, though sometimes the actual cause may never be found. This disease is associated with jaundice (yellowish discolouration of eyes), excessive bleeding and altered consciousness. The disease can damage multiple organs, such as the kidneys, brain and lungs, and needs immediate treatment. 

The treatment of patients with acute liver failure is complex and needs the involvement of liver physicians, intensive care specialist and liver surgeon. Treatment in the early stages is primarily medical and involves treating the cause (anti-viral treatment, stoppage of the medications responsible) and supporting the liver and other affected organs. 

Liver transplantation has a central role in such cases. A combination of parameters is useful to identify patients who need emergency liver transplantation. Once the patient has reached these parameters, time is of the essence and urgent transplantation, usually within a matter of hours to days, is required. These patients should hence be ideally treated in a centre with expertise in liver transplantation from an early stage. 

In these situations, the major limiting factor is finding a suitable donor organ. In the West where liver transplantation is well established, these patients are prioritized over other non-urgent patients and waiting time may be less than a day. Unfortunately, in our country, organ donation is still uncommon. Most parts of the country do not have an organized system to identify patients who need a transplant urgently and allocate an organ to them. This means patients die waiting for a donor liver.

Tamil Nadu was the first state in India, which identified this specific need and developed protocols for patients with acute liver failure. Once a patient is diagnosed to have acute liver failure and is deemed to need a transplant by the treating doctors, the transplant team informs the Tamil Nadu state transplant authority. The next available donor liver of compatible blood group is offered to that patient. Availability of donor organs in a timely fashion can make a difference of life or death for these patients. Similar laws have now been promulgated in other states. 

Despite the enormous strides taken by Tamil Nadu in increasing organ donation, the number of organ donors is still not sufficient to cater to all patients needing a transplant. Living donor liver transplantation where a close family member donates a part of his/her liver is an alternative. Here the potential donor undergoes a battery of investigations to make sure that a part of the liver can be safely donated. When all investigations are satisfactory, the donor and recipient have to attend an interview with the government committee to get approval for transplantation. In special situations like acute liver failure, the Directorate of Medical Education has been able to convene emergency committees to fast-track approvals for these transplants, which have greatly helped improve liver transplant outcomes in our state.