5 strategies to reduce wait-time for cadaveric or deceased donor liver transplantation in India
1. Early registration in the liver transplant wait-list
“The time to repair the roof is when the sun is shining". - John F. Kennedy
The time in waiting list for most of the organs in India is usually depends upon the time of registration. Earlier registration gives an opportunity to be on top of the list and an opportunity to get a liver when its needed. Multiple studies through out the world have shown that earlier transplant leads to better outcomes. Unlike USA, where the organ allocation is based on MELD scoring (sickest gets the liver first), the allocation depends on the center of registration. The patients are usually listed for liver transplantation, when MELD Score is more than 15 or if the patient has liver tumor in cirrhotic liver. Experimental therapies (Stem cell therapy, weight loss etc..) have not proven to be effective yet and further delays the life saving liver transplantation. The referral for transplantation are also delayed due to lack of clear understanding of indications for liver transplantation.
2. Go south
The chances of getting a cadaveric liver transplantation is higher in the south. The reason is quite simply stated, more cadaveric donors are available in south. The following map, state-wise distribution of total cadaveric liver transplantation done (2015) in India. There is a clear trend of higher rate of cadaveric donation in south India compared to rest of the India. More exposure, better government policy, awareness has led to better organ donation rates in south. It makes sense to shift to south till you get your liver.
3. Multi-centre registration.
The only way to realistically increase the chances to get a liver transplantation is get listed in multiple centre. Though it cost a lot in USA with added logistic costs for travel and stay, in India it is relatively simple and inexpensive. Most of the centres accept the transplant workup done at the NABL accredited Labs. The cost for registration at various places is relatively inexpensive and shown in the table below. Foreign nationals can also register but with the initial preference would be given to Indian nationals at regional and national levels.
4. Centres with excellent transplant team
Unfortunately, there are lot of centres in India with single transplant surgeon and minimal support staff. Saidi et al describes about the use of marginal livers which were not used in the region, were utilised by large volume centres in USA with almost equal outcomes. Thats why its imperative to register with a transplant team with competent members, as they are more likely to use marginal organs confident-ally and hence increase the chances of transplantation. One need lots of expertise to use marginal organs and get good results.
5. Blood group - AB
Patients with blood group - AB can receive an organ from any blood group donors. Since the allocation is centre specific, the chances for getting liver for blood group - AB increases multiple folds. The patients with blood group AB should definitely register for cadaveric transplantation. Its a nature as they can receive organs from any blood group.
