Little did a 55-year-old Mumbai doctor suffering from liver cancer, and a 36-year-old Kolhapur farmer putting up with end-stage liver failure, realise till four months ago that their destinies would be so closely intertwined — that they would have successful liver transplants through exchange of their donor livers and become connected forever.
Suffering as they were with terminal ailments, the two — the doctor and the farmer — had lost all hope of life-saving liver transplants, as the only available family donors — their respective wives — were of different blood groups.
A rare donor liver exchange was successfully performed on them three weeks ago at Sir HN Reliance Foundation Hospital here by a liver transplant team headed by renowned liver surgeon Dr AS Soin.
Congratulating his team for its achievement, Hospital’s CEO Dr Tarang Gianchandani said that a team of 35 doctors toiled for 14 hours in 4 operating theatres to perform the two liver transplants. “Apart from Sir HN Reliance Foundation Hospital, Mumbai, only a handful of other hospitals in India and abroad have the infrastructure, expertise and coordination to pull off such a challenging case,” she said.
Dr AS Soin, Director and Chief Transplant Surgeon said: “Atam (name changed) and his wife’s blood groups were B and A and that of Bikram (name changed) and his wife’s, A and B respectively. An exchange of the livers donated by each donor allowed us to transplant both patients and save them. The biggest challenge in swap transplant surgery is that all four operations (two patients and two donors) must take place simultaneously, otherwise the donor for the second transplant (first recipient’s relative) may refuse to undergo surgery once their own loved one has been transplanted”.
Dr Soin’s team comprised surgeons and anesthetists including Dr Amit Rastogi, Dr Thiagarajan, Dr Soumil Vyas, Dr Pravin Agarwal, Dr Hemant Mehta and Dr Vijay Vohra.
While kidney swaps are common, they are rare in liver transplantation as the operations are far more intricate, take eight to ten hours each, must be done with zero error, and apart from blood group, also need liver size matching between patients and donors.
“Out of nearly 3,100 liver transplants, we have done 43 swaps in 86 patients, which is the highest such experience globally,” Dr Soin said.
“We are now developing an AI-based liver exchange algorithm that matches incompatible patient-donor pairs to maximize the number of transplants. In fact, we are now contemplating inter-hospital and inter-city swap transplants. The ethics of possible swaps between different organ donors, for example — ‘liver for a kidney’ swap, are also being debated,” Dr Soin said.
Dr Chetan Bhatt, Director, Gastroenterology and Hepatobiliary Sciences said: “The pre-transplant preparation of both patients was very challenging, as they were very sick – one with advanced cancer and the other with recurrent life-threatening bleeding and liver failure-related kidney dysfunction. Neither of them would have survived more than a few months without a transplant. The successful exchange was an outstanding example of how the sharing of human suffering and joy transcended social barriers and united two families.”
“The swap option is a blessing at the time of organ donor shortage,” Dr Bhatt said.
Three weeks after the transplants, both patients and the donors are on normal diet, convalescing well, and fast returning to normal lives.