Times of India
20 August 2009
By Kounteya Sinha
New Delhi, India

They lived in different parts of the world till about three months back, when terminal liver failure brought them together in Delhi. Now, 18–month–old Nigerian boy Dike and 44–year–old Mumbai resident Priya have become India’s first patients to successfully undergo a swap liver transplant surgery.

Unable to find suitable donors with a matching blood group for either Dike or Priya, doctors from Sir Ganga Ram Hospital decided to try out a liver swap, much on the lines of a swap kidney transplant, which has now become common.

Five months after his birth, doctors diagnosed Dike with Billiary Atresia – a rare condition of newborn infants in which the common bile duct between the liver and the small intestine is blocked or absent. If unrecognised, the condition leads to liver failure. And this is exactly what happened to Dike. On the other hand, Priya’s state was also critical. Already suffering from advanced liver failure due to Hepatitis C infection, she was later diagnosed with tuberculosis.

With transplantation being their only hope, doctors hit a dead end – unavailability of compatible cadaver donors. But by a stroke of luck, Dr A.K. Soin (chief of liver transplant unit), Dr Neelam Mohan (paediatric hepatologist) and Dr Sanjiv Saigal (transplant hepatologist) found that the blood group of Dike’s mother Chinwe was A which matched with Priya. On the other hand, Priya’s husband Haresh belonged to the blood group B which was the same as Dike.

A 35–member surgical team then took 50% of Chinwe’s right liver and transplanted it into Priya while Harish gave 20% of his left liver to save Dike.

Almost two months after the surgery, both Dike and Priya are normal.

“While both donors’ blood groups did not match their own recipients’, they were suitable for the other recipient. Dike’s father had the same blood group as the kid but he had very fatty liver and so wasn’t a suitable donor. When we suggested the idea of a donor exchange, which is also called paired donation, both families jumped at the opportunity,” Dr Mohan said.

Dr Soin added, “The biggest challenge in paired donation transplants is that both transplants must take place simultaneously, otherwise the donor for the second transplant (first recipient’s relative) may refuse to undergo surgery once his own loved one has been transplanted.”

“While donor swaps are common in kidney transplantation which takes two hours, they have not been previously attempted in liver transplantation as conducting two simultaneous living donor liver transplants (four operations) is a daunting task taking 10–12 hours each. The swap transplant took 16 hours in four different operating theatres and took place on June 25,” Dr Soin said.

Dr B.K. Rao, chairman of Ganga Ram Hospital said, “This swap transplantation will come as a blessing at the time of acute organ donor shortage. Around 30% of rejected donors can become suitable swap donors, increasing transplant rates by 30%.”

India at present requires 30,000 liver transplants a year. Unfortunately due to the country’s abysmally low cadaver donation, doctors end up doing just 400–odd transplants a year.

Dr Saigal said, “Encouraged by this case, we have instituted registration of patients with medically suitable family donors who do not match their own recipients due to inappropriate blood group or liver size. This opens up unique opportunities for matchmaking between donors and recipients from different families, thus helping save more lives with liver transplants.”