Registration for A Deceased Liver Donor

A Deceased Donor Liver Transplant involves surgically replacing an unhealthy or diseased liver (that no longer functions normally) with a healthy liver from the deceased donor. This is also medically referred to as Cadaver Liver Transplantation. The liver is donated from a deceased donor either after brain death or circulatory death. Generally, these deceased donors are registered organ donors. However, in some cases, the family members decide to donate the deceased’s organs to save someone’s life after the donor's death. 

Once the person is declared dead, the surgeon removes the liver and places it in a sterile fluid. The recipient of the liver is informed, and the surgeon schedules a date for the surgery as the liver can only survive for 12 hours under strict conditions outside the body.

The liver donation from the deceased person can be made either after a brain or circulatory death. 

1. Donation after Brain Death (DBD) donors: Approximately 75 out of 100 livers donated by deceased donors are from donors whose brain stops working and are declared brain dead.

2. Donation after Circulatory Death (DCD) donors: Approximately 25 out of 100 livers donated by deceased donors are from donors whose heart stopped working and are declared circulatory dead. This type is a newer process of liver transplantation.

Before undergoing a liver transplant, the recipient must be registered online to identify a matching donor for a liver transplant. The recipient registration and listing are done by the following steps:

1. The first step for a liver transplant is to talk to your doctor and find out if you are a liver transplant candidate. If the doctor thinks a liver transplant is right for you, they will refer you to a transplant centre. The doctor will recommend a liver transplant only when they rule out other treatment options. 
2. At the transplant centre, your transplant team will evaluate your medical history and perform some tests, such as a physical exam, urine and blood tests, and imaging tests. 
3. Once approved, the transplant centre will submit your name through an online registration form on the official website of the National Organ and Tissue Transplant Organization (NOTTO) to be placed on the national waiting list for a deceased liver donor. 
4. The Liver Advisory Committee, consisting of three Apex Technical Committee members of the NOTTO, will approve the registration form and the urgency criteria. 
5. Super-urgent listing for a liver transplant can be done in the following situations:
   1. Primary non-function of liver allograft.
   2. Early Hepatic Artery Thrombosis (HAT) requiring re-transplant.
   3. A living liver donor who develops a life-threatening liver failure.
   4. Fulminant Hepatic Failure (FHF).
6. Contraindications to listing for deceased liver transplantation include:
   1. A model for End-Stage Liver Disease (MELD) score of less than 15.
   2. Acquired Immune Deficiency Syndrome (AIDS).
   3. A serious cardiac or pulmonary disease.
   4. A severe infection.
   5. Uncontrolled sepsis (a life-threatening condition caused by your body’s response to an infection).
   6. Extrahepatic malignancy (cancer outside the liver).
   7. Intrahepatic Cholangiocarcinoma (a rare malignant tumour occurring in the bile ducts within the liver).
7. You must be under 65 years when listing your name for deceased donor liver transplantation. 
8. You should be registered only in one centre enrolled under the Transplantation of Human Organs and Tissues Act (THOTA). 
9. You can be registered as a deceased donor while waiting for a living donor transplant.
10. The transplant centre must update your status monthly. For super-urgent patients, the status must be updated daily to NOTTO. 

Usually, there is no restriction on organ donation, and you can donate one or more of your organs and tissues at any age. There are two ways to become an organ donor:

1. Pledging your organs while alive: You can pledge to be an organ donor with a simple procedure. All you need is to complete an online pledge form registered with National Organ and Tissue Transplant Organization (NOTTO). However, please note that even after pledging your organs, your next of kin will decide whether to donate your organs upon death. It is, therefore, critical to discuss this with your family before becoming a donor. 
2. By consent of the family: Once declared dead, the state and national registries are searched to determine if you have pledged your organs personally. Even if you haven’t pledged your organs, your next of kin can consent to organ donation upon death to save someone’s life. 

The registration for organ donation can be done at both state (Reginal Organ and Tissue Transplant Organization - ROTTO) and national (NOTTO) levels. The state-wise waiting list of patients is maintained by State Organ and Tissue Transplantation Organization (SOTTO). 

The allocation for the donated liver is done as follows:

1. Allocation is done based on the state waiting list. If no recipient is eligible on the state waiting list, then it is allocated to the nearby Regional Organ and Tissue Transplantation Organisation (ROTTO). 
2. The liver from a paediatric donor (less than 16 years of age) first goes to a paediatric recipient. If no paediatric recipient is eligible, it goes to an adult recipient. 
3. Blood group ‘O’ liver is first allocated to a recipient with group ‘O’. If no recipient is eligible, then the liver is allocated to recipients with other blood groups. 
4. For blood groups other than ‘O’ (i.e., A, B, and AB), the liver first goes to the recipient with the same blood group. If not, it is allocated to a recipient with the ‘AB’ blood group. 
5. If an eligible recipient is on the super-urgent list, the liver will be allocated to that recipient. If not, the liver will go to the recipient requiring a multi-organ transplant, i.e., simultaneous liver-kidney transplant. 
6. ROTTO is responsible for the coordination of the liver located outside the state. 
7. International patients are at the bottom of the waiting list; hence, their chances of receiving a liver from a deceased donor are rare. 

Although the national waiting list for organ transplants helps allocate livers to those most in need, the demand for livers surpasses the supply. Despite their names on the waiting list, several people die in India due to the unavailability of livers. The need of the moment is to spread awareness about organ donation. Pledge your organs TODAY to save a life in the future!

You can get in touch with an HexaHealth expert for any queries you may have about the registration of a deceased liver donor. We provide the best care and zero-cost surgery assistance. We take care of hospital admissions, insurance claims, and other paperwork at zero cost. Our team of 1500+ expert doctors will assist you throughout the treatment, from registration to recovery after liver transplantation.