NEW DELHI: Ramesh Rani, a 57-year-old woman suffering from liver cancer, recently underwent an organ transplant at a Delhi hospital after her husband and her son donated part of their liver. Doctors said dual donation is rare and even rarer is the use of two left lobes — as was the case here — to form a single graft to be used for transplantation.
The liver is divided into two sections: the right lobe and the left lobe. Usually, surgeons take out the right lobe, which forms 65% of the liver, from a single donor to conduct a transplant.
Dr Naimish Mehta, chief liver transplant surgeon at Gangaram Hospital, explained it was required in this case because the right lobes of both the donors, Ramesh Rani’s husband Mangat Ram and son Manjeet Singh, were larger than usual and if they were removed, the remaining left lobe may have failed to perform liver function.
“Normally, the right lobe is 60-65% of the liver and left is 35-40%. In the case of these donors, the right lobe consisted more than 70% of the liver, so it couldn’t be removed. We decided to take out the left lobe instead and join them to make a single graft to be used for transplantation,” he added.
The complexity didn’t end here. A routine dual lobe liver transplant involves implantation of one right lobe and one left lobe taken from two donors. But, in this case, because both grafts were left lobes, forming a single graft was difficult. Dr Mehta said they had to convert one left lobe into a right lobe by rotating it by 180 degrees. Also, all the structures in the liver had to be joined with sutures in a reverse fashion as the liver is upside down.
“The veins had to be extended with an artificial graft so that there is no bend or kink in the vein of the left lobe while suturing it with the right side of the patient’s body vein,” he added. The transplant was conducted on June 24 last year. It took 18 hours and involved 20 doctors and nursing assistants. “Due to the implantation of two liver lobes, the time taken for surgery was longer, thereby increasing the chances of reperfusion injury which could have led to a heart attack during the procedure,” said Dr Sashank Pandey, senior liver transplant anaesthetist at the hospital.