Shahid Akhter, Editor of ETHealthworld, Dr. Rajiv RochanLead Consultant, Hpb & Liver Transplant Surgery, Manipal Hospital, Learn more about issues related to liver transplant surgery.
Liver transplant: Challenge
As far as advanced medical care is concerned, the Indian scenario is very promising and the results are comparable to the best in the world. This also applies to liver transplants. However, the challenges are very intimidating and many, especially in very expensive and high-risk treatments such as liver transplants. Treatment is dangerous compared to the risks associated with other very sophisticated and complex medical treatments, such as complex cardiac bypass surgery. These operations have been very safe over the last few years. Liver transplantation has evolved significantly and the risk is much lower than it was years ago, but the risk of liver transplantation is still about 5-10%, making it one of the most risky treatment options to date. I am. But the benefits of this life-saving treatment are unparalleled. Patients get a new life lease, which is very important for patients in need of treatment.
Scenarios where health care is primarily funded by the patient himself or the challenges of such treatment in societies like India, at least very advanced health care treatments such as liver transplants, can be very challenging. I have.
Liver transplant: Lack of referral process
The first challenge is the lack of a formal referral process for patients in need of such complex treatments. We know that India’s healthcare system is very fragmented, but the government has primary health centers, local and public hospitals, and very complex tertiary and quaternary care in big cities. Since there is a hospital, I have tried many times to actually formalize it. .. The flow of patients through these hospitals or these doctors is not really standardized, which makes it very difficult to treat patients with advanced liver disease.
What is happening in the field is that a liver transplant surgeon or liver transplant doctor sitting in a quaternary medical hospital will generally meet the patient very late in the natural course of the disease. It becomes very difficult to select such patients with highly advanced liver disease for expensive treatment with significant risks. This would have been much better if we could focus and formalize not only liver transplants in India, but also the treatment or referral of complex treatments for all other complex treatments with significant risk. Is one aspect of being able to. One such method for formalizing these referrals is the standard operational protocol established by society or specialized agencies, for example in either adults or children suffering from decompensated liver disease. Ensuring that patients are in the district hospitals are early on, and patients in need of such complex treatments are required to be seen by a group of specialists rather than a single doctor. A group of doctors specializing in complex liver care.
Liver transplant: Lack of collaboration
Collaboration is the key to good or good outcomes of complex treatments, which also applies to liver transplants. For cancer, we are familiar with tumor boards and MDT conferences. However, for non-cancer-related treatments, such an approach is actually far away, rare in India, and certainly complex liver patients require such cooperation. Liver transplant surgeons are not the only ones who treat patients who need a liver transplant. It is a group of hepatologists, gastroenterologists, surgeons, anesthesiologists, physiotherapists and nutritionists, all of whom are involved in the evaluation of patients and the delivery of necessary treatments. Therefore, collaboration and collaborative decision making are very important to allow careful patient selection for optimal results. This is one of the areas we can do much better in India. Although some baby steps are happening, we are still in the very early stages of this collaborative approach to complex liver problems.
Liver transplant: Treatment costs
India’s third challenge is finance. Liver transplantation is an expensive treatment and many patients pay for it from their pockets. Arranging money for complex treatments takes invaluable time from the patient side. There is a difference between the cost of treatment and the amount paid by the patient. This is very important. In India, the two are equated. However, looking at other Western or more advanced healthcare systems, patients probably pay only a small portion of X, even if treatment costs X. It utilizes a very innovative source of funding. It can be insurance, private insurance that the patient pays in multiple small installments over his lifetime, or state-funded insurance. Here in India, this is a combination of the two, and CSR and crowdfunding, and hospital grants are other highly innovative means of distinguishing between the amount a patient pays for treatment and the actual cost of treatment. Indeed, we have used several innovative sources of funding to actually perform a pediatric transplant at a cost of Rs. 25,000-50,000 per family. The money is subsidized, but the hospital pays quite a lot. Focusing on these two or three challenges can really help in improving the outcome of liver transplant patients.
Pediatric liver transplant
As far as pediatric liver transplantation is concerned, these are a group of patients very close to my heart, thanks to my teacher and the place I trained. Treating these children is very important, especially in the Indian scenario where there were few centers with complex pediatric care about 10 years ago. Looking now, over the last decade, India has at least half a dozen centers, and complex liver care, including liver transplants, has produced very good results. I have to say that our center is one of them. .. Not only do children need liver transplants, but many other liver-related interventions and important follow-ups are also needed. I think another area we can focus on is to draw attention to those who are developing medical policies about the need for treatment for these children. Looking at the national health policy published a few years ago, cirrhosis in children is rarely mentioned, and I think this is one of the specific aspects of care that we really should focus on.
Liver transplant in the hospital manipal group
The strength of the Manipal Hospital Group lies in the spirit of collaboration inherent in the facility. Access to pediatric gastroenterologists from countless highly skilled medical gastroenterologists at the same facility, with such a large footprint throughout South India, India, and hospitals. Large referral network is a credit to many other excellent centers. The spirit of this collaboration, which is the key to performing complex treatments, is already inherent in our facility. I think this is where we outperform many other institutions and liver transplants, as complex therapies will definitely thrive in our center.
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