Liver Transplant Surgery in Nepal

The human body is a constantly working machine which requires all its parts to remain in perfect working condition in order to maintain a harmonious relation between the parts themselves as well as to maintain the regular equilibrium of the body. When even one of the body parts falls out of place from the regular synchrony, it can create devastating results for the entire system. One such important body part, the disorder in which creates havoc for the entire body is the liver.

What happens when your liver is unhealthy?

Prolonged stress on the liver due to factors like excessive alcohol consumption, viral infections (such as hepatitis), fatty liver disease, and autoimmune disorders can lead to liver diseases like cirrhosis, hepatitis, and non-alcoholic fatty liver disease (NAFLD).
When the liver is not in an optimal condition, the following symptoms might be observed:

• Yellowing of the skin and eyes is a common sign of liver dysfunction, indicating a buildup of bilirubin, a waste product that the liver normally processes.
• Feeling excessively tired even after adequate rest can be a sign of a struggling liver, as it may be unable to efficiently convert nutrients into energy.
• Continuous pain or discomfort in the upper right section of the stomach might be an indication of liver inflammation or enlargement.
• Nausea, vomiting, loss of appetite, and changes in bowel movements can be signs of liver problems affecting digestion.
• Swelling in the abdomen, legs, or ankles (oedema) can be a result of fluid retention caused by a compromised liver’s ability to maintain fluid balance.
• Dark urine and pale or clay-coloured stools can indicate issues with bile production and secretion by the liver.
• Sudden, unexplained weight loss could be linked to liver issues affecting metabolism and nutrient processing.

If any of these symptoms are experienced persistently, it is advisable to see a healthcare professional and get tested for overall well-being of health. Where the condition of the liver is still in a salvageable state, the healthcare provider is most likely to recommend treatments and medication to take care of the issue. But in the scenario where the liver is damaged beyond the salvageable state, the patient might be recommended to look for options for a liver transplant.

What is a liver transplant?

A liver transplant is a surgery in which a liver with no longer proper functioning is taken out and replaced with a healthy liver from another person. In a liver transplant procedure, the whole liver of a patient may be transplanted with a healthy one or just a part of it. In general, there are three types of liver transplant surgeries:

• Deceased donor liver transplant
• Living donor liver transplant
• Split-type liver transplant

Deceased donor liver transplant in Nepal:

In most cases of a liver transplant, the healthy liver is acquired from the body of a recently deceased organ donor. This type of liver transplant is known as a cadaveric liver transplant or deceased-donor liver transplant. In such cases, the patient is added to a waiting list for organ donation where the position of the patient on the list is decided based upon the factors like:

• Finding the proper blood and immune match
• Waiting time spent while being on the list
• Medical urgency of the condition
• Survival benefit of the recipient
• Distance from the donor hospital

This type of liver transplant procedure was performed for the first time successfully in Nepal in 2016, at the Shahid Dharmabhakta National Transplant Center (SDNTC), with a team led by Dr Pushkar Chandra Shrestha. The average cost for a deceased donor liver transplant in Nepal cast at around 21 lakhs INR based on various factors like the patient’s condition before the surgery, their chosen hospital services and facilities, medications etc.

Living donor liver transplant in Nepal:

In cases of living donor transplant, the donor is usually a first or second-degree relative of the recipient and is determined as the perfect match based on the blood and immune tests conducted. A section of the healthy liver from the donor is taken and transplanted into the body of the patient. The donor’s liver is able to regrow into a normal size with healthy bodily functions over time. In order to be eligible for a living donor liver transplant, the donor needs to fit into the following criteria:

• The donor should be a perfect match in blood and immune testing
• The donor should be a willing adult between the age of 18 to 60
• The donor should be in optimal health condition both physically and psychologically
• The donor should have a favourable BMI and healthy liver and kidney function
• The donor should not be pregnant or have any underlying health conditions

The living donor liver transplantation in Nepal was initiated in December 2016 when the first four patients received a liver transplant with the help of a Nepalese team of doctors who were supported by an Indian as well as a Korean team of expert surgeons. The average cost for a living donor liver transplant in Nepal can cost anywhere up to 23 lakhs INR approximately.

Split-type liver transplant in Nepal:

A third type of liver transplant procedure is the split transplant. In this procedure the healthy liver is taken from the body of the recently deceased donor and the liver is divided into two parts of left and right lobes. The right lobe is larger than the left lobe and the two parts can be used to help two patients who are an adult and a child respectively. This type of procedure is yet to be undertaken in Nepal but the recent developments in the field might make it possible in the near future. As far as the average cost of a split-type liver transplant goes in countries which have been performing the surgery, based on the Nepalese economy, the same procedure might cost anywhere up to 25 lakh INR in Nepal.

Paediatric liver transplant in Nepal

A paediatric liver transplant is a procedure to replace the unhealthy liver from a child’s body with a healthy liver received from a donor. The need for a liver transplant in the case of kids may arise due to the following reasons:
Tumours in liver or liver cancer

• Genetic disorders like Alagille syndrome that causes the bile ducts of the liver to narrow and fail
• A disease called biliary atresia that obstructs the bile ducts from carrying bile from the liver to the intestines
• Acute liver failure caused due to heavy damage done to the liver because of infections or medication

The paediatric liver transplant can be of either of the three types of transplant procedures. A portion of a healthy liver can be proclaimed from the body of a deceased donor or living donor and transplanted in the body of the paediatric recipient. In most cases of a split-type liver transplant, at least one recipient is a paediatric patient. A paediatric patient can also receive an organ from a deceased minor whose parents or guardians have given consent for donating their organs post their demise.

The first paediatric liver transplant in Nepal was successfully performed in Nepal in 2021 at the Tribhuvan University Teaching Hospital, by a team led by Dr Ramesh Sing Bhandari. The 11-month-old paediatric patient received a portion of a healthy liver from its 35-year-old father, through a living-donor transplant procedure. Looking at the complexity of the liver transplant performed on a child and the added complications, a paediatric liver transplant procedure in Nepal can cost anywhere about 28 lakhs INR approximately.

When do you need a liver transplant?

Surgery for a liver transplant is typically only used as a therapy option for people with severe difficulties brought on by end-stage chronic liver disease. There are also some very rare cases where a healthy and well-functioning liver experiences sudden failure, where the transplant is recommended as the only path of treatment.

The chronic liver disease called Cirrhosis is a common cause of end-stage liver disease. This disease is caused when healthy tissue of the liver is replaced with scar tissue which again stops the liver from working properly.

Other cases in which a liver transplant might be required are:

• ARLD or alcohol-related diseases where the liver gets damaged over time due to alcohol overuse and abuse over the years.
• Immune disorders like autoimmune hepatitis, Primary biliary cholangitis, Primary sclerosing cholangitis
• Genetic abnormalities or cancer

In such cases when the health of the liver has deteriorated to a large extent and the patient is on the verge of liver failure, the option of liver transplant comes to the table.

Who cannot have a liver transplant?

Sometimes even when a person is at the last stage of a liver disease or near liver failure they might not be deemed suitable for a liver transplant. The cases in which a person cannot have a liver transplant are:

• People who have a case of sever-malnutrition and hence are not fit enough to go through the process of surgery and recovery
• Patients who have an infection cannot have a transplant operation until the infection has been treated and cured
• Patients who have underlying health conditions related to heart and lungs
• Patients who have serious mental disturbance and behavioural issues
• Patients with advanced liver cancer where cancer has grown beyond the liver and has started affecting other organs
• Patients who are at the final stage of HIV AIDS infection

These conditions not only make the procedure of liver transplant riskier but also affect the survival rates of the patients because of which such patients are deemed unsuitable for the procedure of liver transplantation.

Liver transplant in Nepal

Nepal successfully completed its first successful liver transplantation in 2016. The country has since actively progressed in the area of transplantation surgery and many more living donor liver transplantations have taken place with the help of expert surgeons in the field. It can be a favourable option to choose Nepal as the centre for liver transplantation procedure for the following reasons:

Cost of liver transplant in Nepal:

The overall cost of any surgical procedure is determined based on the number and types of tests, medications, the preferred medical facility as well as the post-operative care provided by the hospital. In a liver transplantation surgery, the cost can vary also based on if the patient has undergone a cadaveric transplant or a living donor transplant. In the former case, the distance from the donor’s hospital to the patient’s location can affect the overall cost of the procedure while in the latter variant, the donor’s post-operative care and tests prove to be an extra addition to the cost. Based on all these factors, the average cost of liver transplantation varies from country to country.

The average cost of a liver transplant procedure in Nepal is estimated at around 15 to 25 lakhs based on the crucial factor of the type of the transplant being either from a deceased donor or a living donor; whereas the same procedure can cost up to 50 lakhs when performed in India. Considering the high cost that the procedure can take in other countries, Nepal is a considerably much more affordable option for availing the surgery.

Cost of liver transplant in major cities of Nepal:

The cost of a liver transplant procedure is not only dependent on the type of liver transplant but also on the location where the procedure is performed. The location of the transplant surgery can influence the major cost-affecting factors of the surgery like the availability of experienced professionals, and the facilities provided at the hospital among various others. Based on these factors this is how the cost of a liver transplant can vary from one city to another in Nepal:

Being the centre of some of the best and most established medical facilities in both government and private sectors, Bhaktapur provides a more cost-effective option for liver transplantation procedures in Nepal. On the other hand, Chitwan has broken ground by performing liver transplant surgery in the region but might not be as cost-effective.

Best Hospitals for liver transplant in Nepal

While considering a location for a complicated surgery like a liver transplant, it is really important to look into the availability of reputed hospitals which provide the surgery. Nepal has some top-of-the-line medical facilities which excel in the department of liver transplantation. Some of the best medical institutions that provide liver transplantation surgery are as follows:

Shahid Dharmabhakta National Transplant Center (SDNTC) Kathmandu, Nepal:

The SDNTC is one of the most renowned organisations in the field of medicine that has been working in the field of organ transplantation. As the first medical institution in Nepal to successfully complete a liver transplant operation, the SDNTC has a notable reputation among successful medical facilities.

At: Bhaktapur Hospital & Human Organ Transplant Centre, Bhaktapur 44800, Nepal

Tribhuvan University Teaching Hospital, Mahargunj (TUTH) Kathmandu Nepal:

The Tribhuvan University Teaching Hospital is among the most reputed medical institutions in Nepal which had successfully conducted a living donor liver transplantation surgery and has created a trustworthy reputation among locals.

At: Maharajgunj Rd, Kathmandu 44600, Nepal

Liver Transplant Nepal, Buddhanagar, Kathmandu:

Liver Transplant Nepal is a celebrated medical facility which specializes in the field of liver transplant surgery with a team led by experienced and well-known professionals in the field.

At: Liver Transplant Nepal, Buddhanagar, Kathmandu

Center for Liver Disease, Kathmandu, Nepal:

The Center for Liver Disease has a dedicated team of experienced medical professionals who specialise in the issues of liver diseases and transplantation.

At: Madan Bhandari Rd, Kathmandu 44600, Nepal

Bir Hospital, Mahabouddh, Kathmandu, Nepal:

The Bir Hospital is among the oldest and most reputed medical facilities in Nepal which has a well-established department for the treatment of liver diseases.

At: Kanti Path, Kathmandu 44600, Nepal

Norvic International Hospital, Kathmandu, Nepal:

The Norvic International Hospital has a well-equipped Hepatobiliary department that provides both preventative and curative services for liver diseases.

At: Kathmandu 44617, Nepal

These well-established medical institutions and hospitals in Nepal have supreme facilities and post and pre-op care for patients looking for getting a liver transplant operation.

Top Surgeons for liver transplant in Nepal:

Some of the biggest names in the field of transplantation surgery are part of teams of skilled surgeons and medical professionals who perform the procedure. These doctors have years of experience in the field of liver diseases and hepatobiliary and have successfully performed the complex procedure of liver transplantation surgery in their career. Some of the best liver transplantation surgeons available in Nepal are:

Dr Sanjay K Yadav, Liver Transplant Nepal: Dr Yadav, MBBS, MS, FMAS, is a Nephrologist with over 7 years of experience in the field. Dr Yadav specializes in liver transplantation procedures and is well-reputed in the regions of both Nepal and India.

Dr Arun Kumar Singh, National Liver Cancer, Nepal: Dr Singh, MD, MS, LTxS, is a senior consultant and transplant surgeon in the field of hepatobiliary and liver transplant department who has more than 40 years of experience working in the medical field.

Dr Pushkar Chandra Shrestha, SDNTC, Nepal: Dr Shrestha, MBBS, MS, MRCH, is one of the leading nephrologists and transplant surgeons in Nepal. Dr Shrestha had led the Nepalese team in performing the first-ever liver transplant surgery in Nepal in 2016.

Dr Ramesh Singh Bhandari, TUTH, Nepal: Dr Bhandari, MBBS, MS, MCh, is a celebrated Hepatobiliary Liver Transplant and Gastrointestinal Surgeon in Nepal. Dr Bhandari leads the liver transplantation department of TUTH and has successfully completed transplantation procedures at the facility.

Dr Neeraj Joshi, SDNTC, Nepal: Dr Joshi, MBBS, MD, MRCP, is a gastroenterologist and specialist in liver diseases with over 20 years of experience in the field of medicine.

Dr Dipesh Lal Gurubacharya, SDNTC, Nepal: Dr Gurubacharya, MD, DM is a Senior Consultant in Gastroenterology and Hepatology in Nepal with expertise in the field of liver diseases and transplantation.

The medical institutions also train their surgeons and assisting staff with the guidance of renowned specialists from all over the world to ensure the best possible care for the patients. The transplant surgeries are also often assisted and monitored by experienced professionals in the field of liver transplant on an international level.

Risks and Success Rates of Liver Transplant in Nepal:

While considering the operation it is important to understand that liver-transplant surgery is a complicated and difficult procedure to perform and there are a certain level of risks attached to it.

Risks of liver transplant in Nepal:

• The risks generally involved with liver transplantation procedure are:
• The recipient’s body rejecting the donor’s liver
• Internal bleeding or haemorrhage
• Blood clots and increased risk of infections
• Improper functioning of the new liver in the first few hours
• Problems with blood flow and kidney function

These are the common risks associated with liver transplant procedures. In order to tackle these risks and complications, the patients are closely monitored in the hospital in the following weeks of the procedure.

The success rate of liver transplant in Nepal:

The people who are on the line of getting a liver transplant have a shorter life expectancy and getting the transplant can increase their chances to a much higher percentage. In a successful liver-transplant surgery, 90% of the patients have a life expectancy of over 1 year. In about 80% of cases of liver transplant, the patients can live for at least 5 years. It is also observed that in a lot of successful cases, the patients receiving a new organ can live for over 20 years with an acceptable quality of life. On average, it is expected that a patient has a chance of at least 50% of living up to 5 years after the success of a liver transplant surgery. As the more advanced techniques in the

Insurance coverage for Liver Transplant in Nepal:

The process of going through any type of surgery can be a matter of great expense and when a surgical procedure is as complex and critical as a liver transplant surgery, then the cost can grow into manifold. The expense list for a liver transplant generally includes the following criteria:

Pre-op checkups and screenings: These include the various tests, screenings and checkups done on the patient to determine the condition of their organ

Pre-op treatments: In most cases, the patient is hospitalised in order to avail specific treatments in order to prepare them for the surgery.

Hospitalization costs: These include the cost of nursing services, attendants, room rent and other charges imposed by the hospital.

Transplantation surgery: This includes the cost of the whole procedure, medication, and fees of the doctors and the team of experts performing the surgery.

Post-op care for the donor (in the case of a living donor transplant): In the case of a living donor transplant the recipient usually has to take care of post-op care, medication and hospitalization costs for the donor.

Post-surgery care and recovery: This includes the post-surgery tests, screenings, medications, and hospitalization costs of the recipient.

Based on the type of medical insurance availed by the patient and their choice of hospital for surgery, the insurance coverage can vary drastically. There are also special health insurance policies available which can help the patient in coverage of most of the transplantation cost.

Top insurance companies for liver transplants in Nepal

Not all insurance companies and their policies are created equal. So, when looking for a policy that covers the cost of a critical procedure like organ transplantation, a person needs to check for insurance companies that provide specific policies that are meant for providing support during such complex procedures. The following are some of the top insurance companies in Nepal that provide a wide range of health and general insurance policies:

Nepal Life insurance company: The Nepal Life Insurance Company is one of the top insurance companies in Nepal, established by private investors, that provides policies such as Critical Illness Rider, which provides insurance coverage for critical and expensive procedures like liver transplants.

Rastriya Beema Sansthan, Nepal: This is the only government-owned insurance company in Nepal to provide different types of health and life insurance policies.

National Life Insurance Company Limited: This is one of the biggest privately owned life insurance providers in Nepal established in 1988, which has a strong network of branches and agents spread across Nepal.

Life Insurance Corporation Nepal Limited: This is the subsidiary of Life Insurance Corporation of India, established in Nepal in the year 2000. With quality plans and services, this company has grown to become one of the most reputed insurance companies in Nepal.

Metlife Nepal: Also known as American Life Insurance Company Limited, Metlife Nepal was established in 2001 and has gained the trust of the Nepalese population through its world-renowned reputation, quality services and easily accessible branches.

Gurans Life Insurance Company: This privately owned insurance company was established in 2018 in Nepal. With their affordable insurance plans and various profitable policies, they have successfully established themselves as one of the leading insurance companies in Nepal.

By going through the services provided by reputed insurance companies, one can discover suitable health insurance plans and packages that provide coverage for a critical surgical procedure like a liver transplant.

Latest developments in liver transplant in Nepal:

In the coming years, the country is looking for progressing further in the field of medicine for which there can be seen substantial growth and progress in the area of surgical procedures as well. The government of Nepal has also granted permission for the establishment of new organ transplantation centres in the country. The hospitals are always updating their hepatology departments with the latest equipment and the surgeons are provided with training from experienced professionals from countries which are already developed in the field of liver transplant surgery like India, South Korea and the USA.

Quality of life post-liver transplant in Nepal:

The patient who has undergone a liver transplant surgery needs to remain hospitalized for several weeks after the procedure. This is an important part after the procedure as at this stage the doctors and medical staff constantly monitor the patient to ensure that the transplanted organ is adapting well to the recipient’s body and there are no further complications. In the case of a living donor transplant, both the donor and recipient have to keep up to date with the follow-up checkups and screenings after the procedure to maintain a healthy path of recovery. By taking proper medication and maintaining a healthy lifestyle and diet avoiding alcohol consumption and smoking, the patient with a liver transplant can get back to a normal lifestyle with acceptable quality of life with time and patience.

Reviews of liver transplant in Nepal:

The liver transplant program was started in Nepal back in 2016, where in the first round of surgeries five liver transplantations were completed, among which four were living donor transplants while one was a liver transplant from a brain-dead donor. Since then, numerous liver transplant procedures have been completed in the country at different hospitals and locations. The country has seen great success rates with a smaller number of complications with each procedure.

The availability of experienced transplant surgeons supported by the expertise of medical professionals from overseas countries, has made the availing of the procedure a very dependable option in the country. The cost-effective nature of the procedure in Nepal is another reason that makes the location even more attractive for availing the surgery. The facilities provided at hospitals have been found to be adequate by individuals and the post-op monitoring and care have also been appreciated. Overall, getting liver transplant surgery in Nepal has been considered as a favourable option based on economic sustenance and expertise in service, by people who have availed the surgery in the country.

This is why, Nepal can be chosen as a good option as the centre for liver transplant surgery after consulting with the consulting physician based on the patient’s condition, availability of the donor organ and preferred care facilities.