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First Successful Liver Transplant in Bangladesh

Offering life to patients with end stage liver diseases

Dr Md Rajib Hossain
The previous week was distinctly special for millions of people living with end stage liver disease (like liver cirrhosis or liver cancer) in Bangladesh. Long awaited liver transplant surgery has been successfully performed at BIRDEM Hospital, Dhaka. Professor Mohammad Ali, Head, Hepato Biliary and Pancreatic Surgery of BIRDEM Hospital lead the way to reach a historical feat.
A 42 year old Kazi Ershad Ahmed from Comilla is the only recipient who got the liver transplanted locally.
Ershad was diagnosed with cirrhosis of liver in 2007. Cirrhosis is a condition when liver is scarred, damaged irreversibly. Transplantation of a healthy liver is the only option in this case. He consulted several specialists at home and abroad with a hope to get alternative treatment other than very costly transplant surgery in foreign countries. Doctors said that the only hope left for him was liver transplant that was not available at the time he was diagnosed. Indeed, it was too costly for him to afford it in abroad. He thought that he was ill fated and going to die very soon.
When he met Prof Ali, the doctor showed him a ray of hope. Prof Ali offered him to be the luckiest patient to undergo the first ever living donor liver transplant surgery in Bangladesh.
The surgical set up comprised 17 doctors, skilled sisters and multidisciplinary approach like sophisticated equipment and monitoring devices. The operation was performed on June 3,2010 that took 17 hours. Both the patient and donor are in good condition now indicating the operation was a successful one.
Liver transplantation is needed when people suffer from end stage liver diseases like cirrhosis, liver cancer, liver failure etc., most ofwhich are resulted from Hepatitis C and B.
For transplantation of liver,
someone with a good match is to donate part of his/her liver. There are two types of donors a) Deceased Donor Liver Transplant (DDLT), where liver is taken from a brain dead person and b) Living Donor Liver Transplant (LDET), where a living person donates a part of his/her liver to the recipient.
Any healthy person aged 18-65 years who is of matching blood group with the recipient can be a living liver donor. Eligibility of a person for liver donation is assessed after detailed examination and tests
by the transplant team, where donor safety is considered first.
Liver has the tremendous capacity to regenerate. One healthy living donor can live without any difficulty even if 70 percent of the liver is removed. Usually the donated part of the liver completely regenerates from the remaining liver within 6-12 weeks of donation.
Although the success rate is high with proper intervention, there is chance of rejection of transplanted liver like other transplantations. Immunosuppressive drugs need to
be started immediately after liver transplant to prevent rejection. It must be maintained for the rest of the life.
Initial cost of these drugs is high for first few months, but subsequently the cost reduces to one or two medicine at the end of the year and single medicine in 2-4 years time, which needs to be taken life long. Liver functions and drug level also needs to be evaluated repeatedly.
Considering the cost, liver transplant is one of the expensive procedures, most of our people are not able to bear. Experts informed that liver transplant will cost on an average Tk. 30 lakh in Bangladesh and it is the minimum in comparison to others. In European and other advanced countries, the cost is about Tk. 20 million (200 lakh). In India, it is about Tk. 60 lakh. If the government and philanthropic organisations come forward, the estimated cost will be much lower and within the affordable range to the most.
Liver transplantation is a sign that Bangladesh is moving along with the world with its expertise and skillful endeavour. Millions of patients in Bangladesh are pinning their hope to get liver transplant surgery at home, at regular basis, at a reasonable cost. Let us join them to make it readily available in Bangladesh.
E-mail: rajibssmc@gmail.com