An emergency living-donor liver transplant of a 26-year-old athlete suffering from acute organ failure and Covid-19 was performed at a private Chennai hospital by a 50-member team in a bio-secure bubble on May 21. A living-donor liver transplant involves the removal of a portion of the liver from a healthy person for the one with the dysfunctional organ.
The patient, Raghul Gandhi, a Kabaddi player from Puducherry, developed acute liver failure and he was brought to MGM Healthcare in a comatose stage two days after being diagnosed with the disease. A liver transplant is performed on patients who are uninfected and have end-stage liver disease. In the case of Covid-19 patients, it can be performed on those who have had a recovery period of over four weeks and show two successive negative RT-PCR tests.
Gandhi was positive for the disease when he was brought to the hospital in a critical situation. “He was brought to us with a day or two to live. The transplant was to be done within 24 hours or it would not have been possible to resuscitate him,” said Dr Thiagarajan Srinivasan, Director, Institute of Liver Diseases, Transplant and HPB surgery, MGM Healthcare. The patient’s condition was first stabilised with intubation.
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Srinivasan said following their procedure, the Liver Transplant Society of India has issued guidelines to allow liver transplants among Covid-19 positive patients.
The team created a secluded Intensive Care Unit (ICU) for Gandhi in accordance with Covid-19 protocol where he underwent continuous plasma purification, toxin filtration, and liver dialysis. This was around the time when Covid-19 infections in Chennai were peaking in May and the state was facing an oxygen crisis.
The factor that worked in the patient’s favour was that his CT scan did not show any impact on his lungs. The liver disease had not affected his brain. The Covid-19 infection was the cause of his liver failure.
The hospital consulted experts across the country as well as the Liver Transplant Society of India. They arrived at a consensus to conduct the transplant. “Our biggest hindrance came in the form of very limited functioning of the cadaveric organ donation system with only one liver donation in May in Tamil Nadu,” said Srinivasan.
The only option was to identify a donor. But two of Gandhi’s family members were also positive. So, his younger brother was rushed in from Puducherry, which is over 150km from the hospital. He turned negative and presented good antibodies, indicating he has been exposed to the infection but recovered completely.
“The transplant workup procedure which normally takes 3-4 weeks was accelerated at a rapid pace to complete the work up in a record 6 hours,” said Dr Karthik Mathivanan, a liver transplant surgeon.
A bio-bubble was created to separate the team of doctors working for the donor and recipient. Covid-proof transport corridors, ICUs, wards, and operation theatres were implemented throughout the pre-and post-op procedures that spanned 15 days. “Usually, surgeons, perfusionists, and staff nurses move around. But, in this case, we did not just need more manpower, but we had to involve two different teams for the donor and recipient which included technical staff and assistance,” said Mathivanan. The transplant surgery took 12 hours.
None of the surgery team members were infected by Covid. A system for the airflow from the ventilators was used along with filters to keep the air clean in the ICU and the operation theatre to reduce the chances of the team contracting the virus.
Gandhi has recovered from Covid-19 and has a new functioning liver. “I feel normal,” said Gandhi at a press conference on Thursday.
Mathivanan said Gandhi would be able to resume Kabaddi after six months to a year.