The liver is the largest internal organ of the human body and performs several critical functions. There are many chronic diseases that can hinder the functioning of the liver and in chronic conditions can result in liver failure. The removal of a non-functioning liver through a surgical process and replace it with a healthy liver from a living or deceased donor is known as a liver transplant. 

• Deceased Donor (Cadaver): A donor is usually an unfortunate person who has suffered has suffered irreversible brain injury/ brain death or a living 
• Living Donor: Liver comes with a capability of regeneration. Hence, a living donor can donate a part of its liver to another person in need. 

A person suffering from liver failure due to end-stage liver disease (ESLD) must undergo a liver transplant. These diseases include:

• Acute Liver Failure-Also known as fulminant hepatic failure, occurs when a healthy liver suffers from massive injury that results in clinical signs and symptoms of liver insufficiency. 
• Acute or Chronic liver failure-It is caused due to the repeated injury and repair to the liver for many years. This condition leads to the point where the liver can no longer repair itself and is considered as the end stage of scarring known as cirrhosis.

The common causes that lead to such condition of liver failure include:

• Chronic alcohol abuse
• Chronic viral hepatitis (hepatitis B, C and D)
• Accumulation of fat in the liver,  Nonalcoholic steatohepatitis (NASH)
• Iron buildup in the body (hemochromatosis)
• Inherited disorders of sugar metabolism
  • Galactosemia 
  • Glycogen storage disease
• Alpha-1 antitrypsin deficiency
• Metabolic syndrome
• Severe Obesity
• Cystic fibrosis
• Copper accumulated in the liver (Wilson's disease)
• Poorly formed bile ducts (biliary atresia)
• Genetic digestive disorder (Alagille syndrome)
• Infection, such as 
  • Syphilis
  • Brucellosis
• Destruction of the bile ducts (primary biliary cirrhosis)
• Liver disease caused by your body's immune system (autoimmune hepatitis)
• Scarring and hardening of the bile ducts (primary sclerosing cholangitis)
• Medications
  • Methotrexate 
  • Isoniazid

A doctor might evaluate the patient’s current medical condition to know whether he/she fits for Liver Transplant or not. You are a candidate for a Liver Transplant if you experience:

• Blood in Vomit
• Blood in Stools (Black colour stool)
• Abdominal swelling due to Ascites
• Altered Sensorium
• Kidney injury due to liver diseases
• Hepto- Cellular Cancer

A patient with end-stage liver disease is not a candidate for a liver transplant if he/she suffers from:

• Severe, irreversible medical illness with a short-term life expectancy
• Systemic or uncontrollable 
  • Infection 
  • Psychiatric disease
  • Pulmonary hypertension 
• Last stage Cancer (spread outside of the liver)
• The unacceptable risk or Active substance abuse (drugs and/or alcohol)
• Inability to adhere to a strict medical regimen

Before recommending a Liver Transplant, a doctor might prescribe a patient to undergo a few examinations. The results help the doctor to evaluate the patient’s medical condition and help them create an individualised treatment plan. The list of diagnostic tests for liver transplant includes: 

• Imaging tests:
  • Magnetic resonance imaging (MRI) of the abdomen/pelvis 
  • Computed tomography (CT) scan of abdomen/pelvis
  • Ultrasound of abdomen/pelvis
  • Electrocardiogram/chest X-ray
• Colonoscopy
• Dobutamine stress echocardiogram (DSE)
• Mammogram or Pap smear for women
• Other Blood tests

Liver Transplant Preoperative Details
Before proceeding with the surgery the doctors have to make sure that the patient is fit for the procedure. This is done by performing a series of tests and screening process. The patient might be prescribed certain medications, a week, or two before the surgery, to avoid any sort of infection during or after the surgery. 

A patient will receive general anaesthesia before moving to the operation theatre and will sleep through the Liver transplant procedure.

Liver Transplant Operative Details

The liver transplantation is the procedure that actually consists of three operations.

• First Operation: Harvesting the Liver from the donor-For a liver transplant procedure, a patient requires a donor’s liver that is replaced with the patient’s defective liver. There are two types of liver donors:
  • Deceased Donor (Cadaver): A donor is usually an unfortunate person who has suffered has suffered irreversible brain injury/ brain death or a living 
  • Living Donor: Liver comes with a capability of regeneration. Hence, a living donor can donate a part of its liver to another person in need. The team of doctors keeps the donor’s organ working with the help of medications and other "life support" devices. The team removes the donated organs and keep them alive using ice and special solutions until they can be implanted. For the liver, the transplant must take place within six hours of its removal.
• Second Operation: Removing the recipient's damaged Liver- Depending on the medical condition of the patient, the process of the removal of the damaged liver can be very easy or very complicated (especially when a patient has had previous liver surgery). The doctor makes a curved incision in the upper part of the patient’s abdomen and removes the patient’s liver. 
• Third operation: The implantation of the donor’s Liver- The operation involves the final step of replacing the patient’s liver with the donor’s liver. The doctor after transplantation connects the suture (stitch) the new liver to the patient’s blood vessels and bile ducts. 
• Liver Transplant post operative details-A patient has to spend 6 to 10 days in the intensive care unit for monitoring purpose. The recovery time for regeneration of liver following surgery takes around 5 to 7 weeks. After surgery, most people remain symptom-free and feel better. However, they have to take certain precautions and medication for a lifetime to improve their quality of life.

The patient must follow the following precautions after the Liver Transplant:

• Do not drink alcohol if you have undergone Liver Transplant
• Eat a healthy diet and reduce the number of fried foods and spices you eat.
• Maintain a healthy weight/BMI
• Take your medicines on time
• Go for a regular checkups
• Exercise to stay fit like brisk walking and stretching
• Stay hydrated

The surgery might come with mild complications, such as:

• Bile duct complications
  • Bile duct leaks 
  • Shrinking of the bile ducts
• Bleeding
• Blood clots
• Infection at the site of incision
• Complications with donated liver
  • Rejection 
  • Failure
• Seizures
• Recurrence of liver disease 

After a liver transplant, your doctor might prescribe you to take anti-rejection medications for the rest of your life which can cause side effects such as:

• Headaches
• Diarrhoea
• Diabetes 
• Bone thinning
• High blood pressure
• High cholesterol

These anti-rejection drugs work by suppressing the immune system, thus they come with increased risk for infection. Doctors even prescribe medication to fight the infections caused by these anti-rejection drugs