Doctors construct liver in man's body with lobes from 2 donors

In a rare and complex surgery, doctors at a city hospital constructed a liver in the body of a 46-year-old man by joining two liver lobes donated by two of his family members.
Sameer Mitra, a native of West Bengal, had been suffering from cryptogenic cirrhosis - a type of liver disease - for the past three years and it had reached an advanced stage. He had visited several hospitals and was advised a liver transplant, but could not do so due to unavailability of donor.
Sameer's body weight, 93 kilos, made the situation more complex. "Since he was overweight, a suitable donor within his family could not be found as they didn't match Sameer's liver type weight wise," Dr Naimish Mehta, Senior Liver Transplant Consultant at Sir Ganga Ram Hospital, said.

The liver of a normal person weighs about 2 per cent of the body weight and any individual undergoing a transplant requires a liver which weighs a minimum 0.8 per cent of his total body weight. "In this case, the patient required 730 grams of liver," Dr Mehta said.
The patient's wife and children who matched him weight wise were of different blood group, making them ineligible to donate. Sameer's brother-in-law who came forward to donate had a single kidney, hence doctors could not put him at risk.
"The brother-in-law's wife had the same blood group as the patient but her weight was only 45 kg and the right half of her liver weighed only 540 grams," the doctor said.

"So we took out her right lobe and extracted around 220 gms from the left lateral segment of the brother-in-law's liver and joined the two portions inside the patient's body, using his veins. This way it weighed 760 grams," Dr Mehta said, adding "taking a smaller part of the brother-in-law's liver minimised the risk of complications."

"We put the two liver portions together and connected the veins and allowed the blood to pass through it and into the heart of the patient, a process called re-perfusion.
"Though usually re-perfusion is done once, in this case we had to do it twice as the liver parts were taken from two different individuals, hence it was technically challenging," said Dr Shashank Pandey, Senior Liver Transplant Anaesthetist at the hospital.

The doctors had to seek special permission from the government-nominated authorisation committee to carry out the dual liver transplant procedure.
The dual lobe liver transplant was carried out on August 29 and Sameer was discharged three weeks after the operation and is doing fine.