This document provides information about liver transplantation, including: 1. Liver transplantation involves replacing a diseased or damaged liver with a healthy donor liver. It is performed for conditions like cirrhosis, liver cancer, or genetic liver diseases. 2. Candidates undergo evaluation including medical history, physical exams, blood tests, and imaging to determine if they are healthy enough for surgery. 3. The surgery takes 5-6 hours and involves removing the recipient's liver and connecting the donor liver to blood vessels and bile ducts. Patients require lifelong immunosuppression drugs to prevent rejection. 4. India offers liver transplantation at an affordable cost compared to other countries, with services available in major cities across the country

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2. Liver Transplant in India
Liver and its Functions:
Liver is located on the right side behind the rib cage. It has many functions including
processing proteins, fats and carbohydrates, and breaking down toxic substances such
as drugs and alcohol. The liver makes the chemical components that help your blood
clot. If the liver fails, you lose the ability to clot blood and process nutrients needed for
life. The liver also excretes a yellow digestive juice called bile, which may accumulate if
your liver is not functioning properly.
Liver Transplantation:
A liver or hepatic transplantation is a major surgical procedure in which diseased or damaged liver is replaced with a healthy
liver. This procedure is very time consuming and demanding. It is performed in case of acute liver failure or an end stage liver
disease.
Common Reasons for Liver Transplantation:
Some of the most common reasons for liver transplant are as follows;
End-stage Cirrhosis which can be a result of alcoholic cirrhosis, chronic hepatitis, hemochromatosis, primary bilary
sclerosis, etc.
Liver cancers like Cholangiocarcinoma, primary hepatocellular carcinoma, primary hepatocellular malignancies and
hepatic adenomas.
Fulminant viral hepatitis (A, B, C, D), hepatic thrombosis may cause Fulminant hepatic failure.
Genetic liver diseases
Candidates for Liver Transplantation:
Persons who suffer from irreversible acute or chronic liver disease are possible candidates for liver transplantation. The
decision to start the process of determining if you are a candidate should be taken seriously. Besides determining your
candidacy, it is important to consider the emotional, physical and financial aspects of a transplant.
Two main considerations for whether someone is a candidate for liver transplant are:
Your condition will benefit from a liver transplant
The surgery would do more good than harm

3. Donors for Liver Transplantation:
Liver transplantation can be performed with the help of two types of donors:
Deceased donor: Liver transplantation can be done with a deceased donor from someone who has died. The large majority of
liver transplants use the entire liver from a non-living donor for the transplant, particularly for adult recipients
Living donor: A living donor is usually someone in the family or a close friend.
Preparation for Liver Transplantation:
The preliminary evaluation, called a Phase I Evaluation, is the first step in helping you and the transplant team determines if
transplantation is an appropriate treatment option Every patient is evaluated by a liver specialist, called a hepatologist, and a
surgeon. The appointment will take a full day, and can be very tiring. The following tips will help you prepare for this first
appointment:
You must have a family member or another support person or people accompany you to help understand the
significant amount of information you will receive about the transplant process.
Because you will undergo many tests, do not eat or drink anything after midnight of the day before your appointment.
Plan to bring a snack. Please bring any medications you are taking.
Evaluation and Tests for Liver Transplantation:
You will need to bring all of your previous medical records, X-rays, liver biopsy slides, operative reports and a record of
medications to your pre-evaluation. To complement and to update previous tests, some or all of the following diagnostic
studies are generally performed during your evaluation. If specific problems are identified, additional tests may be ordered.
Computed tomography, which uses X-rays and a computer to generate pictures of the liver, showing its size and
shape
Doppler ultrasound to determine if the blood vessels to and from your liver are open
Echocardiogram and stress testing to help evaluate your heart
Pulmonary function studies to determine your lungs' ability to exchange oxygen and carbon dioxide
Blood tests to determine blood type, clotting ability, and biochemical status of blood, and to gauge liver function.
Serology screening is also included.
Not a Candidate for Liver Transplantation:
Certain conditions disqualify a person from undergoing a liver transplantation because
a successful outcome is unlikely. These conditions are known as absolute
contraindications. They include the following:
• AIDS (acquired immunodeficiency disease)
• Cancer presently existing in an organ other than the liver
• Metastatic cancer of the liver (advanced liver cancer that has spread to another
organ)
• Alcoholic liver disease coupled with failure to abstain from alcohol for the last
six months
• Severe active infection
• Active substance abuse (for example, alcohol or heroin)
• Irreversible brain dysfunction

4. Liver Transplantation Procedure:
The surgery usually takes between five and six hours, but may be longer or shorter due to the difficulty of the
operation and the experience of the surgeon.
Liver Transplantation is performed under a general anesthesia.
Before the surgery, a tube is placed through the mouth of patient into windpipe to help breathe during the operation.
A Y-shaped incision in the abdomen is made and the diseased liver is removed. Donated liver is then inserted and
attached to the major blood vessels and to the bile ducts. The incision is then closed at the end of surgery.
Entire procedure of liver transplantation surgery usually takes about 6-12 hour to perform successfully.
Types of Liver Transplantation Surgery:
There are three types of liver transplantation surgery procedures - Orthotopic transplantation, Heterotopic transplantation
surgery and Reduced-size liver transplantation.
Orthotopic Transplantation - The orthotopic approach requires replacing the recipient liver with the donor liver. After the
donor liver is removed, preserved and packed for transport, it must be transplanted into the recipient within 12 to 18 hours.
The surgery begins by removing the diseased liver from the four main blood vessels and other structures that hold it in
place in the abdomen. After the recipient's liver is removed, the new healthy donor liver is then connected and blood flow is
restored. The final connection is made to the bile duct, a small tube that carries bile made in the liver to the intestines.
Heterotopic Transplantation – Heterotopic Transplantation surgery involves the addition of a healthy donor liver at another
site, while the diseased liver is left intact. This liver transplant surgery procedure is performed when the doctor is of the
opinion that the diseased liver might recover. The healthy liver is attached very near to the original liver. If the liver recovers,
the other organ shrivels away. If not, then the original one shrivels and the donor liver performs the body functions.
Reduced-size Liver Transplantation – Reduced-size Liver Transplantation is most often performed on children and involves
the transplanting a part of the healthy donor liver into a patient. This procedure is performed when 15-20% of the original
liver is intact. This way, one donor liver can be used for two successful transplants.
Follow Up Care Post Liver Transplantation:
After liver transplantation, the patient must frequently visit the transplant surgeon, about 1-2 times a week over
about 3 months.
The transplant surgeon and hepatologist monitor the patient's progress through blood tests. After a year of Liver
transplantation, follow-up care becomes individualized.
Post transplant, patient will be on several different medications especially Immunosuppression medications which
keep the body from fighting off the new organ. You may be on other medications to control blood pressure, Insulin,
antibiotics and antivirals, diuretics, and vitamins.
Typically, patients are seen every week for the first month post transplant, and then the frequency is reduced over
time.
Additional testing to monitor your health and liver function may vary from patient to patient. Tests may include
abdominal scans, ultrasounds, and liver biopsies.

5. There are few dietary restrictions. The patient is often advised to restrict salt (sodium) intake. A well-balanced diet
with adequate protein is necessary. For reasons that are not clear, obesity frequently becomes a problem with liver
transplant patients. To avoid this problem, patients should take control of their calorie intake early on.
Liver Transplantation Rejection:
Unfortunately, when the immune system sees a newly transplanted organ as a foreign object that could be harmful to you, it
attempts to rid your body of it. This is called as rejection. The anti rejection drugs taken after surgery help prevent rejection.
These drugs weaken the immune system to allow your body to accept the transplanted organ. Rejection is most common in
the 6 months after transplant surgery, but it can happen at any time. It can also be treated. Treatment is most effective if
rejection is caught early. Fever, Fatigue, Chills, Nausea Body ache and Jaundice are some warning signs of rejection of liver
transplant. The patient needs to be aware of the signs of rejection so that it can be reported to the transplant coordinator
immediately. Some tests are conducted to confirm rejection of the transplanted liver. These tests may include blood work and
Liver biopsy. If the liver shows any signs of rejection, the dosage of immunosuppressant drugs is usually increased. If the
biopsy shows a significant amount of rejection, the patient may be hospitalized for more intensive immunosuppressive therapy.
Advantages of Liver Transplantation:
Liver transplants provide patients a chance for a longer, more active life in the final stages of liver disease or end-
stage liver disease.
There’s no question that transplant is a major operation. The recovery can sometimes be the most taxing but anti-
rejection medications are making the process easier.
If the transplant is performed before the recipient's health deteriorates, he or she is better able to tolerate the surgery
and recovers more quickly.
The donors and recipients recovered quickly, the donors were discharged in about a week and the recipients in 2 to 3
weeks.
Liver Transplantation in India:
Liver transplantation in India is performed through cutting- edge clinical solutions, research, extraordinary patient care and
infrastructure of world-class standards. This has addressed concerns of many patients and has helped them get rid of complex
and most end stage liver diseases.Liver Transplant is a complex surgical exercise and need highly skilled consultants,
ingenious technical staff and advanced technology working with perfect harmony, enormous dedication and team work. India
offers a one stop solution for all those seeking critical procedures such as Liver transplantation.
Cities in India that offers Liver Transplantation at some of the best multi specialty hospitals are as follows;
Mumbai Hyderabad Kerala
Delhi Pune Goa
Bangalore Nagpur Jaipur
Chennai Gurgaon Chandigarh

6. Cost of Liver Transplantation in India:
Liver transplant cost in India allows people of every class and from every part of the world to avail the best medical care suited
to their pocket. Everything from finding a donor and performing the surgery to the prolonged recovery period and lifelong
medication, each factor adds to the cost, making liver transplant difficult to afford for some people. Hospitals in India are a
perfect destination for medical tourism that combines health treatment with visits to some of the most alluring and awe-
inspiring places of the world at an attractively low cost.
Other costs associated with transplantation include:
recovery and in-hospital stay
extensive lab tests
anesthesia
fees for transplant surgeons and operating room personnel
organ recovery
transportation to hospital
lodging, transportation and food for family members while the patient is hospitalized
physical therapy and rehabilitation
patient lodging following discharge
anti-rejection drugs and other medications
Some of the common countries from which patients travel to India for surgery are:
USA UK Canada
Australia Zealand Nigeria
Kenya Ethiopia Uganda
Tanzania Zambia Congo
Lanka Bangladesh Pakistan
Afghanistan Nepal Uzbekhistan

7. ABOUT INDIA
Located in South Asia, bordered by Pakistan, Nepal, China and Bangladesh, India is South Asia's largest, sovereign,
democratic republic. India has an edge over other countries when it comes to offering comprehensive, cost-effective and
timely medical care: it also offers an exotic, adventure-filled or cultural -if you wish array of destinations to discover and
revel in for the travelers. Indian cities like Mumbai, Hyderabad, Goa, Bangalore, Nagpur, Kerala, Delhi, Pune, Jaipur,
Chennai, Gurgaon, and Chandigarh offers best medical tourism service.
Mumbai - Formerly known as Bombay, is the commercial & financial capital city of India. Mumbai is famous for many things,
including its thriving Bollywood film industry, teeming bazaars, colonial-style buildings, Art Deco structures and a superb
choice of restaurants, often being rated as the dining capital of India. The tourist district of Colaba in Mumbai is a great
place to start exploring this great city.
Hyderabad – Hyderabad city is a great place to visit in the state of Andhra Pradesh. The place has witnessed a continuous
growth for last many years. Hyderabad has become a tourist hotspot following ever increasing number of tourists during
past few years. Hyderabad has a well-founded reputation as one of the safest cities in the world.
Goa - The country's smallest state and famed for its colonial Portuguese and Catholic past, most tourists visit Goa for its
endless selection of sandy beaches and coastal attractions. Standing proudly next to the Arabian Sea, Goa is a particularly
compact state and often feels like a large town, being easy to travel. Around Goa, tourists will soon realize that the state has
much more to offer than simply stunning beaches, fishing, water scooters, windsurfing and scuba diving.
Bangalore - Beauty lies in the eyes of beholder and if you want to see one of the most beautiful places in India then
Bangalore is the word for it. Bangalore has earned sobriquets like 'Silicon Valley of India', 'Pub Capital of India', and 'City of
Gardens'. Pleasant climate with colorful gardens with lakes and glittering nightlife, Bangalore has made its own attraction for
travelers as one of the most charming cities in India,
Nagpur - Nagpur is the largest city in central India, but with its friendly atmosphere and dependable transportation, you’ll
instantly feel at home. The city of Nagpur has a well-built infrastructure, is a clean and affluent city which makes a good
jumping-off point for a series of trips into the far eastern corner of Maharashtra.
Kerala - Natural beauty, clean air and primordial greenery amidst the vast expanse of water and sky, typifies the state of
Kerala – better known as God's own country. Kerala is famous for its alternative medical therapies such as Ayurveda, which
help to rejuvenate and revitalize the body. The region is also home to India’s only virgin tropical rain forest – the Silent
Valley National Park, supporting an overwhelming range of life forms, many of which are highly endangered, and endemic
to this part of the planet.
Delhi - "Welcome to The Capital City of India - New Delhi" Delhi is famous as Capital city of India is located in North India.
Delhi is truly a symbol of the old and the new; a blend of ancient well preserved monuments and temples along with jam-
packed burger joints and up market shopping malls. Delhi has state of the art Hospitals and the best qualified doctors.
Pune - Once referred to as the Oxford of the east, Pune continues to be a stronghold for academics and culture. An array of
factors like availability of efficient and experienced doctors, comparatively low treatment costs, hospital facilities of
international standards and many more have made Pune one of the top destinations for medical tourism.
Jaipur - Jaipur is one of the most popular destinations on a tourist's itinerary. The magnificent forts, beautiful havelis and
colourful bazaars make Jaipur a popular tourist destination among tourists. Jaipur has pioneered health and medical
tourism in India.
Chennai - Chennai is one of the most developed urban centers in the Indian subcontinent. The city forms the capital of
Tamil Nadu state and is the fourth largest metropolitan city in India. They have some of the very best hospitals and
treatment centers in the world. Each hospital is equipped with state of the art facilities. The technology brought into practice
is the very latest, including robotic surgery.

8. Knee Replacement Surgery in India
Knee replacement surgery also known as knee arthroplasty is procedure to replace the
weight-bearing surfaces of the knee joint to relieve the pain and disability of
osteoarthritis. It may be performed for other knee diseases such as rheumatoid arthritis
and psoriatic arthritis. The procedure has been proven to help individuals return back to
moderately challenging activities such as golf, bicycling, and swimming. Total knees
are not designed for jogging, or sports like tennis and skiing (although there certainly
are people with total knee replacements that participate in such sports). Knee
replacement is a routine surgery performed on over 600,000 people worldwide each
year. Over 90% of people who have had Total Knee Replacement experience an
improvement in knee pain and function.
Knee Replacement Surgery Candidates
A person would be considered a candidate for knee replacement if there is:
• Daily pain
• The pain is severe enough to restrict work, recreation and ordinary activities of daily living
• Significant stiffness in the knee
• Significant instability (constant giving way) of the knee
• Significant deformity (knock-knees or bow-legs) that hinders normal function of the knee
• Damage from arthritic conditions, such as osteoarthritis, rheumatoid arthritis or post-traumatic arthritis
Success Rate of Knee Replacement Surgery:
Knee replacement surgery is recognized as a miracle of modern surgery. Most orthopedic experts consider replacement to be
the best method of handling arthritis in the knee. Knee replacements have literally put hundreds of thousands of Americans
back on their feet and allowed them to enjoy their golden years.
Knee Replacement Surgery Preparations:
• If you smoke, cut down or quit. Smoking changes blood flow patterns, delays healing and slows recovery.
• If you drink, don't have any alcohol for at least 48 hours before surgery.
• Ask your doctor for pre-surgical exercises. If you are having hip or knee replacement surgery, doing exercises to
strengthen your upper body will help you cope with crutches or a walker after surgery.
• Your primary care physician or an internist will conduct a general medical evaluation several weeks before surgery.
This examination will assess your health and your risk for anesthesia. The results of this examination should be
forwarded to your orthopaedic surgeon, along with a surgical clearance.
• Shortly before your scheduled surgery, you will probably have an orthopedic examination to review the procedure and
answer any last-minute questions.
• You may need to take several types of tests, including blood tests, a cardiogram, a urine sample and a chest X-ray.
• Advice your surgeon of any medical conditions you have and of all the medications you are taking. You may need to
stop taking certain medications or your surgeon may recommend substitute medications until your surgery.
Medications such as corticosteroids, insulin or anti-coagulants will need to be managed before and after surgery.