I wonder why I am often not given the same importance as my colleagues and co-organs, the heart or the brain. Well, I am as important for your health.


I reside below your diaphragm, behind the right ribs, in close proximity to the gall bladder and stomach. You will feel my presence only when I’m overgrown and supersizing myself (not good for you), your doctor is well aware of my resting place.

I am enveloped by the softest sheath called the Glisson’s capsule which protects me. When you are taking a deep breath to give your lungs a good workout session, I move off a bit downwards to let my co-organ have his share of significance and expand with glory- being the decent one that I am!


I am firm, toned and a mass of fragile dark red tissue. I assure you, despite my fragility, I endow you with strength and stamina. To your utter surprise, shock or both, I happen to be the heaviest of your glands next to your skin, weighing a whopping 1.5 kilograms.

My tissues are extensively irrigated by a complex network of blood vessels reaching deep inside my core. In fact, there are two distinct systems of circulation, one set (the portal system) bringing me blood from the intestines and another set (systemic circulation), bringing me blood from the heart.

Here’s what makes me smart and spectacular - I am unique from other tissues in one surprising way - I can regenerate my own tissues. If I am cut, for example, and a part of me is removed - as it is when transplanted into another person whose liver is damaged beyond repair - the cells of the remaining part of me can multiply and I become near normal again. How super smart is that?

WHAT I DO FOR YOU: My roles and responsibilities

I am well behaved and a disciplined organ and rarely will trouble or put you in a mess. But if you do something really bad to me to get me all worked up, you may be inviting problems to yourself.

Frankly, you don’t have any idea of the sheer complexity of the work I carry out which makes you doubtful about my presence. Whether you are watching a movie and mindlessly gobbling the contents of a bucket of popcorn down your gullet, driving to work or sipping an energy drink, partying to the fullest and overdoing it, eating a double cheese burger at mid night, or drinking by the beach side, I am watching you. After having done with your indulgences, I clean up after you and take out the trash. All of the blood leaving your stomach and intestines passes through me, I process this blood and break it down, balance and create nutrients for the body to use.

I work dedicatedly and hard for you, your life depends on it. You got to be lucky, trust me!

Allow me to enumerate the things I do to keep you healthy:

  • I work on the glucose you have produced after a heavy meal. After that double decker sandwich or that three layered cheesy (extra cheese) burger, you end up with so much glucose, most of which you don’t need at that time. What happens to it? I convert it into insoluble glycogen and save it for a rainy day
  • On days when you don’t have the time to eat a proper meal or skip it entirely (you did that twice last week thanks to your disorganized boss and his last-minute agenda revisions) my colleague, the blood sugar, tends to act up, or rather down. Since, I’m unable to see you in a slump, I open the storehouse of glycogen and convert some it back into glucose so the blood sugar behaves itself
  • I convert non-sugary substances like amino acids into sugars, if necessary, and make several proteins for you, notably albumin and the factors needed for your blood to clot.
  • I also make cholesterol. Aha, now that has got you worried, right? Relax. Don’t get carried away by all this super-scary stuff about cholesterol and its really nasty intentions. You need a certain amount of cholesterol to stay healthy. It is crucial to the production of certain hormones and cellular repair
  • I make about 700-900 mg of cholesterol per day. About 300-500 mg comes from your diet (if you eat sensibly.)
  • I convert the highly toxic ammonia (which is a by-product in your body when protein is broken down) into urea which your bloodstream carries to the kidneys and they do a terrific job of getting rid of it. So, I hope you get the drift here. The more red meats and super-heavy proteins you eat, the more I have to hammer away at the ammonia
  • I also make bile which is stored in a small pouch below me - inside my other friend, the gall bladder. This green liquid is essential for fat digestion
  • I detoxify many poisons and medicines to render them harmless. Yeah, all those OTC drugs and antibiotics and whatever else you pop to banish the sniffles, fever and flu, someone needs to tackle them, right? I do it
  • I also make cells required for your immunity (from infections). Super important job because without immunity, you are aware of how vulnerable you can be to infections

MY WISH LIST (Humble yet un-granted)

  • Please eat a balanced diet - an overworked phrase, yet true.
    In any case, how difficult is it to eat a balanced meal? Fats, salt, sugar in limited quantities, good, lean protein and complex carbs in healthy quantities, vegetables and fruits in generous quantities?
    Imagine you are a house proud person and your spouse is a mess-maker. Every time you put your house in order, he dirties it. Eventually, you get tired of cleaning things. How do you think you would feel? I am like that home trying to keep myself clean, efficient and free of junk
  • Alcohol. Yes, the stuff that makes me want to quit once and for all, it is poison for me. Cleaning it or rather processing it and keeping you safe is a laborious task and the more you imbibe it, the more I get shattered trying to clean up for you. I am the happiest when you go off alcohol because every time I have to deal with it, I get damaged a little
  • Get shot! When you get a full course of Hepatitis vaccines, it’s like throwing me a lifeline. I am saved from self-destructing myself in bad circumstances
  • Go out and exercise. Yes, that’s right. Like my co-inhabitants, heart, lungs, brain, I too benefit from your exercise. The blood seems to flow much faster through me, a bit like how you drive faster through a street that is clear of traffic
  • My worst nightmare is to be invaded by germs. Maintain hygiene in your day-to-day life, especially in your food habits, thus avoiding the many infections that transmit through dirty water and food. It’s a battle I sometimes may even lose because they are nasty creatures, who don’t follow the rules of warfare. Fighting dirty is not my forte, it’s theirs
  • Cigarettes. What can I say about them which has not already been said? Every puff you take chokes me. Enough said already


I may be afflicted with a wide variety of conditions: infections-acute or chronic hepatitis of which there are several varieties, deposition of fat in my substance(fatty liver), scarring of my substance (cirrhosis), and cancer (both local and that carried to me from another part of the body by blood).

If I am not well, I usually do not say so at first. I fight it out, I am a valiant being. But if you persist on dumping me with trouble, I guess I do give up out of despair eventually. When a large part of me is affected, I start making my presence felt by signs, so to speak.

So when I am giving up on my faith in you, you may get jaundice, a swollen body and bleeding tendencies. You may also tire easily, lose your appetite and have pain in the abdomen.

So when I am giving up on my faith in you, you may get yellowish discoloration of eyes(jaundice), collection of water in the tummy(ascitis), swelling of feet, and blood vomtius and other bleeding tendencies, and you may get incoherent or comatose. You may also tire easily, lose your appetite, muscle mass and havewith infection may get pain in the abdomen.

If you do suspect that I am not at my best behavior, please visit a doctor who will examine you and do some tests to find out the problem help me and you get back to our respective feet. The doctor will take your detailed medical history and try to delve deeper into your usual lifestyle. He will do a complete physical examination, check your eyes to rule out jaundice and try to feel me with his hand below your right ribs.

The doctor may then recommend a battery of blood and urine tests that will either free me or implicate me, pretty easily. Since I am a living chemical laboratory for all practical purposes, is it surprising that my illness is reflected readily in the tests? The jaundice may reflect as raised Bilirubin levels of which there are 2 main types. Either type may be raised depending on the nature of my illness. Also, the blood level of a few enzymes may go haywire and may be indicative of serious illness. The more advanced sonography and CT scan tests are, of course, available for finding out my structural abnormalities more precisely.


The many medicines available for my ailing condition serves well to buy time till I am able to mend myself, which I do quite well and quite often.


  • Bilirubin test (direct and indirect) to ascertain jaundice and its type
  • Total Proteins and Albumin test
  • Enzymes Alanine Aminotransferase – ALT
  • Aspartate Aminotransferase – AST
  • Alkaline Phosphatase (Elevated levels of the first 2 enzymes indicate liver cellular damage. Elevated levels of the last 2 enzymes indicate obstruction in the bile flow.)
  • Prothrombin time and INR (shows synthetic function of the liver)
  • Viral serology for Hepatitis B and C, Cytomegalo Virus, Epstein Barr Virus and HIV
  • Immunoglobulin Study
  • Ferritin
  • Alpha Fetoprotein
  • Biopsy of Liver tissue

The doctor does a complete physical examination and checks for the liver, spleen, free fluid in the abdomen, obesity, lymph nodes, anemia and jaundice. The history may include questions regarding drugs intake, tattoos, unprotected sex, alcohol intake, occupation, history of diabetes, high lipids in blood and family history.


Sometimes, yes. It may be required but if I am damaged beyond repair in which case , you have to get rid of me and have a new liver instead(liver transplant). It is a complex procedure performed by experts in the field.

The new liver comes from either your own family who is blood group compatible (a chunk of the liver tissue is taken out of the donor and fitted into you (LDLT-Living Donor Liver Transplant),or could be from some brain dead person whose family might kindly agree for donation(Deceased Donor Liver Transplant) thus giving a new lease of life to you and me. The transplanted liver functions in your body – its new host - under cover of good medication(immunosuppression).

But does that mean you will now have only a piece of liver (in LDLT) as a make-good? And what happens to the living donor? Does he/she have to live with a chunk of liver missing? If you remember what I told you about myself earlier on, you will know that I have an astonishing ability to regenerate. So I grow and multiply my cells to make myself whole again in both your body and in the donor. So, in first 2-3 weeks about 80% of size recovery occurs and in the remaining 3 months liver approaches 100% of the original size. However, both the chunks of liver(in yourself and in your living donor) the liver continues to function adequately all along. At the end of the day, both parties end up with two full size livers respectively. Wonderful, isn’t it?

Liver transplant from a brain dead donor generally involves fitting in of full size liver.

While you are waiting for a donor liver, you will be constantly followed up with your physician and surgeon to guard you from and serious illness and if there is any such serious problem because of my ill health, you might require treatment in the hospital however, unlike my co-organ kidney which has a lifeline in the form of dialysis, I do not have a lifeline like liver dialysis.


Weighing in at a little over one kilogram, your liver is a complex chemical factory that works 24 hours a day. Liver is the largest internal organ of the body and is the largest gland of the body. It processes virtually everything you eat, drink, breathe in or rub on your skin; in fact, the liver performs over 500 functions that are vital to life. Unlike kidney, we do not have any artificial machine to take care of all of these liver functions. Once the liver fails to cope up with bodily function, liver transplant is to be considered.

Every day, your liver helps your body by providing it with energy, fighting off infections and toxins, helping clot the blood, regulating hormones and much, much more.

To give you an idea of your liver’s critical roles, here is a partial list of its functions:


  • Cleanses your blood: Metabolizing alcohol and other drugs and chemicals, neutralizing and destroying poisonous substances.
  • Regulates your supply of body fuel:strong> Glucose and fat are the major fuels for the body. Producing, storing and supplying quick energy to keep your mind alert and your body active. It produces, stores and exports fat and glucose
  • Manufactures many of your essential body proteins involved in: Transporting substances in your blood, clotting of your blood, and providing resistance to infections.
  • Regulates the balance of hormones: Including sex hormones, thyroid hormones, cortisone and other adrenal hormones.
  • Regulates your body’s cholesterol: Producing cholesterol, excreting it and converting it to other essential substances.
  • Regulates your supply of essential vitamins and minerals: Including iron and copper.
  • Produces bile: Eliminating toxic substances from your body and aiding with your digestion.


  • Alcohol-Related Complications (Alcholic Hepatitis, Cirrhosis)
  • Hepatitis A and E
  • Hepatitis B
  • Hepatitis C
  • Liver Disease in Pregnancy
  • Non-alcoholic Fatty Liver Disease (NAFLD)
  • Nonalcoholic steatohepatitis (NASH)


  • Alagille Syndrome
  • Alpha-1 Antitrypsin Deficiency
  • Autoimmune Hepatitis
  • Biliary Atresia
  • Cystic Disease of the Liver
  • Galactosemia
  • Gallstones
  • Gilbert's Syndrome
  • Hemochromatosis
  • Lysosomal Acid Lipase Deficiency (LALD)
  • Neonatal Hepatitis
  • Primary Biliary Cholangitis (formerly Primary Biliary Cirrhosis)
  • Primary Sclerosing Cholangitis
  • Porphyria
  • Reye's Syndrome
  • Sarcoidosis
  • Toxic Hepatitis
  • Type 1 Glycogen Storage Disease
  • Tyrosinemia
  • Wilson Disease


Liver disease has no symptoms. Liver disease per se is diagnosed when an individual is investigated for some other cause. Only once the complications develop there may be symptoms. There may be malaise, bodyache, weightloss, anorexia, upper abdominal pain and other non-specific symptoms.


Irrespective of the reason responsible for liver damage, the end result remains the same. As the damage increases, it progresses from fibrosis to cirrhosis. Normal liver is soft and smooth; when it becomes hard and irregular, it is known as cirrhosis of liver. What it functionally means that, the liver fails to cope of with the functions of liver. There are no symptoms of liver fibrosis or cirrhosis. You need to undergo tests to diagnose these stages. If the disease is not controlled, the complications of cirrhosis develops – namely jaundice, altered behavior (Hepatic Encephalopathy), swelling on your feet (oedema), accumulation of fluid in your tummy (ascites), blood vomitus (hematemesis), blood in your stools (malena). It can also progress to cancers of liver and bile duct. Once you start developing all these complications, liver is already completely damaged and the injury is beyond point of no return.


Liver disease can often be difficult to diagnose because its symptoms can be vague and easily confused with other health problems. In some cases, a person may have no symptoms at all yet his or her liver may already have suffered significant damage. Risk factors can vary significantly across the 100+ different forms of liver disease. The good news is that many liver diseases can be prevented, managed or in some cases even cured, but early identification is critical so it is important that you ask your doctor for a liver test.


Liver tests or routinely called as Liver Function Tests, are blood tests used to help determine the health of your liver and your bile ducts. Liver tests are used to guide your healthcare provider, along with your history and physical examination, in the diagnosis and management of your liver disease. These tests measure the levels of certain enzymes and proteins in your blood, how well the liver is performing its functions, or measure enzymes that liver cells release in response to damage or disease. Abnormal liver test results don’t always indicate liver disease. Your healthcare provider will be able explain your results and what they mean.


  • Alanine Aminotransferase (ALT,previously called SGPT) and Aspartate Aminotransferase (AST, Previously called SGOT)
  • Alkaline Phosphatase and Gamma Glutamyl Transferase (GGT)
  • Bilirubin Test
  • Proteins and Albumin Test
  • Prothrombin Time and INR

All above tests are usually clubbed together as LT. Individual values though indicate a liver problem, maynot help in localizing disease and hence the entire battery of tests needs to be done. Based on these results the doctor will be able to take decision on further tests.

Besides these tests, your doctor will order tests to determine the cause of liver disease as well as the stage of liver disease. The tests like HBsAg, Antibody against Hepatitis C, Antinuclear antibody, Anti Smooth muscle antibody, immunoglobulins, caeruplasmin and others guide in determining the etiology for liver disease. They would also test for your hemogram and renal functions to guage the doses of medicines.


The use of fibre-optic endoscopy has greatly facilitated the management of all patients with chronic liver disease. Upper endoscopy plays a pivotal role in the diagnosis and management of oesophageal and gastric varices. Endoscopic ultrasound is increasingly being used to detect varices and in the staging of gastrointestinal tumours. Endoscopic retrograde cholangiopancreatography (ERCP) plays an important role in the diagnosis of recurrent pyogenic cholangitis and endoscopic sphincterotomy is a useful form of treatment. Laparoscopy, with the aid of ultrasound and biopsy is helpful in staging chronic liver disease, identifying focal lesions, and diagnosing peritoneal disease.


It is a diagnostic procedure used to obtain a small amount of liver tissue, which can be examined under a microscope to determine what is causing the liver disease and the degree of fibrosis (scarring) of the liver. This test is rarely performed and has very specific indications.


Transplant is a surgical procedure performed to remove a diseased or injured liver and replace it with a whole or a portion of a healthy liver from another person, called the donor. Since the liver is the only organ in the body able to regenerate, a transplanted segment of a liver can grow to normal size within a matter of few weeks.

History of Liver Transplant

The first LT was attempted in University of Colorado in 1963 by a surgical team led by Dr Thomas Starzl. After 7 unsuccessful attempts, the first successful transplant was performed in July 1967 while first successful split liver transplant in 1988. In 1998, the first living related Transplant in India was done in Delhi. From that time onwards, transplant program has greatly picked up in the Indian subcontinent with states like Gujarat, Tamilnadu, Telangana, Maharashtra, NCR and Odisha offering the facility.


A liver transplant is recommended when a person’s liver no longer functions adequately enough to keep them alive. The indications for liver transplant were previously broadly divided into two categories – Chronic Liver Disease and Fulminant liver failure. Third and fourth indications have come up in recent years between the two extremes – Acute on chronic liver failure and severe alcoholic hepatitis. A successful liver transplant is a life-saving procedure for people with acute/fulminant liver failure. Liver failure can happen suddenly –as a result of infection or complications from certain medications, for example. Liver failure resulting from a long-term problem – called chronic liver failure – progresses over months, years or decades.


  • Alcohol related liver disease is the most common etiology for patients requiring liver transplant in India and worldwide
  • Chronic hepatitis, including hepatitis B and Hepatitis C These hepatitis predominate as the cause of liver transplant in developed countries.
  • Autoimmune hepatitis Disease caused by abnormality of your immune system
  • NASH, or nonalcoholic steatohepatitis, a disease caused by a buildup of fat in the liver resulting in inflammation and damage to liver cells. It is the most rising cause of liver transplant and is expected to become the number 1 cause of liver disease requiring liver transplant within next decade
  • Some genetic conditions, including Wilson disease where dangerous levels of copper build up in the liver, and hemochromatosis where iron builds up in the liver.
  • Disease of vessels – Budd Chiari Syndrome
  • Diseases of the bile ducts - Primary biliary cholangitis, Primary sclerosing cholangitis, and biliary atresia. Biliary atresia, a disease of absent or malformed bile ducts usually identified shortly after birth, is the most common cause of liver failure and transplant in infants.
  • Primary liver cancer, meaning cancers that originate in the liver, such as hepatocellular carcinoma are also amenable to liver transplant if they present within established criteria. Unfortunately most individuals in India are diagnosed late and hence cannot be transplanted.


Referral by your Liver physician / GI physician / Medical Gastroenterologist for transplant is the first step. You are evaluated to determine if you are a suitable candidate. Evaluation will include assessment of your:

  • Liver disease and other conditions you may have;Mental and emotional health
  • Other vital metabolic support systems
  • Ability to adhere to the complex medical regimen required after transplant and
  • Likelihood of surviving the transplant surgery


Extensive testing is required before someone can be placed on the transplant list. This usually includes:

  • Physical exam
  • Detailed medical history
  • Psychological and social evaluation
  • Diagnostic tests to evaluate the status of your heart, lung and other organs
  • Imaging studies, such as CT scans and ultrasound, to assess your liver and blood flow through various vessels
  • Multiple blood tests to determine your blood type, kidney function and liver function, and check for other infectious, immune, and inherited diseases
  • HIV, hepatitis, drug and alcohol screening


Liver transplant surgery is complex and generally takes between 6 and 10 hours. During the operation, surgeons will remove the entire injured or diseased liver and replace it with the donor liver. Several tubes will be placed in your body to help it carry out certain functions during the operation and for a few days afterward.

These include a breathing tube, intravenous lines to provide fluids and medications, a catheter to drain urine from your bladder, and other tubes to drain fluid and blood from your abdomen. You’ll be kept under close observation in a specially designed intensive care unit for a few days and then moved to a regular room. The length of your hospitalization depends on your specific circumstances and if complications arise, the stay could be extended.


The two main risks following liver transplant are infection and rejection of the new liver by your body’s immune system. Your immune system attacks unwanted foreign substances – like bacteria and viruses – that invade your body. But the immune system can’t distinguish between the transplanted liver and unwanted invaders, so it may try to attack – or reject – your new liver.

To prevent rejection, all transplant patients must take anti-rejection medications, called immunosuppressant. These drugs are given to suppress your immune system in an effort to ward off rejection of the new liver. However, by suppressing your immune system you become more susceptible to infections. Fortunately, this problem usually lessens as time passes and most infections can be treated successfully with other drugs.

The other thing to be aware of is that liver disease can recur in the transplanted liver. One of the primary problems with hepatitis C patients was universal recurrence of the virus after transplantation. However, with the advent of newer, more effective treatments, hepatitis C can be cured before or after liver transplantation.

Patients with advanced liver disease from hepatitis B require lifelong medication to suppress the virus both before and after transplantation. Autoimmune diseases such as primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) may also recur.

Rejection does not always cause noticeable symptoms. In fact, sometimes the only way rejection is detected is from routine blood tests. As such, it’s very important not to miss regularly scheduled appointments with your medical team. If there are symptoms, each individual may experience them differently. Some of the more common signs and symptoms of rejection include:

  • fever
  • headache
  • fatigue
  • nausea
  • loss of appetite
  • itchy skin (pruritus)
  • dark-colored urine
  • jaundice (a yellowing of the skin and whites of the eyes)
  • abdominal tenderness or swelling

Myth 1 – Liver Transplant is only for elite class

Liver transplant is 100 times cheaper in India than any other developed country of the world. The overall cost varies from 12 -25 lakhs for the operation. But the most important fact that people do not know is that there are a lot of social organizations and NGOs that help people financially for liver transplant. What people fail to understand that you end up spending more than the cost of transplant after cirrhosis just for repeated admissions with complications. It is advisable to get transplanted rather than getting admitted multiple times in Intensive care unit. A lot of individuals who present to hospitals have spent more than 30-35 lakhs for treatment before even thinking of liver transplant.

Myth 2 – Liver Transplant is not successful

The survival rate in India in whichever center of India you take is equal to the rest of the worlds. In fact when we compare the data from majority of our centers, as we do LDLT, the survival is superior. We expect 90% patients to walk home after a transplant and the survival rate of 5 years is 70 percent which is 5 times that of the patient who is in need for liver transplant.

Myth 3 – You have to travel out of Gujarat to get a liver

We have fully functional transplant set ups in Ahmedabad. The transplant service is offered at Civil Hospital, Sterling Hospitals, Shalby Hospitals as well as Apollo Hospitals. We, at Zydus Hospitals have a complete in house team for Liver Transplant unlike other centres with a combined experience of more than 1000 transplants. You no longer need to travel out of the state to get a liver.


Any person from the family (1st degree relatives- spouse, siblings, parents, children/ 2nd degree relatives- all others) who is blood group compatible can donate his/ her liver.

The living donors are assessed in 4 stages for ruling out any liver disease and any other systemic diseases. This helps the liver team in deciding the suitability of the living donor.


With the present availability and expertise in surgery and anesthesia, the surgery for living donor is very safe. The risk of surgery for the donor is 0.2 to 0.5 %.


Zydus Hospitals, Ahmedabad offers end to end Liver Care solutions. We offer our services right from Clinical Assessment → Disease Detection → Disease Management.

A dedicated team of Gastroenterologists, Liver & Hepatobiliary Transplant Surgeon, Transplant Anaesthetist, Transplant Dietary Specialists & experienced team of co-ordinators.

Together our Liver Care Team will provide you information, guidance & support. More than a team of medical specialists we wish to be a part of your extended family.

The best is to protect your liver from developing cirrhosis. Even if you develop cirrhosis, it is not the death sentence nowadays and you can still expect to survive a functional life with good quality after a liver transplant.