Inside India’s First Successful Three-Way Liver Transplant: How Was It Done?

'It was a do-or-die situation for me', said Saurabh Gupta, one of the recipients of the three-way liver transplant.

A team of doctors at Gurugram's Medanta Hospital have carried out India's first successful three-way liver transplant. The surgeries, led by Dr AS Soin, Dr Amit Rastogi and Dr Prashant Bhangui, were able to give a second life to three patients suffering from terminal liver disease.

Speaking to FIT, Dr AS Soin Says, "This is the first time this is being done for three families. A swap between the three families was arranged, so each recipient can get a suitable liver."

Read on to find out how they pulled it off.

Liver Swap: How Did It Work?

In case of terminal liver failure, patients end up needing liver transplants, says Dr Soin.

He says the success rate of liver transplant is high, but only if all chips fall into place.

"Not everyone who needs it is able to have it because they don’t get suitable donors."

Dr Arvinder Singh Soin, Chairman, Institute of Liver Transplantation and Regenerative Medicine, Medanta

Often patients are too sick to wait to receive liver from the deceased donor list.

In some cases, the patients will have family members willing to donate, but they are not compatible.

Explaining this, Dr Soin says, "there is either blood group incompatibility or volume incompatibility."

"Sometimes the donor's blood group doesnt match. Or, they are smaller in size compared to the patient so the half liver they can donate is not enough for the needs of the recipient."

Dr Arvinder Singh Soin, Chairman, Institute of Liver Transplantation and Regenerative Medicine, Medanta

"Swap transplantation is a concept where both these incompatibilities can be overcome," he adds.

Dr Soin explains that they did this by going over the database of families who have incompatible blood group donors, or volume incompatible donors.

"We then linked them together so that a swap between three families (who are suitable for each) can be arranged," he says.

Patient 1's donor had a volume incompatibility, so they donated to patient 2, with whom they were compatible. A donor from Patient 2's family then donated to Patient 3. And a donor from Patient 3's family donated to Patient 1.

"This way, volume and blood group incompatibly were resolved for all," says Dr Soin.

All three transplants also needed to done simultaneously at the same time.

Explaining why this was, another lead surgeon, Dr Prashant Bhangui said, "If the transplants are done on successive days, there is a small possibility that one of the donors may back out of donation the next day once their family member has already received the exchange donation the previous day."

"Also, one of the recipients may become unfit for surgery the next day as these patients are sometimes quite critically ill before transplant," he added.

How Are the Patients Doing Now?

The procedure began with connecting three patients with terminal liver failure — Sanjeev Kapoor, a businessman from Madhya Pradesh, Saurabh Gupta, a businessman from Uttar Pradesh, and Aadesh Kaur, a homemaker from Delhi.

Speaking to FIT, Saurabh Gupta, a 32-year-old, says, "It was a do-or-die situation for me. This was a godsend," he adds.

"After some treatment here and there, it became clear that if I have to survive, I will have to get a transplant."

Saurabh Gupta, 32

Gupta was diagnosed with liver cirrhosis in 2021 after suffering a bout of COVID in the second wave.

Now, a couple of months after the transplant, Gupta says he's doing well.

"Ten days after the transplant, I was discharged. I stayed on for a few more days, and now I’m fine. I haven’t had any complications."

Saurabh Gupta, 32

According to the lead surgeons, the other two recipients are also doing well.