Dr Arvinder Singh Soin speaks to South First about pioneering advancements and unprecedented success in living donor liver transplants.
Dr Soin in an award-winning liver transplant surgeon. (Wikimedia Commons)
November 1998 holds special significance in India’s history of organ transplantation. Fifty-one years after gaining independence, the first liver transplant — both from deceased and living donors — was successfully performed in the country.
A quarter of a century later, the number of liver patients needing a transplant is on an uptick. The availability of cadaveric livers (from deceased donors) for transplantation is limited and it still remains a challenge.
According to 2022 statistics, more than 1,800 liver transplantations (LTs) are conducted annually in India’s 90-100 active centres. The scarcity of cadaveric livers has prompted many patients to look to living donors for a fresh lease of life.
In the field of liver transplantation in India, there are but a handful of specialists who are worth their salt and at the top of that list is Dr Arvinder Singh Soin. A surgeon renowned for his pathbreaking work in liver transplantation, he has been revolutionalising the field with his remarkable advancements and expertise.
Dr Soin, a Padma Shri recipient, has won global acclaim with about 4,100 liver transplants. Chairman of the Liver Transplantation and Regenerative Medicine Department at Medanta Hospital in Gurugram, Dr Soin’s expertise and pioneering approach attract several patients from across the country, including from South India.
“From conducting India’s first successful liver transplant in 1998, my team has carried out about 4,100 liver transplants with 97 percent success rate,” Dr Soin tells South First. “We have the second-highest number in the world in living donor liver transplants,” he adds.
A critical area in liver transplants is the access and availability of the organ to patients suffering from liver failure and cancer.
Dr Soin recognises the need to ensure the safety of both patients and donors, besides making the transplant successful. To meet these objectives, he has rolled out several innovations.
“Currently, only 15 percent of transplants in the country are done through cadaveric organ sources. There is a need for an increased number of organ donations from deceased individuals and their families. Now, 85 percent of organ transplant in the country involves living donors,” he points out.
Medanta Hospital in Gurugram. (Wikimedia Commons)
To ensure the success rate of liver transplantations, machines are now used. In recent years, significant advancements have been made in improving the viability of liver transplantation using machines, he says.
“Livers from brain-dead patients may exhibit various issues such as fat deposits, damage, compromised blood supply, infections, low blood pressure, etc. These factors can affect the organ’s quality and limit their preservation outside the body,” Dr Soin explains.
Such livers could be “repaired”. Dr Soin has adopted cutting-edge techniques such as Normothermic Machine Perfusion (NMP), Hypothermic Oxygenated Perfusion (HOPE), and Machine Liver Resuscitation (MRT) to improve the quality of livers harvested from brain-dead donors.
The improvement is achieved by addressing issues such as fat accumulation, damage, low blood supply, and infections.
By optimising the condition of the organs before transplantation, Dr Soin has significantly increased their viability and expanded the time window to keep them outside the human body.
Dr Soin has achieved numerous milestones in liver transplantation. His accomplishments include several pathbreaking procedures such as the first left lobe, right lobe, dual lobe, swap, simultaneous liver and kidney transplant, ABO-mismatched living donor liver transplant (LDLT), domino, as well as performing liver transplants on the smallest recipient weighing merely 2 kilograms, as well as the oldest.
The LDLT has witnessed remarkable advancements under Dr Soin’s guidance. One notable technique is robotic liver surgery, which involves a minimally invasive keyhole procedure. By utilising small incisions controlled by a computer console, Dr Soin and his team can extract the liver from the donor.
“The advantages of this approach include reduced pain, faster recovery, and improved abdominal strength for young donors. This breakthrough has played a pivotal role in motivating more young donors and their families to come forward and donate,” Dr Soin explains.
Interestingly, another successfully conducted surgery is on recipients having a blood group different from that of donors. Dr Soin has also mastered two innovative methods: Swap liver transplantation and ABO-incompatible transplantation.
Swap liver transplantation involves exchanging livers between two families with incompatible blood groups, ensuring both recipients receive a compatible organ.
“There may be a patient with blood group ‘B’ and a medically fit donor within the family with blood group ‘O’. Now typically, for a living donor transplantation, we need donors to have the same blood group as the recipient. However, if another family has a patient with blood group ‘O’ and a willing donor with blood group ‘B’, we swap livers between the families,” Dr Soin elaborates.
“All four operations are held simultaneously. Swap surgeries can be extended to three, four, or even five patients. If a swap is not done, then they have to face the risk of either incompatible transplant or not having a transplant at all,” he says.
“This could help hundreds of people waiting for living donors,” points out Dr Soin, who recently performed three swap transplants.
Furthermore, ABO-incompatible transplantation utilises immunomodulation techniques, which prepare the recipient’s body to accept a liver from an incompatible blood group donor.
“Here, the blood group of the patient and donor may not be compatible but through a technique called immunomodulation, we ensure that the donor with blood group ‘B’ can donate to the patient with blood group ‘O’,” he explains.
The patient is prepared for three to four weeks by immunomodulation which involves giving special medicines to suppress the body from producing anti-B antibodies.
“We also wash out the anti-B antibodies by carrying out a plasma exchange. So now, a person with blood group ‘B’ can donate to a person with blood group ‘O’,” Dr Soin says. He was the first surgeon in India to conduct the ABO-incompatible transplantation.
These methods have opened doors for numerous families who would have otherwise been denied transplantation as an option due to blood group incompatibility.
“Yes,” Dr Soin replies. He then talks about dual lobe transplantation — another pioneering concept. It allows for the transplantation of two liver lobes, donated by separate individuals, into a single recipient.
It overcomes the limitation of size mismatch between a larger recipient and a single donor, enabling more patients to undergo successful liver transplants.
“When the patient is large — like the father weighs 100 kg and the daughter is 50 kg — the right side of the liver may not be enough for the recipient. So this method uses two donors who donate half a liver each and both these lobes can go into the same patient,” he explains.
Dr Soin adds that these technologies adopted by him and his team at Medanta have attracted several people from South India. The success rate is 97 percent for living donor transplants in adults and 98 percent in children. Also, donor survival is 99.9 percent, he explains.
Dr Soin has also reduced postoperative pain and accelerated the recovery process. His unwavering dedication to ensuring the well-being of both patients and donors has earned him the trust and gratitude of countless families.
Beyond his pathbreaking surgical techniques, Dr Soin has been at the forefront of advocating for increased access and awareness of liver transplantations.
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