Dr Subhas Gupta - Kidney, Liver & Pancreatic Transplant Surgeon – India

"I am Subhas Gupta. I am a liver specialist, and I do liver transplant surgery. I do liver resection for cancers. I do pancreatic surgery for pancreatic cancer.

I am a postgraduate from the All India Institute of Medical Sciences, New Delhi. Subsequently, I trained in the UK for hepatobiliary surgery at the University of Birmingham Queen Elizabeth Hospital and later on St James’ University Hospital Leeds.

Thereafter, I spent a lot of time in the Far East, in Japan and Korea, where liver surgery is far more advanced than anywhere else in the world. Then came back to India and started doing hepatobiliary surgery.

I am a member of the Royal College of Surgeons, Glasgow and Edinburgh; I am a member of the British Transplant Society and of the Indian Society of Organ Transplantation.

There are many surgeries which I had for the first time in this part of the world and some [surgeries] for the first time in the world. Our group [Indraprastha Apollo Hospitals, Delhi] has to its credit liver transplant surgery in India for the youngest child and the first combined liver-kidney transplant in India.

Our patients for liver transplants come from all over the world, many come from our neighbouring countries like Pakistan, Bangladesh, Sri Lanka, Mauritius, and Thailand. We also get a large number of patients from the US, UK, and South American countries like Venezuela, etc.

The reason for that [overseas patients coming to us] is that living-related liver transplant is a very complicated surgery. Very few centres in the world do this routinely.

Liver transplantation, as you know, can happen from a cadaveric source. When it happens from a cadaveric source, it’s done from a large number in Western countries.

Within India and the Far East, cadaveric organ transplants are not that common. There are a lot of transplants from living donors.

Those patients from the US who cannot get a liver transplant done in the US because they may not have insurance. Sometimes, there’s a scoring system which is called the Mainz score, whereby a liver is given not to the patient who’s most disabled but to a patient who’s most likely to die in the next few months [unless a transplant is done]. As a result, many patients have to wait a long time for liver transplants.

We are not lacking in anything as far as equipment is concerned. And, help from colleagues, is more forthcoming in our part of the world than in England or other parts of the world where I have worked. In England, you cannot talk to a doctor after 5 PM unless he’s on call. Whereas, here you can draw on your colleagues to help you out in difficult situations. Working in India is much better, in the sense that you get much more cooperation from your colleagues.

Currently, we do mainly live-related liver transplants. The best results for living-related liver transplants are probably 90-95%.

And if you look at our cumulative data, we have had 87% rates of long-term survival in liver transplants across the board. But, of course, in some groups, we have had 100% success rates, like in children. Also, in the last two years, we have had a 95% success rate in elective liver transplants.

If you want to have a liver transplant in India, it is essential that someone recommend you for a liver transplant in your own country. Then, there must be a family member of the correct blood group in the age of 18-50 who’s willing to donate part of his liver to the patient. Otherwise, it’s pointless coming here from America.

A liver transplant is a very good operation, but there are some problems with a liver transplant. The problem that we face acutely in India is that we have almost no cadaveric organs. It’s mostly all living donor liver transplantation. Although we have done almost 200 living donor transplants, and no previously healthy donor has had any problems. Still, it is a major surgery for a liver donor.”