Challenges of liver transplantation programs in low‐ and middle‐income countries: An experience from Sri Lanka
Abstract Liver diseases lead to 1.3 million deaths per year around the world, the majority of which are secondary to cirrhosis. In the management of liver diseases in chronic and acute conditions, liver transplant (LT) plays a major role in improving the survival and quality of life of patients. LT...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2024-03-01
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| Series: | Public Health Challenges |
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| Online Access: | https://doi.org/10.1002/puh2.162 |
| _version_ | 1797239479210082304 |
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| author | M. J. S. Jayarathna B. K. Dassanayake Thinley Dorji Don Eliseo Lucero‐Prisno III S. Samarasinghe Vasanthi Pinto M. D. Lamawansa |
| author_facet | M. J. S. Jayarathna B. K. Dassanayake Thinley Dorji Don Eliseo Lucero‐Prisno III S. Samarasinghe Vasanthi Pinto M. D. Lamawansa |
| author_sort | M. J. S. Jayarathna |
| collection | DOAJ |
| description | Abstract Liver diseases lead to 1.3 million deaths per year around the world, the majority of which are secondary to cirrhosis. In the management of liver diseases in chronic and acute conditions, liver transplant (LT) plays a major role in improving the survival and quality of life of patients. LT programmes require the technical capabilities in performing the pre‐transplant evaluation, transplant surgery and post‐transplant care supported by adequate infrastructure and a set of trained teams. Globally, there were 28,000 deceased donor LTs, and 14,000 living donor LTs were performed in 2021. In the South Asia region, India, Pakistan and Sri Lanka conducted 2998 LTs in 2021. Many countries report sociocultural, religious and legislative barriers to acquiring adequate donor livers. We describe the challenges in LT programmes in low‐ and middle‐income countries and experiences from Sri Lanka. Sri Lanka carried out its first LT in 2010, and the service is provided free of charge in the state health sector. In Sri Lanka, the common indications for LT in adults are non‐alcoholic steatohepatitis, cirrhosis, hepatocellular carcinoma and alcoholic liver disease. In children, the indications are biliary atresia, hepatocellular carcinoma and Wilson disease. The common challenges include a lack of an adequate number of doctors and post‐transplant team members, a low number of organ donors and a long waiting list, all of which can be disadvantageous for transplant programmes. To continue providing LT services, there is a need to adopt multimodal strategies in the areas of providing additional skills training to the operating team and promoting organ donation culture in the background of supportive organ donation legislation. With the adoption of the national strategic plan for organ, tissue and cell transplantation, the country hopes to strengthen its capacity of providing transplant services to its people. |
| first_indexed | 2024-04-24T17:52:11Z |
| format | Article |
| id | doaj.art-d4db675c8b2b4f259838cc72b3dfc785 |
| institution | Directory Open Access Journal |
| issn | 2769-2450 |
| language | English |
| last_indexed | 2024-04-24T17:52:11Z |
| publishDate | 2024-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Public Health Challenges |
| spelling | doaj.art-d4db675c8b2b4f259838cc72b3dfc7852024-03-27T14:02:32ZengWileyPublic Health Challenges2769-24502024-03-0131n/an/a10.1002/puh2.162Challenges of liver transplantation programs in low‐ and middle‐income countries: An experience from Sri LankaM. J. S. Jayarathna0B. K. Dassanayake1Thinley Dorji2Don Eliseo Lucero‐Prisno III3S. Samarasinghe4Vasanthi Pinto5M. D. Lamawansa6Department of Anatomy Faculty of Medicine University of Peradeniya Kandy Sri LankaDepartment of Surgery Faculty of Medicine University of Peradeniya Kandy Sri LankaDepartment of Internal Medicine Central Regional Referral Hospital Gelephu BhutanDepartment of Global Health and Development London School of Hygiene and Tropical Medicine London UKTeaching Hospital Peradeniya Kandy Sri LankaTeaching Hospital Peradeniya Kandy Sri LankaDepartment of Surgery Faculty of Medicine University of Peradeniya Kandy Sri LankaAbstract Liver diseases lead to 1.3 million deaths per year around the world, the majority of which are secondary to cirrhosis. In the management of liver diseases in chronic and acute conditions, liver transplant (LT) plays a major role in improving the survival and quality of life of patients. LT programmes require the technical capabilities in performing the pre‐transplant evaluation, transplant surgery and post‐transplant care supported by adequate infrastructure and a set of trained teams. Globally, there were 28,000 deceased donor LTs, and 14,000 living donor LTs were performed in 2021. In the South Asia region, India, Pakistan and Sri Lanka conducted 2998 LTs in 2021. Many countries report sociocultural, religious and legislative barriers to acquiring adequate donor livers. We describe the challenges in LT programmes in low‐ and middle‐income countries and experiences from Sri Lanka. Sri Lanka carried out its first LT in 2010, and the service is provided free of charge in the state health sector. In Sri Lanka, the common indications for LT in adults are non‐alcoholic steatohepatitis, cirrhosis, hepatocellular carcinoma and alcoholic liver disease. In children, the indications are biliary atresia, hepatocellular carcinoma and Wilson disease. The common challenges include a lack of an adequate number of doctors and post‐transplant team members, a low number of organ donors and a long waiting list, all of which can be disadvantageous for transplant programmes. To continue providing LT services, there is a need to adopt multimodal strategies in the areas of providing additional skills training to the operating team and promoting organ donation culture in the background of supportive organ donation legislation. With the adoption of the national strategic plan for organ, tissue and cell transplantation, the country hopes to strengthen its capacity of providing transplant services to its people.https://doi.org/10.1002/puh2.162end‐stage liver diseaseliver cirrhosisliver transplantationorgan transplantationSri Lanka |
| spellingShingle | M. J. S. Jayarathna B. K. Dassanayake Thinley Dorji Don Eliseo Lucero‐Prisno III S. Samarasinghe Vasanthi Pinto M. D. Lamawansa Challenges of liver transplantation programs in low‐ and middle‐income countries: An experience from Sri Lanka Public Health Challenges end‐stage liver disease liver cirrhosis liver transplantation organ transplantation Sri Lanka |
| title | Challenges of liver transplantation programs in low‐ and middle‐income countries: An experience from Sri Lanka |
| title_full | Challenges of liver transplantation programs in low‐ and middle‐income countries: An experience from Sri Lanka |
| title_fullStr | Challenges of liver transplantation programs in low‐ and middle‐income countries: An experience from Sri Lanka |
| title_full_unstemmed | Challenges of liver transplantation programs in low‐ and middle‐income countries: An experience from Sri Lanka |
| title_short | Challenges of liver transplantation programs in low‐ and middle‐income countries: An experience from Sri Lanka |
| title_sort | challenges of liver transplantation programs in low and middle income countries an experience from sri lanka |
| topic | end‐stage liver disease liver cirrhosis liver transplantation organ transplantation Sri Lanka |
| url | https://doi.org/10.1002/puh2.162 |
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