Medical tourism and promoting health of its citizens can bring Indian and Pakistan nearer

According to liver transplant experts at the Shifa International Hospitals, Islamabad, between 700 and 800 Pakistani patients undergo liver transplantation procedures abroad every year, spending about $4 million annually. Meanwhile, more than 500 Pakistanis have received liver transplantations in India so far. 

For example, Nalain was studying at the Myers School in Chakwal, and she was a shining pupil. She topped the Grade 5 exams.

"One day in September 2011, she returned from school with fever,” recalls her father, who worked for the ministry of health in Saudi Arabia. Upon learning of his daughter’s illness, he rushed to Pakistan and took her to a hospital in Islamabad where she was diagnosed with liver disease. The doctors at the Shifa International Hospitals said that she needed liver transplant. “At that time, doctors told me that it would take Rs8.5 million for transplantation, and I could not arrange such a hefty amount,” he says.

Hamid brought the matter to the notice of his employers in Saudi Arabia and the then prince and now King Salman turned out to be a messiah; Hamid took his daughter to Saudi Arabia where Nalain’s mother donated liver tissue to her daughter. Thus the child got her liver transplant.

But seven months later, the problem surfaced again — chronic rejection. A distressed Hamid was told to get his daughter a re-transplantation procedure but there was no one in the family whose blood group matched that of Nalain. And Saudi rules allow only a family member who is not more than 35 years of age to be a donor.

Hamid had to return to Pakistan and arrange substantial funds for a re-transplantation procedure. “I managed to voice my problem from the platform of a TV channel in 2013 and my cry was heard by Amber Riaz Malik, who took responsibility for all the expenses of a re-transplantation,” he tells me.

In Pakistan, liver transplantations are successfully being carried out at the Shifa International Hospitals. But Hamid says that re-transplantation has not been conducted so far in the country.

“I decided to take my daughter to Apollo Hospital which is famous for liver transplantation,” he explains. “Manzoor Hussain, the uncle of my wife, is going with us to donate tissue.” Nalain herself says she wants to become a liver surgeon one day. “I do not want to see people like me, I want to see them healthy,” she asserts.

Hamid is lucky as he is aware about the possibility of organ transplantation. Due to the high prevalence of chronic viral hepatitis and the additional, significant, burden of other chronic adult and childhood liver diseases, it is estimated that more than half a million people will develop end-stage liver disease or hepatocellular cancer. Not all cases are suitable for a transplant but a substantial number are. Successful liver transplant surgery has also been conducted at the Sindh Institute of Urology and Transplantation in Karachi, the Masood Hospital, Lahore, and Sheikh Zayed Hospital, Lahore, by foreign surgeons. But the process could not be continued because of the unavailability of local surgeons.

Hepatitis C is the major reason for liver failure requiring liver transplant. Other indications include Hepatitis B, autoimmune liver diseases and congenital liver diseases in children while the total expenditure for one liver transplant surgery is Rs4.5 million.

Government hospitals need to be upgraded to a level where liver transplants can be done safely. They need to hire competent and appropriately trained professionals, and have incentives built into the system where professionals are rewarded. That’s the only way to get liver transplants started in public-sector hospitals.

Now, 3D printer creates world's smallest working human liver

In an extraordinary feat, American scientists have successfully created the world's smallest human liver using a 3D printer that can work for forty days just like the real organ. Designed by medical research company in California, the mini-livers are just half a millimeter deep and four millimeters wide.

The 3D printer builds up 20 layers of hepatocytes cells that are responsible for carrying out liver functions, and two major types of liver cell.

Additionally, the printer adds cells from the lining of a blood vessel, which allows the liver cells to receive nutrients and oxygen.

Previously the company were able to show that liver function was retained in their 3D liver for over five days. And, now their tissues perform consistently for at least 40 days, a significant improvement over the average 48 hour performance of 2D cultures.

While research is in the early stages, scientists think that future versions could be used for transplants.

A big breakthrough in creating human liver through stem cells

Scientists have for the first time created a functional human liver from stem cells derived from skin and blood and say their success points to a future where much-needed livers and other transplant organs could be made in a laboratory.

While it may take another 10 years before lab-grown livers could be used to treat patients, the Japanese scientists say they now have important proof of concept that paves the way for more ambitious organ-growing experiments. The promise of an off-the-shelf liver seems much closer than one could hope even a year ago. Even though there is still much unknown and it will take years before it could be applied in regenerative medicine.

Researchers around the world have been studying stem cells from various sources for more than a decade, hoping to capitalise on their ability to transform into a wide variety of other kinds of cell to treat a range of health conditions.

There are two main forms of stem cells - embryonic stem cells, which are harvested from embryos, and reprogrammed "induced pluripotent stem cells" (iPS cells), often taken from skin or blood.

Countries across the world have a critical shortage of donor organs for treating patients with liver, kidney, heart and other organ failure. Scientists are keenly aware of the need to find other ways of obtaining organs for transplant.

The Japanese team, based at the Yokohama City University Graduate School of Medicine in Japan, used iPS cells to make three different cell types that would normally combine in the natural formation of a human liver in a developing embryo - hepatic endoderm cells, mesenchymal stem cells and endothelial cells - and mixed them together to see if they would grow.

They found the cells did grow and began to form three-dimensional structures called "liver buds" - a collection of liver cells with the potential to develop into a full organ.

When they transplanted them into mice, the researchers found the human liver buds matured, the human blood vessels connected to the mouse host's blood vessels and they began to perform many of the functions of mature human liver cells. The results offered the distinct possibility of being able to create mini livers from the skin cells of a patient dying of liver failure and transplant them to boost the failing organ. That livers and other organs may one day be made from iPS cells is an "exciting" prospect and holds out real promise for a viable alternative approach to human organ transplants.

Granny gifts a part of her liver to her grandson to save his life

BRAVE gran Tracey Kinder put her own life at risk by giving her grandson part of her liver.

At the same time she made medical history by becoming the first grandparent liver donor.

Mrs Kinder, 42, said: “The doctors told me I had a chance of dying in the operating ­theatre or after surgery but they couldn’t stop me. Nothing anyone could say would have changed my mind.

“I was ready to risk my life to save Reuben.” One-year-old Reuben was born with a rare liver condition, a form of biliary atresia, in which the bile ducts become blocked.

His mother Beth Kinder, 26, a hospital patient adviser, said: “Reuben couldn’t have gone on much longer. When they opened him up they said his old liver had almost stopped functioning.”

Tracey, from Goole, East Yorkshire, stepped forward when other possible donors, including Reuben’s father, builder Mark Gerard, 26, were told a liver donation from them wouldn’t work.

There is a desperate shortage of donors and last year seven children died while waiting for a transplant.

Up to 40 per cent of child liver transplants are now donated by relatives. Surgeons prefer to use parents and younger family members as donors because grandparents are older and likely to be less fit. Mrs Kinder said: “I don’t drink and I don’t smoke and I’m not overweight so I ticked a lot of the boxes, but they still try to put you off with warning you about all the risks of surgery. “I had to offer. I couldn’t just stand by and do nothing. Reuben was becoming more unwell and we had no idea when a donor would be found.”

Reuben was admitted to Leeds General Infirmary in December and stayed there until his operation in May. Both he and his grandmother are recovering well.