News
Liver transplants – another first by NHSL in the state sector
It is a first not just for the flag-bearing Liver Transplant Programme of the National Hospital of Sri Lanka (NHSL) but also for the state health sector.
The first adult living donor liver transplant – securing part of a liver from a person and implanting it in a critically-ill person – has been done this month at the NHSL bringing hope for the poorest of the poor who cannot afford this life-saving surgery. Most people who face end-stage liver failure would have to sell their homes and scrape the barrel, even then an impossible task, to get a transplant in the private sector costing around Rs. 20 million.
The Sunday Times on Tuesday, January 20 meets 46-year-old Pathum from Pannipitiya for an exclusive interview as he prepares to go home. Having been hit by liver failure, when we see him on Day 6 after his operation, he is all smiles and readily agrees to talk to us and also share his photograph.
In his 7th floor room in the state-of-the-art Transplant Unit (Ward 86) of the NHSL’s Epilepsy Unit Building, Pathum, is looking forward to his reunion with his wife and five-year-old twin daughters.
Running an online business, Pathum had felt ill on and off about six years ago – his eyes were tinged with yellow and his legs were swelling up. He did take medicines too. His condition worsened recently.
Pathum thankful to the donor and the doctors. Pix by M.A. Pushpa Kumara
It was then that Pathum self-presented himself to the Liver Transplant Programme. He was very ill and needed a new liver urgently. When the team told him so, his family had found the donor and the processes had started – a set of investigations to check for compatibility between the donor, a female from Colombo, and the recipient.
Once compatibility was established, the multi-disciplinary team held a planning meeting and things fell into place with the surgery set for January 14.
“Donor safety was ensured with a thorough and comprehensive assessment of all systems such as the heart, lungs and liver,” says Consultant Hepato-Pancreato-Biliary & Liver Transplant Surgeon, Dr. Prabath Kumarasinghe.
Wheeled into one of the duplex (twin) operating theatres (OTs) which are side-by-side on the 7th Floor which is shared with the neuro-epilepsy unit, around 6 a.m. on the 14th, the anaesthetist team performed their important tasks, after which the surgical team opened up the donor and carefully dissected part of the right lobe of the liver.
This had been a four-hour surgery with minimal blood loss.
Then came the preparations on the backbench – perfusing (suffusing) the dissected section of the liver with preservative solution before implantation.
The recipient, meanwhile, was opened up around 11 a.m. after which the diseased liver was removed and the perfused donor liver segment implanted, other members of the team chip in, explaining that thereafter the blood vessels and bile duct of the recipient were carefully attached (anastomosed) onto the implanted liver with very fine sutures. This surgery had taken around six hours, while the transplant anaesthetists closely monitored the vitals of the recipient.
They also point out that both – donor and recipient – were extubated (removal of the tubes inserted into the trachea for artificial ventilation) in the OTs themselves and then transferred to the Surgical Intensive Care Unit (SICU) for post-operative care.
The liver transplant operation in progress
Along with Dr. Kumarasinghe, the Surgical Team comprised Consultant Transplant Surgeon Dr. Ruwan Dissanayake; Consultant Vascular & Transplant Surgeon Dr. Gayan Bandara; and Acting General Surgeons Dr. Prasad Perera, Dr. Sumeda Bandara & Dr. Chamal Fernando. The NHSL team had got much support from Consultant Hepato-Pancreato-Biliary and Liver Transplant Surgeon of the Peradeniya Teaching Hospital, Dr. Buddika Dassanayeke who had also joined them in the OT. The Anaesthetic Team comprised Consultant Anaesthetists Dr. Charaka Yapa Abeywardena; Dr. Anjali de Silva & Dr. Oliver Pathmaperuma.
While the teams pay tribute to NHSL Acting Deputy Director General Dr. Pradeep Wijesinghe and Deputy Director Dr. Pradeep Ratnasekera, they are also very appreciative of the Medical Officers, Nursing Officers & Junior Staff of Ward 86 as well as SICU 1 and ICU care provided by Consultant Anaesthetists Dr. Ranmali Kulasiri & Dr. Hemantha Rajapaksha and other doctors and nurses.
The final say comes from Pathum who had been on the brink of death – he showers abundant blessings on the teams for giving his life back to him. Since its launch in 2017, the NHSL’s Liver Transplant Programme has performed 67 transplants after securing livers from cadaveric donors. Last year (2025) alone it performed 12.
The Liver Transplant Programme’s ‘firsts’ include paediatric liver transplant; split-liver transplant; liver transplant for Budd-Chiari Syndrome; redo liver transplant; dual organ transplant; and ABOi transplant, in addition to the usual transplants.
A split-liver transplant is a surgery where a single liver from a deceased donor is divided to provide a portion to two recipients, commonly an adult and a child; a liver transplant for Budd-Chiari Syndrome (BCS) is a cure for this rare vascular liver disease; and a redo liver transplant is a second liver transplant to replace a failing or previously transplanted liver.
Meanwhile, a dual organ transplant is where a patient receives a new liver and another new organ (liver-kidney usually) during the same surgical procedure; and an ABOi liver transplant is when the transplant is for a patient whose blood type is different from the potential living donor.
The staff on duty when the Sunday Times visited Ward 86 on Tuesday
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