Black Country liver transplant patient in world first

The father of three was given a new organ that travelled more than 200 miles before being revived by surgeons. Despite delays and taking seven hours to arrive at Birmingham's Queen Elizabeth Hospital – significantly increasing the risk of failure in a normal transplant procedure – surgeons successfully revived the organ by pumping oxygenated blood through it.

The team resuscitated the liver, which had been transported in an ice box, with a machine using 'warm blood' before carrying out the operation on Mr Mahal,

It was decided the risk had been too high to carry out the liver transplant in the conventional way, which involves taking the organ from cold storage and putting it directly into the patient.

Mr Mahal, of Walsall, who had suffered liver cirrhosis, was discharged from the hospital 11 days after receiving his new liver that had been recovered from a cardiac death patient.

Other transplant centres around the world have carried out the same resuscitation technique on discarded livers, or tested similar procedures on animal models, but the team became the first in the world to successfully transplant a revived liver graft from a cardiac death donor into a patient. The entire process took around 18 hours.

Mr Mahal, who was managing director of his own import and export business prior to his illness, said problems with his liver were first diagnosed almost three years ago, but his condition deteriorated to the point where he was put on the transplant waiting list for a new organ about two months ago.

He was then called on the morning of the procedure and told to get to the hospital as soon as he could.

He said he knew what the surgeons intended to do before the procedure but had not realised it would be the first time in the world that it had happened.

Mr Mahal, 46 of Clover Hill, said: "I was very confident even though this was a new procedure.

"I knew that I was in the best place with the right physicians and staff. And I have been told that it has been very successful, so it's a world breaker.

"I didn't know until a few days afterwards that it was the first time this had been done.

"I'm overwhelmed and still in shock. I want to thank everyone involved. I have a new life now and am getting better day by day.

"I will be able to drive again, work again and take part in normal activities."

The operation involved a team of around a dozen staff led by consultant liver transplant surgeons, a consultant anaesthetist and theatre staff.

Surgeon Thamara Perera, who performed the operation, said: "There has been recent interest within the liver transplant community about the use of various machine devices to 'pump blood' at body temperature into organs retrieved from donors because it has been shown to minimise the damage which is inevitable when organs are preserved in cold storage.

"Many options and different combinations of techniques are proposed and currently under investigation in various clinical studies and trials.

"Several centres in the world are currently investigating the possibility of this type of warm resuscitation at the end of cold storage. However this was the first successful transplant.

"There are other centres that have been testing this technique on animals and discarded livers that are deemed unsuitable for transplantation.

"Our centre initially carried out tests on discarded livers before we got to this stage. The liver unit at Queen Elizabeth Hospital is now performing three different approaches to revive organs from deceased donors which is a unique achievement."

Mr Perera said the machine, which also contains an oxygenator, works by constantly pumping blood at body temperature into the liver through two blood vessels in the organ.

He said: "The warm blood revitalises the liver by taking out the coldness from being in an ice box, but also nourishes it through the oxygenated blood. It is able to simulate the blood supply within a real body.

"One advantage of this technique is that surgeons can actually choose the only grafts that would work on the machine, thereby preventing a graft failure once a transplant is carried out.

"Within the first 90 minutes of using the machine all the parameters became normal, so a collective decision was taken by the surgical and anaesthetic team to transplant this liver.

"When the transplant operation was completed the liver was resuscitated for a further seven hours on the machine, but his immediate outcome was comparable to any other patient receiving a straightforward transplant."

Mr Perera said the hospital trust had previously given approval for the new procedure in April this year but this was the first time they were able to test it.

Organs can be preserved in cold storage for up to about eight hours in the case of a cardiac death donors as the chance of organ failure then heightens.