The Body's Silent Hero: Essential Advice for Protecting Your Liver and Understanding Transplant Success

During periods of high dietary intake, such as festive seasons, the body’s organs are put under stress, with the liver working overtime. Referred to as the "boss of all organs," the liver ensures that if it functions well, all other organs maintain their health; conversely, liver damage inevitably leads to the suffering of all other organs.

The path to maintaining a healthy liver, even during times of feasting, lies in balance.

Diet, Exercise, and Detox Myths

A balanced diet is crucial, focusing on healthy forms of carbohydrates, which should comprise about 20–25% of food intake. Complex sugars are preferred over simple sugars. Fiber is also highly important, making up 30–35% of the diet, as it helps slow the release of glucose into the system. This steady release maintains energy levels without causing glucose overload, thereby reducing the risk of developing diabetes. Proteins, the body’s building blocks, are essential as the liver produces critical proteins necessary for functions like blood clotting. Consuming fresh fruits, salads, and non-sugar items is strongly advised.

Interestingly, the "champion of diet" for liver health is unsweetened black coffee. Consuming at least three cups a day provides substantial health benefits, including the prevention of liver cancer. This protective effect is derived not from caffeine, but from a polyphenol called chlorogenic acid. This means that individuals sensitive to caffeine (experiencing headaches or tremors) can still gain these same benefits by consuming decaf coffee.

When discussing detoxification, experts are clear: one of the main functions of the liver itself is detoxification. There is no proven evidence that any "detox drink" or medicine can successfully detoxify the liver after it has been damaged. The best approach is to abstain from habits that damage the liver, allowing the organ to take care of itself.

Regular exercise is vital for mitigating liver damage and should include both aerobic and strength training. Aerobic exercise should be performed 3 to 4 days a week for 30–35 minutes, specifically targeting Zone 2 exercise. This involves increasing the baseline heart rate by more than 50% (e.g., reaching 120 beats per minute if the baseline is 80) through activities like running, swimming, cycling, or walking. This routine helps protect the liver from becoming fatty or damaged. Strength or resistance exercises should also be incorporated 2–3 days a week.

Why Early Screening Matters

The liver has a unique and highly resilient nature: it is 70% surplus. Because of this tremendous regenerative capacity, a person will only develop the first symptoms of liver disease after almost 70% of the liver is already damaged. This resilience often causes people to neglect liver health, as they do not realize damage is occurring until it is too late.

Individuals identified as being at risk should undergo a liver screening at least once a year. Risk factors include obesity, poor diet, lack of exercise, regular alcohol consumption, or known conditions like fatty liver or viral hepatitis. Simple investigations, such as an ultrasound scan and a blood investigation called the liver function test, can provide crucial clues about liver health before symptoms appear.

Symptoms of liver stress that warrant immediate investigation include jaundice, which is the yellowish discoloration of the eyes and skin, or noticing that the urine is turning dark yellow. Easy fatigability is also a significant physiological sign of potential liver issues.

The Truth About Alcohol and Fatty Liver Disease

A common misconception, particularly among younger people, is that occasional or social drinking is safe. However, experts state unequivocally that there is no safe limit of alcohol. Social drinkers with existing background liver diseases, such as fatty liver, are at risk of developing severe liver damage earlier than others.

The idea that wine is healthier, derived from research into the component resveratrol, is misleading. To reach the therapeutic limits of resveratrol, one would need to drink liters of wine daily, which would cause significant liver damage before any health benefits are achieved. Alcohol, whether wine, beer, whiskey, or brandy, is toxic to the liver.

A major and growing concern today is fatty liver disease, which has been described as the "new diabetes". Fatty liver is an alarmingly common condition, affecting 40–50% of the general population, and it is a major risk factor for other metabolic disorders, including stroke, heart attack, diabetes, and liver cancers. The good news is that in its early stages (Grade 2, Grade 3), fatty liver is completely reversible. Through rigorous lifestyle changes involving diet and exercise, a person can return to a healthy liver in as little as one month.

If liver damage progresses, it moves from hepatitis (mild swelling that is reversible if the cause is treated) to cirrhosis. Cirrhosis is a scarred and fibrotic stage where the liver begins to shrink drastically (from its normal 1–1.5 kg to sometimes 400–500 grams). At this point, no amount of medication can reverse the damage.

Advancements in Liver Transplantation and Donation

Liver transplantation is a highly successful treatment option for patients experiencing liver failure or specific liver cancers. It is a complex procedure that requires world-class infrastructure and multidisciplinary support from specialists beyond the surgeon and anesthetist, including hepatologists, cardiologists, and infectious disease specialists.

A major advantage of liver transplants compared to other organ transplants is the low risk of rejection. The liver has a unique capacity to absorb the antibodies that typically cause rejection, even reducing the rejection risk of other organs if a combined transplant is performed.

For a living donor, life post-donation returns to normal. Donors can recover in about a month, and the donated part of the liver fully regrows in less than two months. Modern techniques, such as robotic surgery, are often used to ensure the procedure is minimally invasive, speeding recovery and minimizing complications. Donors are not required to take continuous medication or undergo lifelong investigations.

For the recipient, a successful transplant adds "life to the years". Recipients undergo a significant transformation, becoming energetic and healthy. While lifelong immunosuppression and follow-up are required, recipients return to a normal and fulfilling life, able to marry, have children, and participate fully in sports and exercise, even running marathons.

Bridging the Organ Donation Gap

Although India performs the second-highest number of transplants globally, almost 90% rely on living donors. This contrasts sharply with Western nations where deceased donation is the primary source, highlighting a critical need for awareness regarding deceased donation in India.

The decision to donate organs from a deceased person is legally made by the patient’s next of kin. Therefore, it is essential that individuals communicate their wish to donate their organs to their families. The most common form of deceased donation is diseased brain dead donation, where a patient in an ICU setting is declared brain dead but their heart and other organs are still functioning. A single deceased donor can provide life-saving organs for at least nine people.

Age is not a prohibitive factor for deceased donation. Even an 80 or 85-year-old’s liver or kidney may be healthy enough to be transplanted into a younger recipient, as a healthy liver can continue functioning for many decades.

Technological advancements are rapidly increasing the safety and efficacy of transplantation. Organ preservation has moved beyond traditional cold storage (which only lasts about 10 hours) to sophisticated machines that allow organs to function outside the body for days. These machines also offer therapeutic potential, such as using specialized solutions to defat a fatty liver before transplantation. Looking ahead, research into xenotransplantation (using genetically modified pig livers) and the 3D printing of livers suggests a future where the shortage of organs may be drastically reduced.

Dr. K. Elankumaran

Head

Liver Diseases and Transplantation Institute

Apollo Hospitals, Chennai