Vomiting blood, black tarry stools, or new confusion and drowsiness are emergencies. Go to hospital now. Variceal bleeding and hepatic encephalopathy both need immediate treatment where you are. Also seek urgent care for fever with abdominal pain and fluid.
Long-standing damage replaces liver tissue with scar until the organ can no longer do its work. Cirrhosis is not always a one-way road, and treating the cause sometimes improves the liver considerably.
Before any transplant conversation, one question matters: what caused this. Hepatitis C is curable, hepatitis B is controllable, and both are common across the countries our patients come from.
The liver responds to repeated injury by laying down scar tissue. Over years the scarring distorts its architecture, blood cannot flow through it easily, and functioning liver cells are progressively lost. That is cirrhosis.
It is described as compensated or decompensated. In compensated cirrhosis the liver still manages its work and people may feel entirely well for years. Decompensation is marked by specific events — fluid in the abdomen, bleeding from varices, jaundice, or confusion — and it changes the outlook substantially.
The causes matter more than almost anything else here. Hepatitis B and hepatitis C are the leading causes across South Asia, the Middle East and Africa. Alcohol and fatty liver disease are increasingly common everywhere. Autoimmune conditions and inherited disorders account for a smaller share.
Two scoring systems are used constantly. Child-Pugh grades severity from A to C using bilirubin, albumin, clotting, fluid and confusion. MELD is a numerical score used to judge transplant urgency. Both come from routine blood tests, and both should appear in any serious assessment.
Hepatitis C is cured in most patients with a course of direct-acting antiviral tablets, and hepatitis B is suppressed effectively with daily medication. Both can halt progression and, in some patients with compensated disease, improve liver function enough that transplant is no longer needed. Stopping alcohol entirely can produce marked recovery over months. A number of patients who contact us about transplant turn out to need antiviral treatment and time — which is a far better outcome, and considerably cheaper.
Blood tests define severity; imaging and endoscopy define complications.
Bilirubin, albumin, INR, creatinine, sodium and platelet count together give us your Child-Pugh and MELD scores, and those determine everything — whether transplant is needed now, later, or not at all. Add your hepatitis status with viral load, the ultrasound or CT report, and your endoscopy findings. A letter saying only cirrhosis tells us very little.
Most patients with cirrhosis do not need a transplant, and many never will.
Direct-acting antivirals cure hepatitis C in the great majority of patients. Antiviral tablets suppress hepatitis B indefinitely. Complete abstinence reverses a good deal of alcohol-related damage over months. Weight loss and metabolic control help fatty liver disease. In compensated cirrhosis, these can stabilise or improve liver function substantially.
Diuretics and salt restriction for fluid, drainage where fluid is tense, beta blockers or endoscopic banding to prevent variceal bleeding, lactulose and rifaximin for confusion, and antibiotics for infected abdominal fluid. Six-monthly ultrasound surveillance for liver cancer is essential once cirrhosis is established.
A portion of liver from a near relative replaces the failing organ. It is the definitive treatment for decompensated cirrhosis and offers excellent long-term survival in good programmes. It requires an eligible near-relative donor, embassy certification and Authorisation Committee approval, and it commits you to immunosuppression for life.
A shunt created inside the liver to relieve portal hypertension can control refractory fluid and recurrent variceal bleeding. It may worsen confusion, so patient selection matters. It is frequently used as a bridge for someone awaiting transplant.
Hepatitis C cured or hepatitis B suppressed changes the trajectory. This is established first.
Compensated cirrhosis is managed and monitored. Decompensation moves transplant onto the table.
For foreign nationals in India, transplant requires a near relative. Where none exists, medical management is the plan, and we will say so.
If you have untreated hepatitis C, we will recommend treating it before anything else. It is a course of tablets, it works in most people, and it is available at a fraction of Western prices.
Decompensated liver disease is not safe to fly with. It needs stabilising locally, and only then can transplant assessment sensibly proceed.
Photographs taken on your phone are fine. Reports in Arabic, Russian or Bengali are fine — we translate them ourselves.
Some of it, sometimes. Curing hepatitis C, suppressing hepatitis B, or stopping alcohol completely can allow meaningful recovery of liver function over months, particularly in compensated disease. Established scarring does not disappear entirely, but progression can be halted and function improved. This is why treating the cause comes before any transplant discussion.
It is a score calculated from bilirubin, creatinine, INR and sodium, used to judge how urgently a transplant is needed. A higher score indicates more severe disease. It is the standard measure used in transplant assessment worldwide, and it comes from ordinary blood tests you may already have had.
Not necessarily. Many people with compensated cirrhosis remain stable for years with good management and treatment of the cause. Transplant is considered when decompensation occurs — fluid, bleeding, jaundice or confusion — or the MELD score rises. Send your blood results and we will tell you which situation you are in.
Almost certainly not. Direct-acting antivirals cure hepatitis C in most patients including many with cirrhosis, and doing so reduces the risk of further deterioration and of liver cancer. Treatment is a course of tablets over a few months and is far more affordable than it once was. It should be discussed before any transplant plan.
Because cirrhosis substantially raises the risk of liver cancer, and cancers found small on surveillance can often be cured, while those found late frequently cannot. Six-monthly ultrasound is the standard of care for anyone with established cirrhosis, and it is one of the most valuable things you can arrange near home.
If alcohol contributed to your liver disease, no — complete abstinence is required, and every credible transplant programme requires a documented period of it before listing. Even where alcohol was not the cause, a cirrhotic liver handles it poorly. This is a medical requirement rather than a moral judgement.
Send bilirubin, albumin, INR, creatinine and sodium, plus your hepatitis status. Those numbers give us your MELD score, which decides most of the answer.
Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.
WhatsApp +91 83035 86344 · Phone +91 83035 86344 · Email tibhind@gmail.com
Coordinators available 9:00–20:00 IST. We speak Arabic, English, Russian and Bengali.