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Liver Transplant in India

What's a liver transplant?

A liver transplant is a surgical treatment where surgeons replace a diseased liver with a healthy organ from another person. H/she may require partial or complete replacement depending on the extent of your medical condition. The healthy organ contributor is known as a donor.

It is the optimum cure process for liver failure. It may happen fast or over a while. The former one is called acute liver failure; doctors point to complications from certain medications for its generation.

Major causes for liver failure

Liver failure can be broadly classified into two categories. The classification is based on the period that the process takes to build up.

Acute Liver Failure

Acute liver failure is the quick generation of liver disintegration. In these cases, your organ ceases to operate within weeks. Studies reveal that acute liver failure is a consequence of medicinal complications.

Doctors try to treat such conditions with targeted medical processes. Transplantation is seldom considered to treat an acute liver failure.

liver transplant complications
Liver Transplants Waiting Lists in India

Chronic Liver Failure

Chronic liver failure happens over a long period that may extend from several months to years. Medical researchers have indicated liver scarring as one of the most common causes of chronic liver failure.

Liver cirrhosis (scarring) behaves like cancer. Scarred tissues replace normal tissues in the organ thus prohibiting it from proper functioning. In major cases, a liver transplant is the only resolution for such a disease.

Principal causes of liver cirrhosis directing to a liver failure and subsequent transplantation can be summed up as under:

  • Presence of Hepatitis B and C in your blood.
  • Consumption of uncontrolled alcohol often damages the organ resulting in appendage failure.
  • Fatty liver disease: it is a non-alcoholic condition; fat builds in and around the lining liver tissues causing inflammation. The condition becomes precarious as it progresses to damage the organ functions.
  • Hemochromatosis is a genetic disease. Diagnostic tests reveal enough iron accumulation in the affected limb.
  • Williston's disease comprises excessive copper build-up in the appendage.
  • Several diseases that affect the bile ducts can also bring forth Liver Failure. These diseases include primary biliary cirrhosis, primary sclerosing cholangitis, and biliary atresia. The last one forms cases of pediatric liver transplantation.

Liver Transplant Types

There are various kinds of liver transplant which are supported two parameters:

disease condition

availability of donors

The various sorts of Liver Transplant are:

a) Living Donor Liver Transplantation (LDLT): This can be understood as a procedure where the living donor's healthy liver is employed for liver transplant and thereby removing the diseased liver from the patient. The liver will regrow to its actual size within a particular period in both the donor & receiver.

b) Domino Liver Transplantation: this can be a sort within which the Liver is taken from a liver transplant recipient and is placed into a person with the disease and awaiting transplant. It's specifically and commonly preferred for elderly patients.

c) Cadaver Liver Transplantation: This is a procedure where the Liver transplant is done with the healthy liver of a mortal and removal of the diseased liver from the patient.

d) Pediatric Liver Transplantation: during this variety of Liver transplants, surgery is done in infants or children where there's little hope for survival without the removal of the diseased liver and replacing it with a healthy organ.

e) Split Liver Transplantation: during this style of the liver transplant procedure, the Liver transplant is performed by taking the healthy liver of a soul and splitting it into two for transplanting into two patients and removal of the diseased liver from both the patients.

f) Auxiliary Liver Transplantation: Under this sort of Liver transplant, the transplantation gets completed in which only part of the diseased liver is removed and the remainder of the organ is left to regenerate over a specific period.

Liver Transplant Symptoms

Predominant symptoms for liver failure include

Gastrointestinal bleeding

With increasing scarring in the liver, portal blood flow faces increased resistance. It causes increased pressure on the portal venous system. The entire portal hypertension thus needs to create alternative on-routes for blood to the heart.

Small veins throughout the abdomen staying outside the organ thus become enlarged and thin-walled due to the passage of abnormal high amount of blood through them generating additional pressure.

The veins within the esophagus and stomach thus turn fragile. They become prone to rupture and bleeding. Bleeding in the intestinal tract can be life-endangering too.

Retention of fluid

Our liver helps in synthesizing proteins circulating within the bloodstream. These proteins include albumin that suspends within the vascular blood space. These proteins generate an osmosis pressure which is very much needed for maintaining proper blood functioning.

If the organ stops operation, the protein rate becomes low causing fluid generation out of the bloodstream. Blood can’t reabsorb the fluid. These are then accumulating in tissues and body cavities. Deposition in the abdominal cavity or chest can be life-threatening.

Encephalopathy

It involves the inability of your abdominal organ to clear and toxins from the blood. Accumulation of these evil substances results in cognitive dysfunction within the entire below-belt functioning.

Encephalopathy can contribute to a disturbed sleep-wake pattern to mild confusion that may lead to a temporary coma.

Jaundice

Several experts have identified the yellowing of skin as the main hue for hepatic dysfunction. The organ eliminates the degradation outcomes of hemoglobin. One of those degradation products is Bilirubin; it is processed and excreted out of our body system through an acute method.

While treating Jaundice, doctors often mention Bilirubin-count that indicates the amount of persisting de-oxidants within the blood. Our tissues and skin thus assume their yellow color. It is a major cause of the disease.

Factors causing chronic liver injury

Chronic liver injury factors have been summed up in the subsequent columns. It is to remind that patients of these diseases are the most potential candidates for an organ substitution.

Viral Hepatitis

It includes Hepatitis B and C infection. Of these, the former one accounts for not more than 10% in the USA alone regarding organ transplants. But, according to reputed medical journal studies, the disease books much larger proportions in the continents like Asia and Australasia.

USA people are more aligned to Hepatitis C infection. Statistics reveal that around 50% of liver transplant cases go alone with such diseased.

Alcoholic Liver Disease

Experts pointed to the consumption of uncontrolled alcoholic substances as the reason for both the abscess and cirrhosis of liver. Therefore, patients arriving at the clinics for metabolic disease treatment are put under a six-month abstinence period, where they are kept under strict observation.

Most alcoholic cases are cured through a controlled diet and guided medication within this period.

liver transplant success rate
liver transplant Survival Rates

Metabolic Liver Disease

It holds up as excess fat deposits in the liver cells. The inflammation it causes injures the organ and causes its scarring ultimately. Risk factors for the disease include blood sugar and increased cholesterol. Considerable transplantations occur to such patients throughout the globe.

Genetic Liver Diseases

These include:

  • Wilson’s disease involving abnormal copper metabolism.
  • Hemochromatosis where your abdominal limb gets excess iron deposits.
  • The Alpha-1 anti-trypsin deficiency: the condition causes deficiency of a gene product required for normal trypsin activities. Trypsin digests protein consumed by us. Prolonged disease sustenance may destruct both the liver and lung.
  • Type I, III, and IV of Glycogen Storage Disease are inherited metabolic disorders.
  • Tyrosinemia causing a disorder of tyrosine metabolism.

Hepatocellular Carcinoma

The disease is a primary cancer of the metabolic organ. Though occurs seldom, chances are elevated with factors that promote liver cirrhosis as well as the presence of the latter. Cancer is a metastatic type that affects other vital organs within our body.

Liver transplantation is an effective treatment for Hepatocellular Carcinoma, provided the disease stays within the metabolic organ. Due to enhance in the demand for transplantable organs, World Health Organization has published specific guidelines that mentioned the criteria of HCC patients to be eligible for such a substitution procedure. The criteria stated limits of tumor number and size to ensure a fewer likelihood for the cancerous disease spread beyond the liver.

The Autoimmune Liver Disease

It destructs your organ with help of the internal immune system. It carries the following subsequent ailments:

  • Primary Billary Cirrhosis where the small bile ducts are crashed down.
  • Cholestatic Liver Disease.
  • Primary Sclerosing Cholangitis involving the destruction of the entire bile ducts around and within the appendage. Most patients suffer from ulcerative colitis. It is an autoimmune colon disorder.
  • Neonatal Sclerosing Cholangitis – it is a pediatric type where the bile ducts of infants are subjected to scarring and infection.
  • The TPN-induced cholestasis – patients receiving IV injections from other conditions get total parental nutrition or TPN. The disease can even cause bile stasis too.

Associated Risks

Complications

Liver Transplant is an acute application needed to be handled by expert hands only. The treatment is prone to multiple serious impediments. The risks have dual folding inclusive of:

  • Risks associated with the procedure.
  • Drugs are applied to patients in an attempt to debar rejection of donor liver by the patient’s body system.

Procedural Risks

  • Bile duct implications include bile duct leaks. The duct may also shrink as an aftermath of the substitution procedure.
  • Hemorrhage.
  • Blood Clotting.
  • Seizures leading to confusion in mind.
  • An infection in the treatment site.
  • Rejection of the donated liver by your body.

The treatment may also leave long-term complications. The most serious about these is the occurrence of similar diseases in the substituted organ. Side effects from medications offered to counter rejection

Your body will produce natural hindrances to the alien organ. The new organ will not be able to start functioning if these obstacles are not removed. Thus, your doctor will recommend some sorts of medications as the process ends. These drugs minimize the reactive power and the donor liver can start operating in the new body system.

However, these anti-rejection medicines offer a variety of side effects to your body pattern. You may become subject to:

  • Diarrhea.
  • Blood sugar disease.
  • High Blood pressure.
  • Severe and frequent pain in your head.
  • High cholesterol.
  • Bone thinning, which may be serious if not treated in time.

These drugs work by suppressing your normal immune system; therefore, these may bring about several infectious diseases. Thus, your doctor offers you medications to combat infections too.

Preparation

Your homework for a liver transplant starts as soon as your physician declares that you need an organ substitution. Usually, the doctor would recommend a good clinic, but you can make attempts to choose an ideal center for you.

Put stress over the following factors while considering transplant centers:

  • Look at their record regarding such performance. Consider both the number and types of surgeries conducted there every calendar year.
  • Enquire about the survival rates too before contacting.
  • You can make a comparison of center statistics vides the databases maintained in the state or union authentic body.
  • Look through the costs charged at various levels of your treatment. Separate charges will be billed for before, during, and post-period procedures. You will have to incur for tests, procurement of organs, transportation, hospital stay, and surgery. Some clinics make a bill for post-procedure follow-up appointments in advance.
  • Make a comparison of the costs assessed by each of the clinics; try to assess if there is any hidden cost within the framework.
  • Ask them about the techniques they use in organ transplantation. Make sure that only updated technology is used there before signing the bond.
  • You need some additional services while you are sustaining through the recovery process post-surgery. These include coordinating support groups, providing assistance in arranging your travel, etc. They must arrange for local housing while you are covering up your recovery period.

The transplant clinic will shot up some tests to check your eligibility for the procedure. Such evaluation process aims to find out:

  • If you possess the required health status for the surgery.
  • If your clinical condition says ‘yes’ for the post-treatment medications that you may need to continue for the rest of your life.
  • If you are medically fit for the procedure.
  • You are okay with the terms and conditions offered by your doctor.

Tests for disease identification

Your doctor will advise some test to evaluate liver condition. These include:

  • Blood and urine tests to assess your organ health.
  • Ultra-sound imaging.
  • Your surgeon may want your heart test report; you must have a strong cardio-vascular system to have transplantation.
  • The general health examination will comprise the routine cancer screening test. Evaluation of general health and check for other illnesses are mandatory too.

Your expectation

Before the procedure

Your medical team will assess disease severity based on the test results mentioned above. The more severe is your disease; you will be placed ahead of patients with not-too-serious hints.

Waiting for a new liver

You will get a new liver from a donor; you have already placed it in the list of patients requiring a donor's liver. Patients who can utilize diseased-donor are fairly quickly come out of the list. Waiting for a living donor may take months, even years.

While you are waiting for the new liver, your doctor treats the organ complications causing the failure; it eases up your lingering process. However, complications of end-stage failure are serious. Such patients are kept under close observations either retaining in the clinic or through an at-home medical hub.

Be it you are waiting for a donated liver or the transplant is fixed by the time, you must stay healthy. Staying healthy and active indicate that you are ready to make the process as it arrives. Besides, your recovery will also speed up.

At the procedure

Deceased-donor organ transplantation

You should report at the clinic no sooner than you receive a notification about the availability of a deceased donor. You will be under general anesthesia while the procedure is on.

Your surgeon will make a long incision across the abdomen to have access to the organ. Incision size and location based on your treating doctor’s approach and body configuration.

After removing the diseased organ, your surgeon will replace it with the donor. Then h/she will connect your blood vessels and bile ducts to the donor's liver. The process takes up to 12 hours; the duration also depends on your overall medical condition.

Living donor transplant

Under such cases, the clinic will fix the surgery date according to the availability of your donor. The surgery starts with the donor; your surgeon removes the organ portion to place into your body.

Then h/she starts operating on you; after removing the inactive limb, h/she places the previously-confiscated appendage portion in your body. The process as the doctor stitches after connecting the blood vessels and bile ducts to the substituted organ.

The degenerated organ will regain its size within weeks.

After the procedure

  • You will have to stay in the clinic for a few days when the treating team will monitor your condition.
  • Signs of complications are properly taken care of.
  • They will test organ function rapidly to ensure that the new organ can adapt to the alien body.
  • You will be released after a few days; but, it is imperative for you to strictly follow their checkup schedule.
  • You may be ordered to have multiple blood tests. For the first few weeks, it may be a few times each week. Its frequency will be reduced as your condition promotes.
  • You will be recommended immunosuppressant drugs that debar your immune system from attacking the new organ. Several other prescription medications are also offered to eliminate your post-procedure complications.

Final word

Risks of death are high even for successful liver transplantations. Statistics say that around 70% of people with successful transplant experience survive for a maximum period of five years. Rests die within that period.

Studies reveal that living donor transplants have better short-term survival rates than people who have undergone the deceased-donor method.

Liver Transplant cost in India
Liver Transplant India

Liver Transplant Cost in India

  • Find low-cost treatment at the best hospitals in India as compared to other western countries.
  • International patients can get quality treatment and surgery at an affordable price.
  • The surgery costs range from $25,000 To $40,000. It depends upon the complexity of the treatment and services facilities from the hospital.

Get details of the Liver Transplant hospitals in India that offer higher success rates at affordable cost. The cost of Liver Transplant varies widely. For Liver Transplant, it is necessary to choose the proper specialist in India. HMSDESK helps patients seeking medical care and specialty treatments from the Best Transplant Surgeon in India. Various hospitals and clinics in India have gained massive popularity all over the world. International patients preferred places for the surgery or treatment would be tier one, in developed cities like Bangalore, Chennai, Hyderabad, Kolkata, Mumbai, Delhi, Mangalore, Kochi, Jaipur, and Pune.

Frequently Asked Questions about Liver Transplant

Who will be a liver donor?

Donation is a voluntary process. Numerous parameters or factors get considered before determining a possible donor. To become a donor, the individual must be

  • A willing adult between the ages of 18 and 60
  • Should be prepared to undergo the pre-donation evaluation process, surgery, and recovery
  • Should be in a physiological state and condition
  • Must have a compatible blood group
  • Should have a healthy liver and kidney that functions effectively
  • Bodyweight should be appropriate (BMI but 32)
  • He/she must be willing to abstain from alcohol until fully recovered
  • Under the below-mentioned condition's the individual cannot donate:
  • If they're under the age of 18 or over the age of 60
  • Cardiopathy or lung disease
  • Having incompatible people
  • Suffering from HIV or hepatitis
  • If the person is mentally unfit.
  • The tests for identifying the potential liver donor include
  • Blood tests
  • Chest X-ray
  • CT scan
  • Electrocardiogram (EKG)
  • Physical exam
  • Tissue matching

Thus, in short, the donors must have a well-matched people and liver anatomy that's appropriate for donation. Capable liver donors should not litter with any serious medical condition, like disease, diabetes, cardiopathy, or cancer. For a living donation, the individual must surely be a detailed relative of the patient whose age should be between 18-55 years, have a compatible blood type, and weight between 50-90kg.

What Diets and Nutrition need are followed after Liver Transplant?

After the liver transplantation of a patient, it's important to eat a well-balanced diet to recover and keep their liver healthy. Most of the time transplant team includes a nutrition specialist (dietitian) who will discuss the nutrition and diet needs and answer any questions that patients have after their transplant.

  • In general, the diet of patients after liver transplant should be low in salt, cholesterol, fat, and sugar.
  • To prevent damaging their new liver, it is critical to avoid alcohol. Don't drink alcoholic beverages or use alcohol in cooking.
  • The patient's dietitian will provide them with several healthy food options and concepts to use in their nutrition plan. Their dietitian's recommendations may include:
  • Eating a minimum of five servings of fruits and vegetables daily
  • Avoiding grapefruit and fruit crush due to their effect on a bunch of immunosuppression medications
  • Having enough fiber in their daily diet
  • Choosing whole-grain foods over processed ones
  • Drinking low-fat or fat-free dairy products, which is vital to take care of optimal calcium and phosphorus levels
  • The dietitian may additionally recommend:
  • Eating lean meats, poultry, and fish
  • Following food safety guidelines
  • Staying hydrated by drinking adequate water and other fluids every day.

How long the liver transplant operation takes? And what average hospital stay for the donor and Patients?

Liver transplants are a time consumed surgery that mostly takes 4 to 14 hours. A typical liver transplant can last from 8-12 hours. The surgery for the donor lasts approximately 5-6 hours. At the time of the surgery, surgeons will remove the patient's liver and replace it with the donor's liver. The surgeon will disconnect their diseased liver from their bile ducts and blood vessels before removing it. The blood that flows into the patient's liver is blocked with the assistance of a machine to return to the remainder of their body. The surgeon will put the healthy liver in situ and reconnect it to the patient's bile ducts and blood vessels. The blood will then flow into the new liver within the patient's body. Surgeons will have to place several tubes into the patient body. These tubes are necessary which help their body to hold out essential functions during the operation.

The average hospital stay after liver transplant for patients is two weeks to a few weeks. Some patients often get discharged earlier, while others could also be within the hospital for a much longer period, it depends on how the new liver is functioning and on the complications that may arise after the surgery. Seven to ten days of hospital stay after surgery can be advised for the donors. About 7-10 days’ post-surgery incision staples are removed.

What about the donor after he/she has donated liver? Can he/she lead a standard life?

For a donor or a patient involved in liver transplantation surgery, life often goes back to normal some months after surgery. By that time, the liver will probably reach its actual size, and both the patients, likewise because donors are back to their routine life. During the hospital stay, a donor will stay for per week. They may feel weak and tired after their surgery because of the pain but it is normal, it can be relieved with the assistance of pain medications. Within the primary day or two, the doctor will ask the donor to urge up, move around, and do breathing exercises. The danger related to liver transplants for a donor is simply 0.1 to 0.5% only. The donor must avoid lifting heavy weights for the initial three months. Long-term problems are rare still hernias may occur and a few donors can have ileus thanks to the intestine getting stuck to the scar of surgery.

Does someone have high infection rates and lead a restricted life after a liver transplant?

It can be a misconception that patients and plenty of liver donors have that isn't true. The patients and the donors are highly at risk of acquiring infection than usual this condition won't last lifelong. The Susceptibility to infection will rapidly deteriorate after 3-6 months after the liver transplantation surgery when the doses of the immunosuppressive medicine get reduced. They will lead a traditional and healthy life with proper diet, medications, and exercise. The foremost important thing is that whether or not the patients or the donors encounter infection it's treatable and curable.

Can liver diseases reoccur after liver Transplant?

Although the probabilities or probability of disease reoccurrences are less, sometimes the disease can reoccur after liver transplant surgery. The most common diseases which will result in chronic liver failures are:

  • When the chemical activity within the liver cells changes can cause Metabolic diseases.
  • When the conventional healthy tissues within the liver die because of reactions of medicines or drugs and other acute infections.
  • When the cancerous tumors start growing in the liver resulting in Primary carcinoma.
  • Due to serum hepatitis or C
  • Inflammation's caused within the liver due to Autoimmunity
  • A rare disease of the liver and bile ducts that happens in newborns called Biliary Atresia.

The transplant team will advise the patients on the incidence of recurrence of specific liver ailments. In cases where there's a risk of recurrence, the transplant team will monitor the patients very closely to prevent a recurrence. The patients should strictly follow the instructions given by their transplant team to revert to a healthy life.

What Diets and Nutrition need are followed after Liver Transplant?

After the liver transplantation of a patient, it's important to eat a well-balanced diet to recover and keep their liver healthy. Most of the time transplant team includes a nutrition specialist (dietitian) who will discuss the nutrition and diet needs and answer any questions that patients have after their transplant.

  • In general, the diet of patients after liver transplant should be low in salt, cholesterol, fat, and sugar.
  • To prevent damaging their new liver, it is critical to avoid alcohol. Don't drink alcoholic beverages or use alcohol in cooking.
  • The patient's dietitian will provide them with several healthy food options and concepts to use in their nutrition plan. Their dietitian's recommendations may include:
  • Eating a minimum of five servings of fruits and vegetables daily
  • Avoiding grapefruit and fruit crush due to their effect on a bunch of immunosuppression medications
  • Having enough fiber in their daily diet
  • Choosing whole-grain foods over processed ones
  • Drinking low-fat or fat-free dairy products, which is vital to take care of optimal calcium and phosphorus levels
  • The dietitian may additionally recommend:
  • Eating lean meats, poultry, and fish
  • Following food safety guidelines
  • Staying hydrated by drinking adequate water and other fluids every day.

What type of exercises are performed after a liver transplant?

Exercise and physical activity should be a daily part of the patient's life after a liver transplant as it continues to improve their overall physical and mental state. Soon after their transplant, they must walk the maximum amount as they will. Then, looking at their progress, they'll start incorporating more physical activity into their way of life.

Walking, bicycling, swimming, low-impact strength training other physical activities they enjoy can all be an element of a healthy, active lifestyle after transplant. But they have to make sure to test in with their transplant team before starting or changing their post-transplant exercise routine.

What are the outcomes?

Your odds of a fruitful transplant and long haul endurance rely upon your specific circumstance.

As a rule, about 75% of individuals go through the live surgery for at any rate five years. That implies that for every 100 individuals who get it in any capacity whatsoever, around 75 will live for a very long time, and 30 will bite the dust inside five years.

Individuals who get one from a living benefactor frequently have preferable transient endurance rates over those who get a perished giver organ. In any case, looking at long haul results is troublesome because individuals who have a living giver generally have a more limited hang tight for a transplant and aren't as debilitated as the individuals who get a perished benefactor organ.

Why consider India for Liver Transplant?

India is promising as one of the favorite destinations for Liver Transplant tourism in the world due to its affordability, accessibility, and much cheaper rates.

India has become one of the most promising countries for all types of medical and Liver Transplant from a highly skilled hepatologist at many affordable prices. After surgery or treatment patient and attedant There are many Visiting places in India such as spiritual or historic palaces & museums to snow peaks, long coastline, backwater, rich heritage, and much more.

How am I able to find the best Liver Transplant Surgeons in India?

Just submit the inquiry form with details, and we will assist in finding the most suitable solutions as per your condition.

Which are the best Liver Transplant Hospitals in India that provide affordable Liver Transplant?

Visit HMSDESK to find and get details about Liver Transplant Hospitals in India. There are a good number of top Liver Transplant Hospitals in India that offer affordable treatments.

Is a low-cost Liver transplant Surgeon in India make any surgery successfully?

Hepatologist in India have experience and skills are known across the world for surgery or Liver Transplant.

Can you arrange a vacation tour after the treatment for me?

HMSDESK can arrange the best memorable vacation tour in India for you.

For Liver transplantation Some Countries From Which Patients Travel To India:

For Surgery Some Countries From Which Patients Travel To India:

  • USA
  • New Zealand
  • Nigeria
  • Kenya
  • Zimambe
  • UK
  • Ethiopia
  • Cuba
  • Uganda
  • Tanzania
  • Canada
  • Zambia
  • Congo
  • Sri Lanka
  • Bangladesh
  • Australia
  • Sudan
  • Maldives
  • Afghanistan
  • Uzbekistan

Best Organ Transplant Hospitals

Hospitals in India offer State-of-the-art equipment and the latest technologies.

  • Fortis Hospital
  • Blk Super Speciality Hospital
  • Yashoda Hospital
  • Saifee Hospital
  • Jaslok Hospital
  • Manipal Hospital
  • Max Super Speciality Hospital
  • Medanta Hospital
  • Nanavati Super Speciality Hospital
  • Sir Ganga Ram Hospital
  • Apollo Hospital
  • S L Raheja Fortis Hospital
  • Artemis Hospital
  • Wockhardt Hospital

Top Organ Transplant Surgeons

  • Dr. Gomathy Narasimhan
  • Dr. Sonal Asthana
  • Dr. Manoj Shrivastav
  • Dr. Mohamed Rela
  • Dr. Arvinder Singh Soin
  • Dr. Anupam Saha
  • Dr. Harsha Jauhari
  • Dr. Ashwini Kudari
  • Dr. Shravan Bohra
  • Dr. Murugan N
  • Dr. K. R. Balakrishnan
  • Dr. Subhash Gupta
  • Dr. Ashwini Goel
  • Dr. Shailendra Lalwani
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