National Liver Board - Purpose, Benefits, Members and Process

India accounts for the world’s 20% share of deaths associated with liver diseases. It is the 10th most common cause of death in India. The disease burden is majorly spread between hepatitis, cancer and liver cirrhosis. This burden is increasing at ~2.5% year on year. It is also predicted 75% of the patients may not be able to afford treatment for these liver conditions.

General physicians might not be aware of liver conditions, complications and suitable lines of treatment. Liver diseases also often go undiagnosed until it has progressed to a more advanced stage, which can lead to serious complications. And the chances of a reversal of liver disease are low and lead to complications such as ascites, hepatic encephalopathy, and variceal bleeding, among others.

In some cases, a liver transplant may be required, which is very difficult to search. The life span available for a patient without a liver transplant with these complications is 2 to 3 years.

Hence, there is a need for specialist opinion to identify the most suitable line of treatment for the patient with liver complications. Thus, the NLB comes into play with the primary goal of creating awareness about liver disease and promoting prevention measures. 

NLB not only helps the patient with the treatment but also with diagnosis and the further process, which can ultimately improve patient outcomes. NLB is ideal for patients with critical liver diseases. The following are the key reasons to consult the NLB:

1. To be sure about the diagnosis and the treatment that the patient needs based on the liver condition.
2. To support the information about the illness and treatment that the patient has already been given.
3. To be aware of the whole process from diagnosis to treatment.
4. To make an informed choice and feel confident about choosing the best treatment plan in accordance with the shared opinion of all the experts.

The NLB is an important panel of experts dedicated to promoting liver health and preventing liver diseases. Some of the key benefits of the NLB are:

1. Improved patient care: NLB can help ensure patients with liver disease receive optimal care by promoting evidence-based practices and facilitating collaboration among healthcare providers.
2. Standardisation of care: The board gathers to develop standardised diagnosing, treatment and management guidelines for liver diseases to ensure that the patients receive consistent, high-quality care regardless of location. 
3. Reduced treatment time: The NLB members meet to discuss the patient’s condition and for the diagnosis and the best treatment. This multidisciplinary approach shortens the time for diagnosing and treating the patient and reduces unnecessary efforts.
4. Raising awareness: The NLB is committed to increasing public awareness of liver diseases, their causes, and their prevention. By educating people about healthy liver habits, the NLB helps to reduce the incidence of liver disease and promote good liver health.
5. Education and training: Developing educational resources and training programs for healthcare providers to improve their knowledge and skills in diagnosing and managing liver disease is necessary to reduce the prevalence of liver disorders.

Treatment with National Liver Board	Treatment without the National Liver Board
Combined opinions from 5 highly experienced experts	Opinion from a single specialist
Easy access to super specialists	The time-consuming process to access the specialist doctor
Quick response to patient queries with suitable recommendations	Slow and easy response time
Multi-disciplinary evaluation of the patient’s condition to ensure the most optimal line of treatment	Single-line evaluation of patient’s condition
Panel of doctors helps in early diagnosis and early treatment leading to a better outcome	Valuable time is lost in the pre-treatment process leading to a delayed outcome
Consistent and personalised care treatment	Inconsistent quality of care
Saving patients with unnecessary cost implications	Unnecessary tests with a high risk of infection and additional cost burden
Timely consultation summary is shared back to the patient	No consultation summary is provided to the patient

The NLB comprises a diverse range of experts from various fields, including hepatology, gastroenterology, etc. who are dedicated to improving the prevention, diagnosis, and treatment of liver diseases. The NLB panel in India consists of the following experts.

1. Dr K R Vasudevan: A renowned liver transplant specialist and GI Surgeon in Noida with 25 years of experience. He has completed over 1500 liver transplants in adults and children with a donor success rate of 99.5 %. He is specialised in laparoscopic live donor liver transplants in adults and children, cadaver liver transplants, laparoscopic pancreatic surgery, and treatment for simple and advanced liver cancer with various other gastroenteric-surgical procedures.
2. Dr Manik Sharma is a well-known Medical Gastroenterologist with 15 years of rich experience. He is famous for his focus on precise diagnosis and empathetic treatment of patients. He has expertise in treating liver disorders, pancreatic disorders, Inflammatory Bowel Disease, Endoscopic Ultrasound (EUS), etc.
3. Dr C P S Chauhan: One of the best Interventional radiologists with a rich experience of 21 years. He has advanced training in Cardiac CT from Singapore. The speciality interests of Dr Chauhan include simple and complex Peripheral vascular intervention procedures like TIPS, hepatobiliary stenting, treatment for Liver Tumours by TACE/TARE/Microwave or RFA etc.
4. Dr Atul Sharma: He is an eminent Medical Oncologist in Noida with a rich experience of 16 years. He has expertise in procedures like ERCP, EUS, ESD/ EMR, colonic transit study, oesophageal/ anorectal manometry, Per Oral Endoscopic Myotomy (POEM), Immunotherapy, chemotherapy or systemic therapy for liver cancer.
5. Dr Abhishek Gulia: He is a well-known Radiation Oncologist with a vast 16 years of experience in radiation oncology. His speciality interest includes treating cancer of the liver, breast, uterus, head and neck, lung, recurrent cancers, brain tumours etc. Key procedures done include Stereotactic Radiation Therapy Liver, SBRT liver.

The NLB is an important resource for individuals seeking guidance and support for liver-related health issues. Below are the people who can approach the NLB.

1. Individuals who have liver diseases or are at risk of developing liver diseases can approach the NLB for guidance and support. This includes patients with 
   1. Hepatitis B and C are viral infections that cause liver inflammation, leading to liver damage and other complications.
   2. Liver tumours: These are abnormal growths in the liver, which can be cancerous or non-cancerous.
   3. Liver cirrhosis: It is a late-stage liver disease where healthy liver tissue is replaced with scar tissue.
   4. Chronic liver diseases is a long-term liver condition that leads to inflammation, scarring, and liver damage.
   5. Acute liver failure: In this condition, a sudden loss of liver function may occur. It can be caused by various factors such as drug overdose, viral hepatitis, or autoimmune hepatitis. 
   6. Gastric varices: Occurrence of swollen veins in the stomach in people with liver disease, often leading to life-threatening bleeding.
   7. Portal vein thrombosis: A blood clot in the vein that carries blood to the liver, leading to liver damage and other complication.
   8. Portal vein atresia: It is a rare congenital disorder in which the portal vein does not form properly, leading to liver damage.
   9. Other liver-related disorders. 

1. Family members or caregivers of patients with liver diseases can also approach the board for information and resources.
2. Healthcare professionals such as doctors, nurses, and researchers can also approach the NLB for guidance and collaboration on liver-related issues.The board works closely with healthcare providers to develop and implement strategies for the prevention, diagnosis, and treatment of liver diseases.

The panel of the NLB discuss about the disease and the treatment required. Different procedures may be suggested depending on the patient’s condition. The procedure may include 

1. Liver transplant: It is a surgical procedure that is performed to replace a diseased or damaged liver with a healthy liver from a donor when the damage is beyond repair. For example, in case of end-stage liver disease, acute liver failure, etc.
2. Interventional procedures: 
   1. Trans-Arterial Radio-Embolization (TARE)
   2. Transarterial Chemoembolization (TACE)
   3. Transjugular Intrahepatic Portosystemic Shunt (TIPS)
   4. Balloon-Occluded Retrograde Transvenous Obliteration (BRTO)
   5. Hepatic Vein Stenting
3. Liver cancer treatment
   1. Chemotherapy or Immunotherapy
   2. Radiofrequency Ablation (RFA) for liver cancer
   3. Stereotactic Body Radiotherapy (SBRT)

The process for approaching the NLB can vary depending on the country or region where the board is located. In general, below mentioned is the steps involved in the NLB process:

1. The patient will contact the HexaHealth helpline (9513632661) or email at hello@hexahealth.com to inquire about Liver Care Board and discuss the condition.
2. The counselling team will understand the condition, prepare the case summary, collate all medical reports (diagnostic and radiology reports, OPD prescriptions, previous hospitalisation documents, etc.) and put the case forward for the board's consideration.
3. The board of five professionals will discuss the patient's condition, and they will offer their suggestions for the patient, including any necessary medications, check-ups or treatments.
4. HexaHealth expert will share the same with the patient for further action and treatment.
5. The patient can follow up after the advised timeline for the board to review the progress in outcomes.

Working Structure of National Liver Board in an Ideal Patient Case

Board Meeting

1. The National Liver Board shall meet for 30 mins within 48 hrs of a patient query to discuss the patient's case.
2. If required, the patient & family attendant can be requested to be available for a video consultation or medical discussion with the board to understand the condition better

Pre-Requisite from the Patient Case

HexaHealth counsellors will try to gather as much medical information as possible from the patient. There will be some basic minimum reports required to assess the case before putting it across to the board.

Patient outcome Summary

1. Post the consultation, the board shall share a combined consultation summary containing all the recommendations
2. It will be duly communicated and shared with the patient by the Hexahealth counsellor, so that the patient’s family is aligned with the expected outcomes from the liver board consultation

In conclusion, the National Liver Board plays a crucial role in the prevention and treatment of liver diseases in the country. By bringing together experts in the field, they provide valuable guidance to healthcare professionals and individuals affected by liver diseases. The benefits of the National Liver Board are many, including increasing awareness, providing access to the latest treatments and therapies, and improving outcomes for patients.

If you have doubts about National Liver Board or liver disease, contact a HexaHealth expert. HexaHealth is your one-stop platform for all your medical needs. Our team of doctors will provide personalised care assistance at every step of the way, from guidance to after-care and resolve all your queries. Call an HexaHealth expert TODAY!