The liver, a large internal organ situated in the upper-right abdomen, performs numerous functions fundamental to human survival. It is one of the most active organs in the body. Permanent survival without this organ is not possible. However, medical advancements now offer pathways to sustain life when the liver fails, primarily through support systems or replacement.
The Liver’s Indispensable Roles
The liver serves as the body’s primary detoxification center, processing and neutralizing harmful substances such as drugs, alcohol, and metabolic waste products. It converts these toxic compounds into less harmful forms for excretion. This cleansing function prevents the buildup of substances that would poison the bloodstream and impair organ function.
Beyond detoxification, the liver plays a central role in metabolism. It processes carbohydrates, converting excess glucose into glycogen for storage and releasing glucose back into the bloodstream when energy is needed. The liver also metabolizes fats, synthesizing cholesterol and lipoproteins, and processes proteins by breaking down amino acids and converting ammonia, a toxic byproduct, into urea for excretion.
Another function is bile production. Bile, a yellowish fluid, is critical for digestion, particularly for emulsifying dietary fats and aiding the absorption of fat-soluble vitamins. It also serves as a route for the excretion of waste products, including bilirubin, a breakdown product of red blood cells.
The liver synthesizes many proteins. These include albumin, the most abundant protein in blood serum, which helps maintain fluid balance and transports hormones and fatty acids. It also produces clotting factors necessary for blood coagulation, preventing excessive bleeding.
What Happens When the Liver Fails
When the liver ceases to function properly, severe consequences emerge due to the accumulation of toxic substances. One outcome is the buildup of ammonia, a byproduct of protein metabolism, which the failing liver cannot effectively convert into urea. This leads to hepatic encephalopathy, a brain disorder characterized by confusion, disorientation, and potentially coma.
Impaired metabolic functions also contribute to issues with nutrient processing. The inability to synthesize and store glucose can lead to low blood sugar levels. The liver’s role in fat and protein metabolism is compromised, impacting energy production and the body’s ability to maintain muscle mass and repair tissues, potentially resulting in malnutrition.
Fluid retention is a common complication of liver failure, often manifesting as swelling in the legs (edema) and accumulation of fluid in the abdomen (ascites). This occurs because the liver can no longer produce sufficient albumin, leading to imbalances in fluid regulation. Increased pressure in the veins supplying the liver, known as portal hypertension, further exacerbates fluid leakage.
Bleeding disorders also arise when the liver fails, as it cannot produce enough clotting factors for blood coagulation. This can lead to easy bruising, prolonged bleeding from minor injuries, and internal hemorrhages, including bleeding from enlarged veins in the esophagus or stomach. Jaundice, a yellowing of the skin and eyes, is caused by the liver’s inability to clear bilirubin from the blood.
Modern Medical Solutions for Liver Failure
Medical solutions exist for liver failure, enabling survival. Liver transplantation is the long-term treatment for irreversible liver failure. This procedure involves replacing the diseased liver with a healthy one, either from a deceased donor or a portion from a living donor.
The liver’s ability to regenerate makes living-donor transplantation possible. A part of a healthy donor’s liver is transplanted into the recipient. Both the donor’s remaining liver and the transplanted portion can grow back to nearly full size and function within weeks to months. This regenerative capacity expands transplantation possibilities.
In cases of acute liver failure or as a temporary measure while awaiting a transplant, artificial liver support systems can bridge the gap. These devices, sometimes compared to kidney dialysis, help remove toxins from the blood when the liver cannot. They can partially mimic the liver’s detoxification capabilities, reducing the burden on the failing organ.
Artificial liver support systems can effectively remove toxins, but they do not fully replicate the liver’s synthetic and regulatory functions. These systems serve as temporary life support, aiming to stabilize patients until their own liver recovers or a suitable donor organ becomes available for transplantation.