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Living Liver Donation
Living Liver Donation FAQs
Living liver organ donation provides those waiting for liver transplantation with many advantages over deceased organ donation. These include:
Less waiting The length of time it takes for an organ to become available is significantly reduced when the organ comes from a living donor versus a deceased donor. Depending on their condition, diagnosis, status, blood type and size, patients can be on the waiting listing for months or even years. If a relative or loved one meets the criteria for living donation, the wait time can be reduced. Healthier donor organ Living donors tend to be healthy adults who undergo a thorough medical evaluation. As a result, the liver from a living donor may be may be healthier than an organ from a deceased donor. Surgery can be scheduled electively With living donor liver transplantation, it is possible for the recipient to have surgery earlier. This decreases the risk of complications during the early post-transplant period and increases the chances for a better result overall. It also decreases the chance of the recipient becoming too sick and too weak to qualify for surgery. In addition, the time between recovering the liver and transplanting it is minimized to minutes instead of hours, something that is critical to the preservation of the donor organ. A feeling of satisfaction For a living donor, knowing that he or she has made a contribution to the improved health of another individual is a very positive psychological experience.
About 30% of the liver is removed for an adult to child donation and about 60-70% for adult to adult donation. The liver can be divided into two distinct lobes which can function independently of each other. The right lobe, which is slightly larger than the left, comprises about 60-70% of the total liver volume and is the lobe most often removed for transplant purposes. The left lobe, which is slightly smaller than the right, comprises about 30-40% of the total liver volume. When the recipient is a small child, a piece of the donor's left lobe called the left lateral segment is usually removed.
Both the donor and the recipient undergo surgery simultaneously (although the donor's procedure begins about three hours earlier than the recipient's) so that the donor organ can be transplanted immediately into the recipient. This minimizes the length of time that the liver is without circulating blood, ensuring a healthier, better functioning donor organ for transplant.
Potential living liver donors are carefully evaluated. Only those individuals who can donate a portion of liver that will function immediately are selected. Since the health and safety of the donor is of paramount concern during the evaluation, only those donors for whom a risk of death is less than 1% are considered.
A potential donor must: A potential donor must be free from:
No. You do not need to be a blood relative of the recipient in order to qualify as a potential donor. A spouse or a friend is often a living donor.
Studies indicate that the risk of rejection between a donor and a recipient who are related is no less than for non-related donors and recipients. What's more, the amount of anti-rejection medication needed doesn't seem to be affected by the relationship between the donor and recipient. On the other hand, if the donor and recipient are identical twins it could be expected to have a very positive impact on the success of transplantation and possibly a reduction in the risk of complications following surgery.
The evaluation process ensures that the donor's liver is healthy and of adequate size to meet the needs of the recipient. It is also conducted to make sure that a potential donor is free from any medical or psychiatric illness which could make the procedure more risky or difficult as well as any diseases which could be transmitted to the recipient. Finally, the evaluation process ensures that the donor is making the decision freely, without pressure or coercion.
No. The recipient remains on the waiting list during potential living donor evaluation. Should the potential donor not be able to donate, the recipient still has the same priority status on the waiting list.
The evaluation time varies. Completely healthy donors may be notified as soon as several weeks after all the various tests, evaluations and consultations have been completed. The evaluation may take longer if issues are identified during the work-up.
The decision about whether or not any particular donor qualifies is made collectively by the transplant team, which is made up of physicians, surgeons, nurse coordinators, social workers and others. The donor's safety is put ahead of every other factor in making this decision.
This is a joint decision made by the transplant team, the donor and the recipient, based on the recipient's time of best health and the donor's schedule.
For the living donor, there are some risks involved as there would be with any surgery requiring general anesthesia. These include:
While the risk of severe complications is minimal with living liver donation, risks specific to this procedure include:
Although it is not routine during this type of surgery, sometimes it is necessary. In the event that this may be required, you will be asked to donate two units of your own blood 2-4 weeks before surgery.
Even a light smoker should stop smoking before surgery. Heavy smokers are not eligible for living liver donation because of the additional risks that smoking creates.
If you are going to be a living liver donor, stop drinking alcohol. If you have a history of alcohol use, it is important that you share this information with someone on the transplant team. Although alcohol use may not preclude you from being a living liver donor, it could mean that you need to undergo a liver biopsy to make sure your liver has not sustained any damage.
Do not stop taking any prescription medication unless your physician tells you to do so. That being said, you should avoid aspirin or non-steroidal medications such as Advil or Motrin for seven days prior to a liver biopsy or surgery. These medications affect the blood's clotting ability and increase the risk of bleeding complications. Women who are taking birth control pills or hormone replacement therapy will be advised to stop because of the increased risk of blood clot formation after surgery.
At the very least, you will need 4-6 weeks to recover from surgery. Depending on the amount of pain and fatigue which you experience post-operatively - and everyone is different - you may need 8-12 weeks for a full recovery.
For this kind of surgery, yes. Even with pain medication, you can expect to be in significant discomfort for at least a week or even two weeks.
There are a number of things that can happen to delay or cancel a scheduled liver transplant procedure. First, the recipient's condition could deteriorate, making him or her a poor candidate for surgery. Second, the recipient could develop an infection or some other condition that would have to be treated before the surgery could be re-scheduled. On rare occasions, the sudden availability of a deceased organ may cause the living donor liver transplant to be canceled. Since a deceased organ donor transplant must take place within a very short time, it would have priority over the scheduled living liver transplant.
About 8-10 hours.
Yes, at ten days, one month, three months and then at one year. After this, you will be examined annually by your primary care physician.
No, not unless you develop a wound infection. Otherwise, you would only require pain medication for a short period of time.
About 10 days after surgery.
Most of the liver regenerates within the first two weeks after surgery and is back to near normal size by about three months.
No. You can only be a living liver donor once.
Barring any post-operative complications, the living liver donor can expect to return to a completely normal life within three months of surgery and to remain healthy for the rest of his or her natural life. Since the procedure of living donor liver transplantation is fairly new statistics on the long-term follow-up of donors who have undergone this surgery are not yet available.
A living donor usually feels a sense of accomplishment but donors must be prepared for the possiblity of recipient death. If this were to happen, it is natural be feel very sad and disappointed but most living donors also have the peace of mind that they did everything possible to help someone they care about.
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