What is a Living Liver Donor?

Live donor liver transplantation is a procedure in which a living person donates a portion of his or her liver to another. The liver is unique in that it has the ability to regenerate in 2-8 weeks after the transplant.

Liver transplants are the most effective form of treatment for individuals with end stage liver disease. However cadaveric donation provides organs for only about 1/3 of the people on the national waiting list. As a result about 20% of patients die each year waiting of a liver. There are about 17,000 people are the national waiting list while only about 4,500 cadaver live become available each year. In response to the scarcity there has been an increase in living donor liver transplantation.

This increase is possible due to the unique anatomy of the liver which makes it favorable for partial donation. The anatomy of the liver is such that there are specific segments with their own blood supply that can be divided and transplanted into another individual. The liver also has the unique ability to regenerate within weeks of removing a segment. These characteristics of the liver encouraged transplant surgeons to pursue living donation.

What does the liver do?

The liver is an organ located in the right side of the abdomen below the ribs. The liver has several life-critical functions:

1) It is a powerhouse that produces varied substances in the body, including (1) glucose, a basic sugar and energy source; (2) proteins, the building blocks for growth; (3) blood-clotting factors, substances that aid in healing wounds; and (4) bile, a fluid stored in the gallbladder and necessary for the absorption of fats and vitamins.

It also acts as a filter, removing impurities from the blood. Finally, the liver metabolizes and detoxifies substances ingested by the body

Advantages of live donation

There are several advantages that live liver donation has over cadaveric donation:

• Because the surgery is elective it can be performed before the recipient physically declines while typically occurs with a long wait on a transplant list
• Because the surgery is scheduled, the recipient’s condition can be optimized prior to transplant (with regards to lab test, ascites, infection, cancer treatment, etc.)
• There is a shorter preservation time for the donor liver.
• Because the recipient does not take a liver from the cadaveric donor pool, this increases the availability of cadaveric livers for those who do not have a living donor

What is the donation process?

Pre-Op

In order to ensure that you are physically able to donate part of your liver and that you are an appropriate match for the recipient the following tests will be performed.

Blood type– To determine appropriate match for recipient.

Blood tests– To look for abnormal liver results, screen for previous exposure to hepatitis, find out blood count before donating blood

Chest x-ray– To look for abnormal results

Electrocardiogram– To look for abnormal results

Physical exam– To ensure donor health

MRI– To evaluate liver size and look for abnormalities

Angiogram– To evaluate the anatomy (roadmap) of the blood vessels to the liver

Liver biopsy– To determine if liver tissue is favorable for donation

Psychiatric Evaluation– To ensure the donation is being done without any external pressure and to ensure the donor understands the possibility that the transplant might not be successful

Once the above evaluation is complete, a surgery date is chosen. Potential liver donors donate one to two units of their own blood to have available for the surgical procedure. Prior to the actual operation, the donor will once again meet with one of the transplant surgeons, to go over the procedure in detail and to obtain surgical consent. At this time, the donor will also speak with an anesthesiologist.

The Operation:

During living liver donor transplantation, the donor and recipient each have their own surgical team and are in adjacent operating rooms. In the donor’s operating room, the surgeons remove part of the liver, usually the right half or lobe, of the liver. In addition to removing a portion of your liver, the doctors will remove some of the blood vessels and ducts that assist with the function of the liver. In the recipient’s operating room, the surgeons are busy removing the recipient’s entire diseased liver and getting ready to transplant the donated portion of donor liver. The partial liver is immediately placed into the recipient. The blood vessels are attached into the recipient, as are the ducts. The surgery for both the donor and recipient takes about ten to twelve hours.

Post-Operation:

The donor is usually in the intensive care unit for about 24 hours and in the hospital for 5-7 days. Most patients are up and out of bed (with assistance) by the second or third postoperative day. It is usually necessary to stay off work and usual home activities for a month full time and 2 to 4 weeks part time, depending on the rapidity of the recovery.

The donor will return for several follow up visits in the first month after surgery. Visits will include a physical exam and laboratory tests. Follow-up scans will be performed soon after the surgery and several months after to follow the regeneration of the liver.

The Risks Associated with Live Liver Donation:

The specific risks are similar to other major surgical procedures of the liver. These include:

• Bleeding, infection, complications from general anesthesia.
• The possibility of complications of the bile duct, such as bile leaks, which may require reoperation, or scarring of the bile ducts later on that may require surgery or an invasive procedure.
• Common risks associated with blood transfusion.
• There are reported extremely rare cases in which the donor’s liver function is inadequate following the procedure. This could result in the donor needing a liver transplant.
• Some deaths have occurred throughout the world, but to the best of our knowledge the risk is less than 1%.
• At present, there is not enough information or follow-up from the number of adult living donor liver transplants worldwide to accurately predict the risks. Present experience has proven that the operation can be performed with a low complication rate

Financially Ramifications

All the pre-operative testing, the transplant surgery and the post-operative care should be provided for by the organ recipients insurance. It is legal for the recipient to cover the live donors cost related to the operation, which may include travel expenses, lodging and lost wages due to time away from work. Live donorship should not change a donors life, disability, and health insurance cost. Contact you insurance agent to verify this.

Psychological Benefits

The sense of satisfaction at having saved someone’s life cannot be measured by words. This sense of generosity is compounded because another person with liver disease, completely unknown to them, will be able to receive a cadaver liver from the transplant waiting list that the recipient would have needed without living donation

Making the Decision

Deciding to become a kidney donor is a one of the most altruistic gifts that one can give. It is a significant decision for both you and the recipient. To ensure you make this decision fully informed, review the following:

Below are some questions to guide you in the process

• How do I feel about organ donation
• Do I know enough to make a logical and educated decision?
• Am I being psychologically pressured to be a living donor?
• What are the medical risks involved?
• Am I up to it physically?
• Do I have a “support network” to help me through this process?
• Am I prepared to deal with the possible rejection of the organ?

Resources:

• http://www.shareyourlife.org/UnderstandingDonation/LivingDonation.php
• http://www.livertransplant.org/livedonorlivertransplant.html

Speak to your physician. This is meant only as general guide to live kidney donation.

What are the Risks?

Before making the decision to become a living kidney donor, one should familiarize oneself with the risk involved so you can make a fully educated and informed decision.

The specific risks are similar to other major surgical procedures of the liver. These include:

• Bleeding, infection, complications from general anesthesia.
• The possibility of complications of the bile duct, such as bile leaks, which may require reoperation, or scarring of the bile ducts later on that may require surgery or an invasive procedure.
• Common risks associated with blood transfusion.
• There are reported extremely rare cases in which the donor’s liver function is inadequate following the procedure. This could result in the donor needing a liver transplant.
• Some deaths have occurred throughout the world, but to the best of our knowledge the risk is less than 1%.
• At present, there is not enough information or follow-up from the number of adult living donor liver transplants worldwide to accurately predict the risks. Present experience has proven that the operation can be performed with a low complication rate.

Read the following articles about process and risks of becoming a donor:

Adult to Adult Living Donor Liver Transplantation

Selection of Donors for Live Donation

Confidentiality:

The HOD Society will not share personal information with either party without prior consent from both parties. The HOD Society may share basic medical information, such as blood type, to determine preliminary compatibility of the parties

Liability:

The HOD Society simply shares contact information with permission of both parties and is not responsible for any events that consequently occur. You are solely responsible for your interactions that take place after the transfer of contact information.  HODS makes no representations or warranties as to the conduct of any interactions. In no event shall HODS be liable for any damages whatsoever, whether direct, indirect, general, special, compensatory, consequential, and/or incidental, arising out of or relating to the conduct of you or anyone else, including without limitation, bodily injury, emotional distress, and/or any other damages resulting from communications or meetings.  You agree to take reasonable precautions in all interactions.