Living Donor Liver Transplant

Overview

What is a living donor liver donation?

When a person has a liver that is failing to function properly, the person must receive a liver transplant to survive. The donated liver can come from either a living or deceased donor. In the case of a living donor, a healthy, living person has agreed to donate a portion of his or her liver.

Why is there a need for living liver donors?

The number of people waiting for a liver on the transplant list is much greater than the number of livers available from deceased donors. Due to this shortage, many patients die or become too sick to receive a liver transplant from a deceased donor by the time one becomes available.

Who can be a living liver donor?

A living liver donor can be a family member or friend of the person with the failing liver or can be an anonymous donor who simply has an unselfish desire to save someone’s life.

Other criteria that must be met to be considered a liver donor include:

  • Must be in good mental and physical health.
  • Have no major illnesses, including no history of fatty liver or viral hepatitis.
  • Must be between 18 and 60 years of age.
  • Must have a compatible or identical blood type with the person who is to receive the liver (an incompatible blood type can be considered in extreme circumstances).

Recipient Blood TypeDonor Blood Type
OO
AA or O
BB or O
ABA, B, AB or O

As a living liver donor, you must not gain financially from donating your liver. It is illegal to accept money or other gifts in exchange for receipt of a portion of your liver. Also, your decision to donate must be 100 percent voluntary. You must not feel pressured by anyone to donate and may decide – at any time – not to donate.

What is the process to become a living liver donor candidate?

Gather information by phone. The first step is to gather some basic contact and general health information. A potential living liver donor must first call the Transplant Office (216-444-1976, option 1) and ask to speak to liver donor office. The receptionist will collect some general information. Next, a liver donor coordinator will call to gather more detailed medical information and answer any questions. A liver transplant surgeon will review all of the information. If the surgeon believes that initial criteria have been met, the coordinator will arrange an in-person evaluation.

Come to hospital for medical tests and interviews. Next, the potential liver donor will undergo 3 to 4 days of interviews and medical evaluations by members of the donor advocacy team. This team consists of the living donor coordinator, social worker, independent donor advocate, liver specialist (for medical evaluation), transplant surgeon (for surgical evaluation), transplant anesthesiologist, and nutritionist. Tests include blood tests, heart tests, and imaging studies with CT and MRI scans. Some potential donors may require additional testing, consultation, and a liver biopsy.

Await the decision from transplant teams. The decision to accept a person as a living liver donor is made by a sequence of transplant teams. First, the donor advocacy team reviews the results of all the tests and interviews and makes a recommendation to the liver transplant selection committee. Both the donor advocacy team and the liver transplant selection committee put the safety of the donor ahead of all other considerations. The liver transplant selection committee makes the final decision and the potential living liver donor is then notified of the decision.

Procedure Details

What is the surgical procedure for transplanting a liver from a living donor?

Evaluating the liver through images. Before performing the actual surgery, many images – including 3D images – of the donor’s liver are analyzed. The surgeons determine the precise size of the donor’s liver, blood vessel anatomy, how much liver tissue will be transplanted, the exact section of liver tissue to be removed, and calculate how much liver tissue is needed to allow the transplant recipient to survive. At least 30 percent of the living donor’s liver must remain in the donor.

The possibility of using the liver donor’s left lobe is considered first since this is a safer operation for the donor. A smaller portion of the left lobe, called the left lateral segment, is used if the liver transplant recipient is a small child.

Sections of the liver used for liver transplant

Living donor liver surgery. The transplant procedure begins with an incision made down the abdomen to enter the abdominal cavity. The predetermined amount of the left or right lobe is removed from the donor. The gallbladder is also removed. The surgery takes about four to six hours to perform.

Recovery after surgery. The donor leaves the operating room with a drain in his or her abdominal cavity (to drain fluid and blood), IV lines in the arm and neck (to provide fluids and medications), a nasogastric tube (to relieve pressure in the stomach by removing contents and air), and a urinary catheter (to drain urine from the bladder). The donor’s first night is spent in the ICU, then he or she is transferred to the regular nursing floor if stable. The hospital stay is about 1 week. The donor is expected to leave the hospital without any tubes or drains, and return to visit the surgeon about 1 week after discharge. Follow-up checkups are required at 1 month, 3 months, 1 and 2 years after donation and more often if there are complications.

Risks / Benefits

What are the risks and complications of living donor liver donation?

There are risks to all surgeries performed under general anesthesia. Surgical risks include:

  • Bleeding
  • Bile leaks
  • Infection
  • Blood clots
  • Nerve damage

Common complications for the donor include:

  • Pain
  • Pneumonia
  • Fatigue due to the large amount of liver that is removed
  • Small bile leaks from the cut surface in the remaining liver
  • Wound infections
  • Gastrointestinal upset (constipation, occasional nausea and diarrhea), which usually go away in a few weeks
  • Hernia at the incision site

There is a small risk that the liver may not regenerate or that the remaining liver fails, in which case an emergency liver transplantation may be required.

The risk of death is 1 in every 1000 liver donors for a left lobe donation and 4 to 6 in every 1000 for a right lobe donation.

What are the benefits to the recipient of receiving a living donor liver compared to a liver received from a deceased donor?

Among the benefits are:

  • The waiting time to receive a liver is short.
  • Patient can receive a liver transplant before he or she becomes too sick. (The waiting time is long for obtaining a deceased donor if the patient has a low MELD or PELD [scoring system for children under 12] score. Also, there is a significant risk of death or of becoming too sick while waiting regardless of MELD score.)
  • A liver from a living donor typically lasts longer than a liver from a deceased donor.
  • Transplant surgery can be scheduled on a convenient day for both you and your donor.
  • Better chance of survival. The liver from a healthy, living liver donor is transplanted within minutes of being removed from the donor.

Recovery and Outlook

How long is the recovery period after discharge from the hospital following liver donation?

Most donors are able to return to their daily activities in four weeks. Driving can be resumed in about three to four weeks. Most donors can return to work in two to three months.

The liver is the only internal organ that can regrow (regenerate). Most donors’ livers can regenerate to almost their original size in six to eight weeks after surgery. However, the liver will continue to grow throughout the first year after surgery. During this period of time, you should live a healthy lifestyle and limit alcohol intake.

Additional Details

What other issues does a potential living liver donor need to consider?

A person who is considering becoming a living liver donor needs to be physically, financially, and emotionally ready to be a donor. Questions that the potential donor and transplant team will review include:

  • Are you physically able to undergo surgery and the recovery period?
  • What medical conditions do you have and will liver transplant surgery worsen any of these existing health conditions?
  • Can you be off work for two to three or more months? Can you manage this period of lost wages?
  • Can you afford to pay costs not covered by insurance, including your travel, lodging, and potentially child care costs? You may also be denied future health, life or disability insurance.

Emotional and psychological issues discussed include:

  • How will you feel if the recovery does not go as you expected?
  • How will you feel if the liver recipient’s recovery is not what you thought it would be? What anxiety might be caused if the recipient’s liver is rejected, the recipient needs another transplant, or dies?
  • Are you prepared for a certain level of pain and discomfort that occur after surgery?
  • Will the surgical scar cause body image issues?

Other issues:

  • Do you have one or more caregivers who will be able to care for you? A dedicated caregiver will need to be with you 24 hours a day for two to three weeks after discharge.
  • If YOU are a caregiver to others, who will be picking up your caregiver responsibilities?
  • You will also not be allowed to drive for three to four weeks.

It’s important for any potential donor to take as much time as needed to absorb all the information presented so you can make an independent, informed, and confident decision. Make sure you fully understand the liver donor procedure, its risks and potential complications, your own health issues and how a liver donation may affect your condition, as well as all financial and emotional/psychological issues. Know that you may change your mind to become a living liver donor at any time. If you have any questions, please ask any member of the transplant team.

Resources

Last reviewed by a Cleveland Clinic medical professional on 02/06/2019.

References

  • Expert knowledge and experience of healthcare providers at Cleveland Clinic. (https://my.clevelandclinic.org/departments/transplant/programs/liver/living-donor-clinic) Accessed 11/25/2018.
  • Donate Life America. Living Donation. (https://www.donatelife.net/types-of-donation/living-donation/) Accessed 11/25/2018.
  • National Living Donor Assistance Center. Living Liver Donation: What are the Risks and Benefits? (https://vimeo.com/62838528) Accessed 11/25/2018.
  • United Network for Organ Sharing. Becoming a Living Donor. (https://transplantliving.org/living-donation/being-a-living-donor/) Accessed 11/25/2018.
  • Transplant Recipients International Organization (TRIO). (https://www.trioweb.org/) Accessed 11/25/2018.
  • United Network for Organ Sharing (UNOS). (https://unos.org/) Accessed 11/25/2018.
  • Children’s Liver Disease Foundation. (https://childliverdisease.org/) Accessed 11/25/2018.
  • Children’s Liver Association for Support Services. (https://www.classkids.org/) Accessed 11/25/2018.

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