Living Liver Donor & Transplant

What is a living donor liver donation?

Most organ donations for organ transplants come from deceased donors. But the liver is special. The liver is the only organ that can regenerate itself and grow back from a small piece to its full size. This means that a living donor can volunteer to donate a part of their healthy liver to someone else in need. Miraculously, when you become a living liver donor, your healthy liver can become two healthy livers.

A living donor liver transplant is two procedures that happen simultaneously: one for the liver donor and one for the transplant recipient. If you donate, a surgeon will remove a portion of your liver — typically one lobe, or less for a child — and transplant it in the recipient right away. After a successful living liver donation and transplant, both pieces of the divided liver will grow back to full size within a few months.

Could I be a living liver donor?

If you and your liver are in good health, you could become a living liver donor and save a life. You can’t always donate your liver to a particular person you know — it depends on if your blood type and liver mass is compatible with theirs. But when you donate a part of your liver to someone in need, you reduce the greater need. This makes it more likely that another donor liver could save the person you know.

What are the requirements for living liver donation?

When you volunteer to become a living donor, you’ll begin a screening process. A team of healthcare professionals will thoroughly evaluate you to make sure you meet the requirements for liver donation.

The basic requirements for living liver donation are that:

• You’re between 18 and 60 years old. Children and older people are not candidates.
• You don’t have a history of substance use. Alcohol and drugs affect the health of your liver.
• You’re in good physical condition. Some health conditions might make surgery unsafe for you. You’ll have screenings, like blood tests and cardiac tests, to make sure you’re fit for surgery.
• Your liver is in good health. You can have liver disease without symptoms and without knowing it. You’ll have liver screening tests to ensure that your liver is healthy and fit for donation.
• You’re in good mental and psychological health. Your team can’t accept your donation if they find that you’re mentally or psychologically compromised. They’ll make sure that you fully understand the risks and the commitment involved and that you aren’t under any coercion.
• You aren’t gaining financially by donating. It’s illegal to accept money or gifts in exchange for a liver donation. Your team will need to be sure that your offer is 100% free and voluntary.

What is the process to become a living liver donor?

To start the process, call your local organ transplant hospital or the hospital you wish to donate to. A coordinator will speak with you to gather some general information and answer your questions. If they believe you’re a candidate for liver donation, they’ll arrange for you to come to the hospital to continue your evaluation. You’ll take a variety of medical screening tests and consult with a variety of specialists.

You might meet with a(n):

• Anesthesiologist
• Hepatologist (liver specialist)
• Independent donor advocate
• Psychologist
• Social worker
• Transplant surgeon

After your tests and interviews, two independent teams will evaluate your offer. The first is a donor advocacy team. This team is primarily concerned with your safety. If they clear you for liver donation, they’ll recommend you to the liver transplant selection committee. This team will review your overall fitness to become a donor. They’ll make the final decision and select a recipient for your liver donation.

Who will be the recipient of my liver donation?

You may wish to donate a part of your liver to someone you know. This is called a “directed donation.” You can do this if your blood type is compatible and your liver size is comparable with theirs. If you’re not a match with your intended recipient, you can try a “paired exchange” program. That means you and your intended recipient pair up with another donor and recipient who don’t match, and you swap.

You can also donate freely to someone you don’t know. This is called a “non-directed donation.” Once you’re approved to donate, the transplant hospital will match you with a stranger on the waiting list. You can donate your liver anonymously or you can choose to meet your recipient if both of you wish to meet. The transplant team will protect your identity and their identity if you and they prefer that.

How do I prepare for the liver donation and transplant procedure?

Once you and your liver recipient have been selected, the transplant team will coordinate with both of you to schedule your simultaneous procedures. When you have your date, you can begin to make arrangements. You can expect to stay in the hospital for a week after surgery. Recovery time at home may take up to six weeks. You may need to take time off from work or arrange for help with childcare.

You may also need to:

• Adjust your food, drink or substance use before surgery
• Stop taking certain medications before surgery
• Have additional imaging tests of your liver, like a CT scan or MRI
• Sign your informed consent to become a living liver donor

Meanwhile, your surgical team will prepare by thoroughly image-mapping your liver. They’ll take a comprehensive series of images, including 3D images, and analyze them to select which part of your liver to remove and determine the best surgical approach. At some transplant centers, minimally invasive surgery might be an option. If so, they’ll evaluate whether it’s feasible in your case.

What happens during a living donor liver transplant?

You and your recipient — whether you know each other or not — will have surgery at the same time. While one surgical team removes a portion of your liver, another will remove the failing liver in your recipient, preparing to receive your donation. Your procedure will be shorter than theirs — about four to six hours. You’ll have general anesthesia, so you won’t feel any sensation or have any awareness during surgery.

You may have:

• Laparoscopic surgery. This minimally invasive method allows your surgeon to operate through only a few small incisions, about a half inch long. It makes recovery from surgery a little easier and faster.
• Open abdominal surgery. If circumstances don’t allow for laparoscopic surgery, you’ll have open surgery. Your surgeon will make one long incision of 6 to 12 inches to open your abdomen.

Your surgeon will select the section of your liver that they’ve predetermined to remove. They’ll carefully disconnect it from your blood vessels and bile ducts. After removing the piece, the transplant team will transfer it to your waiting recipient and begin the process of attaching it to their blood vessels and bile ducts. While this is in progress, your surgeon will close your incisions and finish your surgery.

What are the benefits of living liver donation?

More than 15,000 people in the U.S. each year join the waiting list for a liver transplant. Some are in the hospital with sudden liver failure, and only have days to recover. Others are in the end-stage of a long battle with chronic liver disease, and are steadily declining. Some have primary liver cancer that could be cured by a liver transplant, but only if it doesn’t spread first. For all of them, time is of the essence.

The longer they wait for a liver transplant, the sicker they become. If they become too ill to survive the transplant surgery, or if their cancer advances beyond their liver, it will be too late to save them. Each year, more than 2,000 die or become too ill waiting for a liver transplant from a deceased donor. If any of them had a living liver donor, they could bypass the waiting list and schedule their transplant surgery right away.

Living donor liver transplant recipients enjoy:

• Shorter wait times and higher transplantation success rates
• Healthier donor livers and longer life expectancies after transplantation

In addition, most living liver donors report:

• Psychological benefits, like improved self-esteem and perceived personal growth
• They have no regrets, and up to 100% would make the same choice again

Could I be a living liver donor more than once?

Living liver donation is a once-in-a-lifetime opportunity. While your liver can regenerate after being divided, this takes a toll. Your liver can recover and continue to function well for you, but it doesn’t have an unlimited capacity to do this. A second surgery would be too stressful for your liver and raise your risk of complications to an unacceptable level. So, transplant teams don’t accept repeat donations.

What are the risks of liver donation surgery?

Any surgery performed under general anesthesia comes with a risk of complications, like:

• Bleeding
• Blood clots
• Infection
• Nerve injury
• Paralytic ileus
• Post-operative pneumonia

Additional risks associated with liver surgery include:

• Abdominal adhesions
• Bile duct injury
• Incisional hernia
• Post-operative thrombocytopenia

There is a small chance of liver failure or death after liver donation. According to a previous report, the chance of death after liver donation is 0.2% (1 in 500 living donors).

What potential psychological downsides should I consider?

Beyond the physical risks, you may want to consider other ways that being a living liver donor might negatively affect you, either psychologically or practically. Some of these may include:

• Anxiety or turmoil about the outcome of the surgery
• Some postoperative pain, despite medication
• The long recovery period with lost paid time off or lost wages
• The possibility that the transplant might fail for the recipient

Does liver donation cause any long-term health effects?

Liver donation doesn’t appear to affect long-term health. General health and quality of life scores in previous liver donors are equal or greater than in the general population.

Some people have reported lingering fatigue, gastrointestinal issues or psychological issues after surgery. But these are not expected outcomes. With proper support from your healthcare team, they should resolve with time.

What is recovery like after living donor liver donation?

For the living donor, life after liver donation will go back to normal in stages. You’ll spend about a week in the hospital after surgery. This will be the most intensive part of your recovery. You’ll have various tubes installed to manage your pain, deliver fluids and drain your bladder. After that, you’ll gradually start moving, eating and going to the bathroom on your own.

You can expect:

• To be able to take care of yourself at home after the first week
• To be able to drive again after two to three weeks
• Your incision wounds will heal in two to six weeks
• To return to regular activities after six to eight weeks
• Your liver will be back to full size within two to three months
• You’ll have regular check-ups with your surgeon over the next year