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.
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.
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:
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.
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.
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.
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.
There are risks to all surgeries performed under general anesthesia. Surgical risks include:
Common complications for the donor include:
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.
Among the benefits are:
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.
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:
Emotional and psychological issues discussed include:
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.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: 02/06/2019