Living Donor Liver Transplantation Q&A with Dr. Elizabeth Pomfret and Dr. James Burton

What is live donor liver transplantation?

Live donor liver transplantation is when a healthy person donates a portion of their liver to another person in need of a liver transplant. About 40-60% of a healthy person’s liver is removed and transplanted into an adult recipient after their original diseased liver is removed. Infants and small children require less liver volume. The portion of liver that remains in the donor and the portion that is transplanted into the recipient then regenerate over the next several months to the size that their bodies need.

Is live donor liver transplantation right for you?

With only about half of people United States donating their organs when they die, there are more people waiting for liver transplantation and organs available. Unfortunately, the results of this is many patients die on the transplant list waiting for an organ.

Live donation offers another way to perform lifesaving transplants. Choosing the option of live donation can: 

Make a recipients wait for transplant much shorter.

Give the recipient the chance to receive a transplant.

Allow options on the timing of the transplant.

Allow transplantation before the recipient becomes too sick.

On average, live donor liver transplant recipients have outcomes as good as–and often better than–those of recipients of deceased donors. Also, live donor liver transplant recipients are 50% less likely to die waiting for transplant, compared to those waiting for deceased donor.

Who is a candidate to receive a live donor liver transplant?

To be a candidate for live donor liver transplant, the recipient must first be an acceptable candidate for deceased donor liver transplant. Sometimes recipients are too sick or have anatomical or medical problems that would prevent them from having a successful live donor liver transplant. Live donor surgery is best for patients who do not have a spot that high enough on the transplant list to receive a deceased donor liver but who are sick enough to need a liver transplant. Recipient should talk to their transplant team and ask if live donor liver transplantation is right for them.

What are the potential risks or complications?

Any time major surgeries are done there are risk. The risk are directly related to the amount of liver tissue that is removed from the donor. The risk of death or need for the donor to need a transplant as a result of a complication from this surgery is estimated to be 0.1% (1 in 1000) to 0.5% (1 in 200), depending on how much liver tissue was removed.

Some of the serious complications from the surgery include the risk of a bile leak, the need for a reoperation or blood transfusion, damage to a bile duct or blood vessel, infection and slow liver function during liver regeneration. More often (90% of the time) the complications are minor and can include wound infections or gastrointestinal upset (such as nausea, bloating, constipation and/or diarrhea). This will be discussed in extensive detail during the donor’s evaluation. Occasionally the donor evaluation will identify an incidental finding during the donors evaluation that will require further medical follow-up.

Who can be a live donor?

Typically donors are greater than 18 and less than 55 years of age. They must be in excellent medical and psychological health. It is required to have a compatible blood type with the potential recipient and be able to understand the risk of the surgery and be willing to follow the requirements for clinic visits and ongoing communication with the transplant team before and after donation. The potential donor does not need to be a relative of the recipient. Friends and even total strangers can donated part of their livers.

What are the steps to becoming a live donor?

The first steps in being evaluated includes taking a health history questionnaire. Once this is reviewed by a physician the next step would be blood testing. These blood tests can happen anywhere that is convenient for a potential donor. If the results of the blood test are normal the donor is scheduled for a formal living donor evaluation at the transplant center. The donor evaluation is a detailed process that includes a physical exam, EKG, chest x-ray, additionally laboratory testing and imaging of the liver with CT and MRI. Additional testing and consults may be required depending on certain risk factors. These are determined on a case-by-case basis. During the donor evaluation there are visits with a transplant surgeon, hepatologist, donor coordinator, social worker, independent donor advocate and dietitian.

Once all the testing has been completed, the living donor team review the results and decide if one is a suitable candidate to donate a part of their liver. Donor safety is the top priority. If approved as a donor candidate and the donor wants to move forward with donation, surgery is scheduled at the earliest and appropriate time for both the donor and the recipient.

How much does it cost to be a donor?

Donors are not responsible for any medical cost associated with donation. This includes cost associated with initial lab testing, evaluation, hospitalization, surgery and follow-up. Donors are responsible for costs of transportation and lodging for the evaluation and after transplant. There may be funds available for assistance with these cost. This can be discussed with the social worker at the time of the donor evaluation.

How is liver transplant surgery performed, and how long will it take?

Two different transplant teams will simultaneously work on both the donor and the recipient. Depending on the size of the adult recipient, 40-60% of the donor liver is removed and replaces the entire liver of the recipient. A smaller amount of liver tissue is required for pediatric recipient (about 20%). The donor surgery typically requires 4-6 hours.

How long will the donor be in the hospital?

Most donors are in the hospital for 4-6 days. It may take longer if there are complications. If donors live out of state or are traveling a long way, they will need to stay in the area an additional 2-3 weeks after discharge before returning home.

Average recovery time differs from donor to donor and depends on the level of discomfort and fatigue. By 6-8 weeks, donor activity level will have increased. Most donors feel “normal” by 10-12 weeks. Individuals whose jobs includes mostly administrative duties typically feel like going back to work around 4-6 weeks, while those with physically demanding jobs usually do not return to work for 10-12 weeks.

Does being a family member make you a donor?

Being a family member does not necessarily make a better donor candidate. Risk of recipient rejection does not appear to be lower with a donation from a blood relative. Also, the relationship does not affect how much immunosuppression medicine the recipient receives after transplant.