Living liver donation allows a healthy individual to provide a life-saving transplant to someone with liver failure. A family member can often be a living liver donor, which can significantly shorten the waiting time for a patient needing a new liver.
The Possibility of Living Liver Donation
Living liver donation is feasible due to the liver’s unique capacity to regenerate. Unlike most other organs, the liver can regrow to its original size and function after a portion has been surgically removed. When a segment of a healthy liver is transplanted, both the remaining part in the donor and the transplanted segment in the recipient will regenerate. This regenerative ability allows a portion of a healthy liver, often 25% to 65% of its mass, to be safely removed for transplantation.
Who Can Be a Living Liver Donor?
Becoming a living liver donor involves meeting comprehensive medical and psychological criteria to ensure the safety of both the donor and the recipient. Donors are typically healthy adults, generally between 18 and 60 years of age, though some centers may consider slightly younger or older candidates on a case-by-case basis, with a compatible blood type.
Physical health assessments ensure donors are free from significant organ diseases, cancers, hepatitis, or active infections. A healthy body mass index (BMI), often below 30 or 32, is also a common requirement. Donors must abstain from alcohol and certain medications, and stop smoking before surgery due to their impact on liver health and surgical risks.
A thorough psychological evaluation ensures the donor’s mental and emotional stability and that the decision to donate is voluntary. Donors must have a strong support system for their recovery and understand the commitment involved in the evaluation, surgery, and post-operative care.
The Living Liver Donation Process
The process begins with a comprehensive evaluation, including medical screenings like blood tests, urine tests, CT scans, MRIs, chest X-rays, and EKGs, to assess overall health and liver function. Donors meet with a multidisciplinary team, including transplant surgeons, hepatologists, social workers, psychologists, and an independent donor advocate. The advocate ensures the potential donor understands the process, risks, and benefits, and that their decision is voluntary.
Once approved, the surgery date is scheduled. On the day of the transplant, both the donor and recipient undergo simultaneous surgical procedures. The donor operation, known as a partial hepatectomy, involves surgically removing a specific portion of the liver, typically a right or left lobe. This procedure usually takes about four to six hours, and the removed liver segment is immediately transferred to the recipient.
After the segment is removed, donors typically have drains placed in their abdominal cavity for several days to manage fluids. The donor is then moved to a recovery area for close monitoring.
Risks and Recovery for the Donor
Living liver donation is a major surgical procedure with potential risks. General surgical risks include bleeding, infection, blood clots, and complications related to anesthesia such as allergic reactions or pneumonia. Specific to liver surgery, there is a possibility of bile leakage, bile duct injury, or abdominal adhesions. While rare, severe complications such as liver failure or death can occur, with reported mortality rates being very low, such as 0.2% or 1 in 500 cases.
Following surgery, donors typically spend five to seven days in the hospital. Pain is managed with medication, and patients are encouraged to begin walking early to aid recovery. Most donors experience significant discomfort for two to four weeks. Full recovery takes time, with most returning to regular activities within six to eight weeks, though physically demanding jobs may require a longer absence.
Donors are advised to avoid lifting heavy objects for several weeks to prevent complications like hernias. The liver begins to regenerate immediately after surgery, reaching approximately 80% of its original size within six weeks and nearly full size within a few months to a year. Long-term follow-up appointments are scheduled for at least one to two years to monitor the donor’s health and liver function.
Alternatives to Family Donation
If a family member is not a suitable donor, several alternatives exist for individuals awaiting a liver transplant. The most common is deceased donor transplantation, where a liver becomes available from a person who has died. Patients are placed on a national waiting list, and organs are allocated based on medical urgency and other factors. However, demand often exceeds supply, leading to long waiting times.
Another option is a paired exchange program. This program allows incompatible donor-recipient pairs to swap donors with other incompatible pairs, enabling both recipients to receive a compatible liver. This expands the pool of potential living donors. Some individuals also choose to be non-directed or altruistic donors, donating a portion of their liver to an anonymous recipient on the waiting list. These alternatives provide transplant opportunities for patients who cannot receive a direct donation from a family member.