The Possibility of Living Liver Donation
Donating a portion of one’s liver is possible due to its remarkable ability to regenerate. This unique characteristic allows a segment of a healthy liver to be transplanted into a recipient, while the remaining part in the donor regrows to its original size and function. The regeneration process typically occurs within a relatively short timeframe. In the donor, the remaining liver can return to its previous size within a few months, with significant growth observed within weeks. Specifically, within about six weeks, the donor’s liver can regenerate to approximately 80% of its original size, continuing to grow for up to a year to reach around 90% or more.
Similarly, the transplanted portion in the recipient also grows, restoring normal liver function. This regenerative capacity ensures both donor and recipient can have fully functioning livers after the procedure. This rapid regrowth underpins the success and safety of living liver donation, offering a life-saving alternative for those awaiting a transplant.
Who Can Be a Living Liver Donor?
Becoming a living liver donor involves meeting strict criteria designed to ensure donor safety. Potential donors are generally between 18 and 60 years old, though some centers consider up to 65, and must be in good overall physical and mental health without significant medical conditions.
A comprehensive evaluation assesses various health aspects, including the absence of uncontrolled high blood pressure, diabetes, heart disease, or existing liver conditions like cirrhosis or hepatitis. Blood tests check for underlying health problems, such as anemia, clotting disorders, or autoimmune diseases, and ensure blood type compatibility. A healthy body mass index (BMI), typically less than or equal to 32, is also a common requirement.
Psychological evaluation is a significant part of the screening process, ensuring the donor understands the commitment and makes an informed, voluntary decision. This assessment confirms psychological stability, rules out coercion, and explores motivation to ensure it stems from an unselfish desire to help, without financial gain, which is illegal.
The Living Liver Donation Process
The journey to becoming a living liver donor begins with an initial inquiry to a transplant center, followed by a comprehensive evaluation. This includes tests like blood work, chest X-rays, EKGs, and imaging of the liver (CT scans or MRIs) to assess overall health and liver anatomy.
During the evaluation, the potential donor meets with a team of specialists, including a transplant nurse coordinator, hepatologist, surgeon, psychologist, and an independent donor advocate. This advocate prioritizes the donor’s safety and interests throughout the process. Once deemed suitable, surgery is scheduled, often several weeks in advance.
On the day of the transplant, both the donor and recipient undergo surgery simultaneously. For the donor, a surgeon removes a portion of the liver, typically a lobe ranging from one-third to up to 60%, depending on the recipient’s needs. The procedure lasts about four to eight hours, involving careful division of the liver to ensure viable blood vessels and bile ducts for both the remaining donor liver and the transplanted segment.
Donor Safety and Recovery
Living liver donation is a major surgical procedure, and as with any surgery, it carries potential risks. Common complications can include bleeding, infection at the surgical site, blood clots, or issues related to anesthesia. Specific to liver donation, there is a possibility of bile leakage or bile duct problems, which may resolve on their own or require intervention. While rare, serious complications such as liver failure or even death can occur, with reported mortality rates around 0.2% (1 in 500 donors).
Following the surgery, donors typically remain in the hospital for about five to seven days. Pain management is provided, and while some discomfort may persist for several weeks, it is usually controlled with medication. Donors are encouraged to gradually resume normal activities, with most able to return to non-strenuous work within four to eight weeks. Lifting restrictions, such as not lifting over 15 pounds for four weeks and 30 pounds for 12 weeks, are common.
Full recovery can take several months, with many donors feeling completely normal within four to six months. Follow-up appointments are scheduled regularly for up to a year, and sometimes for five years, to monitor the donor’s health and liver regeneration. Despite the potential risks and recovery period, long-term health outcomes for living liver donors are generally positive, with most reporting good health and quality of life comparable to the general population.