Living Liver Donor FAQs
Living donation takes place when a living person donates an organ (or part of an organ) for transplantation to another person. The living donor can be a family member, such as a parent, child, brother or sister (living related donation).
Living donation can also come from someone who is emotionally related to the recipient, such as a spouse or an in-law or a very close friend (living unrelated donation).
The main advantage is the transplant can be booked for a time that best meets the needs of the recipient and donor. Because cadaver livers are allocated based on medical urgency, recipients often wait until they are the sickest on the list, and are weaker going into surgery. Some patients may develop complications that preclude transplantation or may even die while on the transplant list. As living donors are usually young, healthy adults who have undergone a thorough medical evaluation, there is a high degree of confidence that the donor liver is of good quality. Preservation time (when the liver is without blood) is minimal. Long term survival of the graft is greater with a living donor.
The donor could either be a relative, spouse, or close friend.
- donor's blood type must be compatible with the recipient's
- donor must be relatively close in size (or larger) than the recipient
- donor should be in good physical and mental health
- donor should be between 18-55 years old
- decision to be a donor should be made after careful understanding of the procedures, and consideration of the risks and complications involved
- History of Hepatitis B or C
- HIV infection
- Active alcoholism or frequent heavy alcohol use
- IV drug use
- Psychiatric illness under treatment
- History of malignancy
- Heart or lung disease requiring medications
- Longstanding diabetes
The potential donor will be asked to complete a questionnaire, and have their blood tested to determine blood group and virology.
If the blood type is compatible, and the details of the questionnaire indicate suitability, the potential donor is evaluated by our team who will obtain additional history and will then arrange further blood work, urinalysis and abdominal scans.
Our team will review all the information and if suitable thus far an appointment will be arranged for the donor for next level investigations which include a CT scan and MRI to measure the size of the liver, and assess blood vessels and bile ducts.
The donor will be evaluated by the team consists of Transplant Surgeons, Hepatologists, Psychiatrist, Cardiologist, Chest Specialist, Gynaecologist ( For Female donors), Transplant coordinator and an Independent Doctor.
When complete, the details are once again reviewed by the transplant team. A decision regarding the suitability of the donor will be made at that time. This decision will be communicated to the donor by one of the team members.
If the assessment indicates the donor is not suitable for Live Liver Donation, the physician will meet with the donor to explain.
As with any surgery involving general anesthesia, there are possible complications, including heart complications, stroke and blood clot formation in the legs or lungs. There is also a risk that the remaining portion of your liver will fail and you will need an urgent liver transplant yourself. While these complications are very rare, the risks exist, and we will discuss them with you in more detail during the evaluation. The most common complications of this surgery are small bile leaks from the remaining portion of your liver, minor wound infections, and gastrointestinal upsets such as constipation, indigestion, occasional nausea or diarrhea. These usually resolve after a couple of weeks.
The liver is divided into a right lobe, consisting of 60% total liver volume and a left lobe, consisting of 40% total liver volume. The anatomical division between the lobes permits surgeons to divide the liver into two distinct sections, which can function independently of each other.
The size of the portion and specific part of the liver that is donated depends on the size or needs of the recipient and liver size and anatomy. For instance:
- If recipient is a child, a portion or all of the left lobe is taken.
- If recipient is an adult of smaller size, the entire left lobe is taken.
- If recipient is a larger adult, the right lobe is removed.
We strongly advise that donors stop smoking, even if they are a light smoker. Heavy smokers may be excluded from donation due to their increased risks.
One should only stop prescription medications under the advice of a physician. A donor should not use aspirin or non-steroidal medications such as ibuprofen for 7 days prior to surgery. These types of medication affect the time it takes for blood to clot and may increase one's risk of bleeding. It is possible to use paracetamol if needed. Women taking birth control pills or hormone replacement therapy will be advised to stop taking them because of the increased risk of blood clots during recovery from surgery.
No. While every step is taken to ensure the scheduled surgery date and time, a number of situations could arise that may create a change in plans. The recipient's condition might deteriorate or they may become ill with an infection. Also, due to emergencies, the Operating room and/ICU may not be able to accommodate the surgery on the scheduled day.
Donors are brought to the operating room, gently put to sleep, and a breathing tube is inserted and monitoring lines are placed.
Surgeons then make an incision under the rib cage and carefully assess the size of the liver with our own eyes after having seen it with a CT scan. Next, we remove the gallbladder and inject dye into the biliary tree to make sure it is safe for division. Then we dissect the portal vein and artery where it divides the different sides of the liver. We isolate the vein that drains that part of liver and then divide the liver in half very carefully with attention to tying all the blood vessels and bile ducts in that plane. And then we close it up.
Yes, for the first couple of days donor will have a catheter in urinary bladder, IV line in neck and an intravenous (IV) lines in arm to provide them with fluids, and to allow medications to be administered.
The donor may also have one or two tubes (drains) from their abdominal area to drain bile or blood. One may be discharged with one or both of these tubes to be removed at a later date. Doctors and Nurses will instruct the donor on the care of these drains once the donor is discharged from the hospital.
We expect that the donor will return to a normal life within 3 months after their surgery, provided they do not experience any complications.
One may want to refrain from sexual intercourse for a couple of weeks until all incisions are well healed.
There is no definite answer, but we recommend that donors not become pregnant for at least 6 months following the surgery, as by that time wounds are well healed.
At this time, we do not believe future donation will be possible.
We advise that donors not drive for at least the first 2-3 weeks after the surgery. One must be physically and mentally strong, with normal reflexes, be free from abdominal pain or discomfort before resuming driving. Narcotic pain medications, such as tramadol, should not be taken before driving.
As soon as the donor wakes up from the anesthesia, they will begin "exercising". They will need to take deep breaths and cough to make sure they are getting air into all areas of your lungs. This will help prevent pneumonia. They will also begin to exercise the muscles of their legs by flexing and relaxing them periodically. The donor will be helped out of bed within 24 to 48 hours after the surgery and will begin walking soon. Walking as soon after your surgery as possible, will help prevent such complications as blood clots, pneumonia, and muscle wasting. Donors are encouraged to continue a program of daily walking when they are at home. The goal is to be back to normal health within 2-3 months.
Donors should avoid any heavy lifting (no weight greater than 5-10 Kg) for the first 3 months, until the abdomen has completely healed. After 3 months, if one is feeling well and are not having any complications, they may begin to return to their normal activities. Begin slowly and build up gradually. Be cautious with activities that strain abdominal muscles.
Some donors may go home with a tube in their abdomen that will need to be removed within several weeks. Donors will need blood tests every 3 months for the first year. Ultrasound at 6 months and at one year is also recommended. This is to ensure that there are no delayed complications (such as bile duct narrowing) as a result of the surgery.