Living Donor Liver Transplantation  About the Procedure
All About Living Donor Liver Transplantation
The clinical team at the Center for Liver Disease and Transplantation (CLDT) has pioneered and perfected the use of living-donor transplantation, first in children, and now in adult patients with serious liver disease.
This guide to the procedure has been prepared for anyone considering becoming a donor.
Q: What is living-donor liver transplantation?
A: Living-donor transplantation involves the removal of a portion of the donor's healthy liver for transplantation into a recipient in need.
A family member, usually a parent, sibling or adult child, or someone emotionally close, such as a spouse, may volunteer to donate a portion of their healthy liver.
This procedure is made possible by the liver's unique ability to regenerate.
After transplantation, the partial livers of both the donor and recipient will grow and remodel to form complete organs.
Q: Why is living-donor liver transplantation desirable?
A: The principal advantage of living-donor transplantation is that it provides immediate organ availability to those awaiting transplantation.
The timing of the transplant operation can be planned and the progression of recipient's liver disease and its life-threatening complications can be avoided.
Research is finding that patients with living donors have a lower than average MELD score.
Nationally, nearly 17,000 individuals wait for liver transplantation, while only 6,700 deceased-donor organs (those coming from brain-dead donors) become available each year.
Living-donor transplantation offers the possibility of earlier transplantation to those in need, before their health deteriorates to life-threatening status.
 Q: How did living-donor liver transplantation begin and how prevalent is it?
A: Living-donor transplantation was first performed in children as a means to alleviate long waiting times for deceased-donor organs.
Dr. Jean C. Emond, Vice Chair for Transplantation, helped pioneer this procedure in children in the 1980s, and has expanded its application to adults.
The CLDT is one of only a few programs in the nation now offering living-donor transplantation in post-adolescent patients.
He and his team have proven that the dangers of removing larger sections of the donor's liver for adult recipients can be overcome.
Q: Who can become a donor?
A: Potential liver donors are carefully evaluated to select those individuals who can safely donate a portion of their liver which will function immediately.
The Center's primary concern throughout the evaluation is the safety of the donor.
This means that if CLDT physicians estimate the risk of death for a donor could exceed 1%, that person would not be permitted to donate.
General criteria for liver donation include:
- being in good general health
- having a blood type compatible with recipient's
- having an altruistic motivation for donating.
Q: What are the major risks in donating?
A: Risks to the donor include, but are not limited to, bleeding, infection, bile leakage, and possible death.
Donors in the CLDT's living-donor transplantation program have experienced few complications after surgery and during recuperation; all are currently alive and well.
Q: What is involved in the donor evaluation process?
A: A living-donor candidate must complete the following evaluation process to determine if they can safely donate:
- The first testing determines if the donor's blood type is compatible with that of the recipient.
Additional blood tests are performed to test for healthy functioning of the donor's liver, kidneys and thyroid, and to screen for exposure to transmittable viruses such as hepatitis and HIV, the virus that causes AIDS.
- If donor's and recipient's blood types are compatible, a physical examination with a CLDT physician is scheduled to further assess the donor's overall heath.
- Consultations with the CLDT's social worker and psychiatrist are scheduled.
- Magnetic Resonance Imaging (MRI) is performed to create a detailed anatomical "road map" of the donor's internal organs to aid the surgery.
- Sometimes additional testing, such as pulmonary function testing, echocardiogram, or exercise stress testing, is required.
The standard time required to complete the donor evaluation process is two to four weeks.
In rare emergency situations, however, it can be completed in as little as 48 hours.
Q: What happens during donor surgery?
A: Depending on which part of the donor's liver is removed, the incision is either straight up and down, or in the shape of an inverted "T."
Typically, the gallbladder is removed.
The donor's liver is carefully split into two segments and one portion is removed for the recipient.
The surgeon then closes the incision with self-absorbing sutures or staples, which are later removed during a follow-up visit to the surgeon's office.
The liver begins to heal and regenerate itself, generally taking six to eight weeks for full regeneration.
Q: How long does the donor remain hospitalized?
A: Typically, a donor remains in the hospital from four to seven days after surgery.
Donors spend their first night after surgery in the Surgical Intensive Care Unit for close monitoring by specialized nursing staff.
The following day, they are usually transferred to the general surgical floor where the nurses are specifically experienced in caring for liver donors.
Donors are encouraged to get out of bed and sit in a chair the day following surgery, and to walk the corridors as soon as they are able.
To make the donor's immediate recovery as comfortable as possible, Columbia University Medical Center provides Patient-Controlled Anesthesia (PCA) which enables self-administration of pain medication following surgery.
Q: How long before the liver donor is fully recovered?
A: Every donor's recovery time is different but, typically, donors spend four weeks recuperating after surgery.
In the month following discharge from the hospital, donors return weekly to the Center for Liver Disease and Transplantation for outpatient monitoring.
Individual recovery rate and the type of occupation dictate how soon a donor can return to work, but it commonly averages three to six weeks.
The CLDT's clinical staff helps donors determine when it is safe to resume normal activities.
Q: What healthcare costs does the donor incur?
A: The donor's medical expenses, including the costs of evaluation (if performed by the CLDT), doctors' fees, and hospitalization, are covered by the recipient's health insurer.
The Health Resources and Services Administration (HRSA) has established a program providing financial assistance to donors called the National Living Donor Assistance Center (NLDAC). The program covers travel, lodging, meals, and incidental expenses incurred by the donor and/or his/her accompanying person(s) as part of:
- Donor evaluation, clinic visit or hospitalization,
- Hospitalization for the living donor surgical procedure, and/or
- Medical or surgical follow-up clinic visit or hospitalization within 90 days following the living donation procedure.
The program will pay for a total of up to five trips; three for the donor and two for accompanying persons. The accompanying persons need not be the same each trip.
To learn more, please visit http://www.livingdonorassistance.org
If you are interested in being evaluated for liver donation and want additional information, please contact the Center for Liver Disease and Transplantation by calling our toll-free number for referrals and consultations, 1.877.LIVER MD (1.877.548.3763).
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