A live donor liver transplant removes a malfunctioning liver and replaces it with a portion of a healthy liver from a living donor. People must meet the criteria for living donors, such as being over 17 and having good mental and physical health.
According to the Department of Health and Human Services, around 8,096 liver transplants took place in 2020 alone, with 11,772 candidates awaiting transplantation at the end of 2020. Liver transplants traditionally come from deceased donors. Centers prioritize transplants and allocate these livers to individuals based on their level of sickness.
On the other hand, a living donor liver transplant is partial liver transplantation. It can be an alternative to waiting for a deceased donor until the liver disease becomes too severe to require a full organ transplant.
This type of transplant involves receiving a portion of a healthy liver from a live donor to replace the recipient’s diseased liver. Due to the liver’s capacity to regenerate, both portions of the livers in the donor and the recipient grow and function normally into complete organs.
This article discusses the criteria for live donor liver transplants, why doctors perform the procedure, how to prepare for it, and how it works. It also looks at the recovery time, possible complications, costs, and survival rates.
Individuals interested in being living donors must undergo a comprehensive pretransplant evaluation to ensure they are eligible. They must meet the following requirements:
- be aged 18–60 years
- be in good physical and mental health
- have a body mass index (BMI) of less than 35
- have a compatible blood type with the recipient
- have no history of specific health issues, including:
- significant conditions affecting other organs, such as the:
- no active, ongoing malignancy such as cancer
- no HIV or AIDS
- no active or chronic infections
- no active substance misuse
- significant conditions affecting other organs, such as the:
According to the National Organ Transplant Act, it is illegal to accept money or gifts in exchange for donating a piece of a person’s liver. The evaluating team will ask if a person donated the liver voluntarily, freely, and without guilt or coercion. The team will also ensure that the donor fully understands the risks and benefits of living donation.
A person cannot live without a functioning liver. An individual may be eligible for a liver transplant if their liver fails. Liver failure can be acute (sudden onset) or chronic (longstanding):
The following may cause acute liver failure:
- viral hepatitis
- acetaminophen overdose
- acute liver disease from toxins
Many conditions can also lead to chronic liver failure. These include:
- hepatitis B
- hepatitis C
- alcohol liver disease
- nonalcoholic liver disease
- primary liver cancer
- primary biliary cirrhosis
- autoimmune hepatitis
- primary sclerosing cholangitis
- alpha 1 antitrypsin deficiency
- a failed prior liver transplant
- polycystic disease
- veno-occlusive disease
- Wilson’s disease
A person may also qualify for a liver transplant if it improves their quality of life. A person must have strong social support and access to funding or insurance.
Individuals may not qualify as liver transplant candidates if they have:
- cancer outside the liver
- current alcohol and substance use
- uncontrolled infections
- uncontrolled HIV or AIDS despite treatment
- failure of other organs, such as severe heart and lung disease
- irreversible brain damage or disease
- disabling psychiatric conditions
- documented medical noncompliance
Getting a live donor liver transplant allows people to receive a transplant rather than wait for a liver from a deceased donor. This type of transplant reduces the risk of the person’s liver disease or their health worsening while waiting for a transplant.
As the procedure is elective, the time the donor’s liver spends artificially preserved and without blood is less. Recipients may “receive” live donor livers better and have fewer complications after the procedure. About 30% of live donors will experience complications — most are mild and temporary.
Recipients receiving live donor livers generally have quicker recovery times and have improved long-term outcomes.
It is rare to find suitable deceased-donor organs suitable for children. Based on a
The transplant begins with a thorough health and psychological evaluation for both the donor and the recipient to ensure safety and compatibility. This process may take weeks to months, and both parties will have separate transplant teams.
The evaluation process involves many tests to determine the safety and possible risks of the procedure. The series of tests include:
- blood tests, such as:
- physical exam
- imaging tests, such as:
- heart and lung tests such as an echocardiogram and a pulmonary function test
- screening tests for viruses, such as HIV and hepatitis
There may be additional consultations with other allied health professionals and experts, including:
- independent donor advocate
- transplant surgeon
- social worker
- Left lateral section graft: This removes roughly one-fifth of the total liver mass. This type of graft may be suitable when transplanting to a young child.
- Left lobe graft: This removes
one-thirdof the donor’s liver. Doctors use these transplants for older children or small adults.
- Right lobe graft: This removes two-thirds of the donor’s liver. This type of graft is ideal for adults the same size as the donor.
On the day of the transplant, doctors will administer general anesthesia for the duration of the procedure. Two teams simultaneously operate on the recipient and donor. Surgeons will make an incision on the stomach. They will remove a portion of the donor’s liver — partial hepatectomy.
The other team will remove the diseased liver from the recipient — total hepatectomy — and transplants the healthy donated portion of liver into the recipient’s body. They also connect the blood vessels and bile ducts to the new liver.
The donor operation typically takes about 4–8 hours.
Both donor and recipient stay in the intensive care unit for recovery and monitoring. Tubes and intravenous lines remain in the body after surgery. These lines provide people with medication or fluids directly into their veins. The healthcare team will monitor how the liver performs and help manage the person’s blood sugar level and fluid and electrolyte balance.
Once stable, the doctors will transfer the people to a recovery unit. They will remove the tubes slowly as a person practices to move again. The team will also gradually reintroduce liquids and solids.
Most donors stay in the hospital for 5–7 days and fully recover after 3–6 weeks. Meanwhile, most recipients fully recover after 3–6 months.
The team will schedule frequent follow-ups after the surgery.
All surgeries performed under general anesthesia contain general risks. These include:
- blood clots
- nerve damage
- hernia at the incision site
There is also a risk of death, though this is very rare.
Some risks of living donor liver transplant include:
- bile leakage
- bile duct scarring
- organ damage
- postoperative fatigue
- postoperative pneumonia
- organ rejection
- failure of the donor’s liver
Possible long-term complications
A person with a transplanted liver may also face possible long-term complications.
New malignancies occur
The average liver transplant costs vary widely depending on the person’s health, age, hospital, and region.
Most health insurance typically covers a liver transplant. The cost will depend on the specific health coverage of a person’s plan.
In 2017, the estimate of costs for one liver transplant admission in the United States was
According to the Organ Procurement and Transplantation Network (OTPN), the national survival rate for living donor transplants from 2008 to 2015 was:
- 88% 1 year after the surgery
- 82% 3 years after the surgery
- 77.3% 5 years after surgery
The living donor recipients had better graft survival than deceased donor recipients at all points, with a 5-year graft survival of 90.1% compared to 83.3%, based on a 2020 OPTN annual report.
A live donor liver transplant may be an alternative to a long waiting list and limited availability of donated livers from deceased people.
Living donor transplants show better outcomes and survival rates. However, as with any other surgery, it has risks and associated postoperative complications.
A person considering donating may consult with their doctor about their eligibility, the transplant process, and costs.