Living liver donor transplantation is a surgery that removes a diseased liver from one individual and replaces it with a portion of a healthy liver from a living donor. The liver is able to regrow to full size in both donor and recipient.
There are about 17,000 people waiting for liver transplants in the United States, but only enough livers from deceased patients to perform about 5,000 surgeries each year. For this reason, living donation is a good option for some individuals.
The liver is the only organ that is able to regrow. It can regenerate to nearly full size from as little as 30% of the original size within about a year. This capability is what makes living donor transplants possible.
During a living liver donation, a living donor will provide a single lobe of their liver for transplantation into the recipient. A fully functioning liver will grow in the recipient, and the donor’s liver will regrow to its original size.
The donor and recipient of a living liver transplant might be family members or have a close association. This is what medical professionals call a directed donation.
If an individual wants to donate a portion of their liver to someone they do not know, the medical community refers to it as a nondirected donation. A transplant hospital would need to guide the process in either case.
How does it work?
Surgical teams usually conduct both surgeries for living liver transplants in nearby operating rooms. One surgeon removes a portion of the liver, usually the right side, from the donor.
They may take anywhere from 25–65% of the liver. Surgeons then transplant this portion of the liver into the recipient in the other operating room. Teams may perform these surgeries with open incisions or use an imaging instrument called a laparoscope that shows what is inside the body. Doctors call this type of procedure keyhole surgery. However, keyhole surgery for liver transplants is very new, and not all facilities may offer it.
The doctor will provide the donor and recipient with enough liver to maintain bodily functions. Over the next several months, both livers will regrow to full size.
There are always risks with any surgery. In the case of living liver donation, there are a few risks for both donor and recipient.
Living liver donor risks
Risks to the donor include:
Liver transplant surgery is major surgery, and potential donors should also consult with the transplant center and their insurance company about the impact on their health insurance. Insurers may consider the donor to have a preexisting condition following donation.
Time off work and lost wages are other considerations. Recovery time may be lengthy, as the hospital stay may be less than 1 week, but a doctor may advise being off work for 6–10 weeks.
Living liver recipient risks
Risks recipients face include:
- bile duct leakage or shrinkage
- blood clots
- failure of the donated liver
- liver rejection
Potential donors and recipients should discuss living donor liver transplant risks with their hospitals.
A living liver donor transplant may be a good option for some people with end stage liver disease. The transplant hospital will help decide if someone is a candidate through a series of examinations.
They look for individuals who:
- could improve their quality of life through a liver transplant
- do not have other uncontrolled or untreatable diseases
- are likely to survive the transplant surgery
- have tried other treatments, which have not worked
- have support systems in place
- accept the risks and benefits of a living liver transplant
Factors that could disqualify an individual include:
Below are some statistics relating to living liver donor transplants.
How common are they?
Living liver donor transplants are not yet very common. According to the Organ Procurement and Transplantation Network (OPTN), doctors have performed about 170,000 liver transplants since 2008, and only 6,586 have been living liver donor transplants.
About 25% of people on the waiting list for a liver transplant die each year without receiving one.
Vs. deceased donor liver transplants
OPTN data suggests that the hospital with the largest living liver transplant program in the U.S. is the University of Pittsburgh Medical Center (UPMC).
According to UPMC research and follow-up visits, individuals who underwent a living liver donor transplant experienced fewer complications and had higher survival rates after 3 years than those who received a deceased liver donor transplant.
They also saw the following benefits:
- On average, individuals who received livers from living donors stayed in the hospital for 11 days compared with 13 days for deceased liver donations.
- In living liver donation, there was a 53% chance of needing a blood transfusion during surgery compared with a 78% rate during deceased donation surgery.
- Only 1.6% of living donor patients needed post-transplant dialysis, compared with 7.4% of deceased donor patients.
- Upon 3-year follow-up, the survival rate for living liver donor transplant recipients was 86%, compared with 80% for deceased donation recipients.
Additionally, there is usually no waiting period with a living liver donor transplant, so hospitals can schedule surgery before the recipient experiences a life threatening event. It can occur at a time that suits the schedules of both donor and recipient.
To become a living liver donor, an individual must meet several requirements that the transplant facility will thoroughly explain. Generally, these will include:
- being over the age of 18
- being in good physical and mental health
- not misusing alcohol or drugs
- having no history of health issues such as liver disease, kidney or heart disease, uncontrolled high blood pressure, active cancer, or certain infections
- having a body mass index of 35 or below
- having a blood type that is compatible with the recipient’s
- understanding and accepting the risks and benefits of living liver donation
The liver is a remarkable organ that can regrow from just a piece. That is why a transplant team can leave a portion behind in the donor and place a piece into the recipient. In time, two full-size livers will develop.
First, though, the transplant team will cut the donor’s liver into two pieces in a surgery that can take 4–6 hours. They will determine how much of the liver the recipient needs. They may require anywhere from 25–65%. The surgeons will generally take this from the right lobe.
The process of evaluation for being a living liver donor usually takes about 2–4 weeks. However, emergency situations can expedite the process in a matter of days.
Before surgery, the donor will undergo a series of medical tests, including:
- blood tests
- physical examination
- MRI and CT scans
- chest X-ray
- screening tests that may include an echocardiogram, stress test, and pulmonary function test
They may meet with a social worker or psychiatrist to discuss the donation process and undergo a mental health evaluation.
The surgery occurs at a transplant hospital, generally in a room next door to the recipient. The donor’s surgery will take several hours. Afterward, they will usually stay on the surgical intensive care floor overnight for monitoring.
According to Columbia Surgery, a donor can expect to spend 4–7 days in the hospital. The hospital staff will carefully monitor the donor’s health and incision to determine when they can return home.
Each individual recovers differently from surgery, but on average most donors recover within 3–6 weeks. They will need to return to the hospital during recovery for lab work and monitoring and to determine when it is safe to return to work, school, and their usual activities.
The Scientific Registry of Transplant Recipients reports that donation failure and survival outcomes were similar or slightly better for living liver donor transplants than for transplants from deceased donors.
In deceased donor transplants, the recipient’s body rejected the liver 8.9% of the time after 1 year, 21.6% of the time after 5 years, and 42.6% of the time after 10 years.
In living donor transplants, the recipient’s body rejected the liver 7.1% of the time after 1 year, 23.7% of the time after 5 years, and 32.1% of the time after 10 years.
Survival outcomes were similar between living and deceased transplants, with 7.4% of all transplant recipients deceased within 1 year, 19.7% within five years, and 39.5% within 10 years.
Living liver donation is a viable option for those with end stage liver disease. It can take a person off the lengthy liver transplant waiting list and get them into surgery before a life threatening health crisis occurs.
To become a living donor, a family member or close associate of the individual with liver disease will have to undergo an evaluation to determine their eligibility and health.
As with any surgery, there are some risks for both the donor and recipient that require consideration. However, the risks are generally lower than those accompanying transplantation from a deceased donor.
Living liver donation is when an individual with a healthy liver volunteers to donate a portion of it to someone with end stage liver disease. Because the liver can regenerate, the donor and recipient can grow full-sized livers again.
The donor and recipient’s surgeries take place at the same time, in rooms next to one another. The surgeon removes up to 65% of the donor’s liver, and a surgical team transfers it to the recipient’s operating room. Surgeons then place the donor liver into the recipient.
The donor and recipient will need to stay in the hospital for several days, followed by monitoring by doctors for several weeks. The livers will begin to grow immediately and return to full size within a few months.