How does living liver donation work?

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At any given time, there are nearly 14,000 people waiting for a liver transplant, according to the United Network for Organ Sharing. But in 2018, only 7,170 people received a transplant from a deceased donor. With a list that long, it could be months or years before a patient is matched with a donor.

There is a way to shorten the wait time for transplantation – through living liver donation. This option offers the opportunity to transplant patients before they get too sick for surgery.

In a living liver donation, a portion of a healthy donor’s liver is transplanted into the recipient, after the removal of the diseased liver. The donor and recipient surgeries are carried out simultaneously in different operating rooms so organ preservation and transportation time aren’t factors. Since the liver has the ability to regenerate, the livers in the donor and recipient grow back to 85 to 90 percent of the original size and regain full function within six to nine weeks.  

Nationally, less than 5 percent of all liver transplants are from a living donor. If you’re considering living liver donation, here’s an overview of the process.

Qualifications for living liver donation

In order to be a living liver donor, you should be in good overall physical and mental health, have a strong support system and have the ability to be off work during the recovery period. At Ohio State, we require donors to have some form of a relationship with the recipient, such as a family member or friend.

Eligible donors are between the ages of 21 and 55. Ideally donors should have a BMI under 30. However, patients are evaluated on a case by case basis up to a BMI of 33. Donors cannot have any chronic or serious medical conditions such as cancer, diabetes, hepatitis or HIV. Alcoholism and active drug abuse will also rule out donor candidates.

Donor evaluation

Potential donors start the evaluation process by completing a detailed assessment form, which is reviewed for medical and psychosocial concerns. If donors meet the initial qualifications, they will take a blood test to determine blood type and tissue compatibility and general health.

If the donor and recipient have compatible blood types, a donor evaluation appointment is scheduled at the transplant center. This is a full day of activities that includes the following:

  • Education session with a transplant surgeon and living donor nurse coordinator about the evaluation process, surgery, recovery and life after donation
  • Consultations with a transplant social worker and independent living donor advocate to make sure donors understand the donation process, requirements and risks, as well as to ensure donors have adequate support following surgery and aren’t being coerced into making a donation
  • Evaluation by a clinical health psychologist for any underlying mental health concerns
  • Evaluations by a transplant surgeon and independent hepatologist to determine if the candidate is a suitable donor
  • Evaluation by a transplant hepatologist to identify any underlying liver disease or other medical conditions that would inhibit donation
  • Imaging, including a chest X-ray, EKG, CT, MRI of the liver and biliary system, and Fibroscan to measure liver scarring and fat build up
  • Additional age appropriate cancer screenings, including Pap smear, breast exam, mammogram, prostate-specific antigen test and colonoscopy, will be scheduled as needed 

Following the assessment, a transplant surgeon creates liver computer models to determine if the candidate is suitable for donation. Then the donor is presented to the patient selection committee for approval. If they’re approved, the surgery is scheduled within a few weeks. About 10 to 14 days before surgery, the donor and recipient have blood drawn for final testing. 

The evaluation and assessment process can take two to three months. We purposefully go slowly because we want donors to have time to reflect and think about what they’re doing. It’s a very big commitment.

Surgery

On the day of the surgery, donors arrive early in the morning. They’re taken to the pre-operation area. A final examination will be done to make sure the donor is in excellent health. Donors will have the opportunity to ask the transplant surgeon any last-minute questions before being taken into the operation room.

The donation surgery takes four to six hours and is done under general anesthesia. After surgery, donors spend a few hours in the recovery room followed by a day in the surgical intensive care unit for close monitoring to ensure they are recovering well. The second day in the hospital until discharge is spent in the transplant unit. There the donor will practice coughing and deep breathing to protect the lungs. They are encouraged to get out of the bed and walk with support around the unit.

Most donors are able to go home five to seven days after surgery. If donors live more than two hours from the medical center, they may be required to stay in the area for up to three weeks after surgery.

Recovery

During the recovery period, donors should drink extra fluids and eat a healthy diet low in sodium, rich in fruits and vegetables, and low in fat. They’ll take medication to prevent blood clots for six weeks. 

Donors can drive four weeks after surgery as long as they’re no longer taking pain medication and can return to work within six to eight weeks, if their job doesn’t require heavy lifting or strenuous activity. If that’s the case, return to work may be delayed for a total of 12 weeks. Living liver donors should be able to resume most normal activities eight weeks after surgery. 

After donation surgery, donors are required to be seen by the liver transplant team at one week, three weeks, six weeks, three months, one year and two years. After the two-year surgery checkup, donors should have yearly physical exams that include liver function testing with their primary care doctor for 10 years. Additional appointments and tests may be scheduled as required.

If you’re considering living liver donation, contact The Ohio State University Wexner Medical Center Comprehensive Transplant Center at 800-293-8965.

Sylvester Black is a liver transplant surgeon and Robin Petersen-Webster is a living donor coordinator, both at The Ohio State University Wexner Medical Center.

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