Living Donor Liver Transplantation

Living Donor Liver Transplantation
Living donor liver transplantation, is a complex technique, that involves transplanting the donor’s right portion of liver into the recipient, after removal of the diseased organ. A liver may be divided in two parts, because each lobe has its own arterial and venous blood supply and drains bile through two separate ducts that join together outside the liver. Livers can regenerate and, after three to four weeks after transplant, grow to its original size both in the donor and recipient. Donor hospitalization after surgery is usually five to seven days provided no complications arise. The donor may return to normal life after four to six weeks. Strict criteria are used to select the donor so as to prevent any complications.

Why Living Donor Liver Transplantation? 
By knowing facts about liver transplants, you can make an informed decision about being a donor. Approximately 20,000 patents need liver transplants in India every year, yet less than 600 patients actually receive a transplant.

Many adult patients cannot survive the wait times for a deceased-donor liver. Because there is a long waiting list for those needing transplants, 1 out of 4 patients who need a new liver will die before one becomes available.  When considering facts about liver transplants, remember that the liver is one of the few organs that will grow back if a portion of it is removed.

What are the advantages of a live organ donation?
Living donor liver transplantation is now an accepted method, used more commonly because of the severe lack of livers from recently deceased donors. The live donor procedure also allows greater flexibility for the patient because the procedure may be done for people who are in the lower stages of liver disease.
A living-donor transplant means a patient can have a transplant before their liver failure gets worse.
It means a shorter wait time for a liver.
Because the surgery can be planned in advance, the chance for a successful transplant is better.
The quality of the liver may be better, because living donors are usually young, healthy adults who have gone through a complete medical
evaluation.
With a living-donor transplant, the preservation time (the time when the liver is outside the body) is shorter.

Who can donate?
The donor may be a family member, such as a parent, sister, brother, or adult child. The donor can also be a husband or wife. It is against the law for people to sell their body parts.

In general, liver donors must:
Be at least 18 years old
Be in good health with no major medical or mental illnesses
Be a non-smoker for at least 4 to 6 weeks before surgery
Be able to understand and follow instructions before and after surgery
Have a compatible blood type
Have an emotional tie with the recipient
Not have a selfish motive for donating
Have a similar body size
Be able to go through certain medical tests like blood work, radiology studies, and a liver biopsy
A person should feel no pressure to donate part of his or her liver; nor should any money be given or received.

What are the tests needed for evaluation of a living donor?
People who want to donate their liver go through a complete medical exam to make sure their liver is healthy and that it is safe for them to donate. Safety is important for both the donor and the recipient

Medical evaluation is done (a) To make sure the donor does not have any health problems, like diabetes or heart conditions, that could increase the risks of problems during and after the surgery, (b) To make sure the donor liver that is the right size for the recipient.

The general tests performed as part of the evaluation include:
Physical examination. A complete physical examination is performed as part of the evaluation.
Blood tests 
Donor’s blood type (it should be compatible with the recipient’s blood type.)
Liver and kidney function tests
Cholesterol, blood sugar tests, blood counts
The donor is also tested for viruses such as hepatitis B, hepatitis C, and HIV
            Ultrasound/MRI/CT scan. These tests are done to get images of the liver to make sure the donor’s bile ducts, arteries, and veins are the right
fit for the intended recipient. These tests also measure the volumes of the liver that will go to the recipient, and make sure that it is
adequate.
Additionally, they are used to assess the piece of the liver that will remain in the donor to ensure that it is sufficient.
Chest X-ray, EKG and Cardiac Echocardiogram. These are standard tests done before any major operation to check for lung or heart
problems.
Consultation. Every donor will meet with several doctors for a complete assessment. All donors will also have a comprehensive psychosocial
assessment to talk about their reasons for donating a liver and to make sure they are in a stable mental condition for the surgery.

What happens during the operation?
An upper abdominal incision, in the shape of an inverted ‘L’ is made to expose the liver. The liver anatomy is re-checked, and an X-Ray of the bile ducts obtained (cholangiogram) to ensure patient safety. The donor’s liver is split into two parts. One part is removed for the transplant. The wound is then closed with suture or staples.

Donors stay in the hospital from 4 to 7 days after surgery, longer if problems occur. The first night after surgery is usually spent in the intensive care unit (ICU). The next day, the patient may be moved to the general surgical floor where nurses have experience caring for liver donors. The nurses will encourage one to get out of bed and sit in a chair the day after surgery and to walk as soon as able.

What are the potential complications of surgery?
As with any major surgery, there are risks. There is a 10 to 25 percent chance a donor could have complications from the surgery. A donor may develop some problems during or right after the operation; they might also experience problems later. Surgical problems include bleeding, infection, bile leaks, or damage to the bile tree (the ducts that run through the liver). Other risks can come from anesthesia and general surgery.

It is quite helpful to talk to a donor who has already gone through the surgery and can talk about his or her experience.

How long does recovery take?
You may be in hospital for a week, if all is well. It takes about 4 weeks to recover from surgery.  Most donors recover fully after the operation and can do normal activities within a few months after the surgery.