Our clinical team has pioneered and perfected living donor liver transplants in both children and adult patients. Get all your questions answered about this innovative procedure, including what it involves, the benefits it offers donor recipients, and how to become a living donor.
What is living donor liver transplantation?
A living donor liver transplantation is a surgery that removes a diseased or malfunctioning liver and replaces it with a portion of a healthy liver from a living donor. Due to the liver’s unique ability to regenerate, the partial livers of both the donor and recipient soon grow into complete organs.
What are the benefits of living donor liver transplantation?
Because this type of surgery uses a portion of a liver from a living donor, rather than a liver from a deceased donor, it offers several significant benefits:
- Shorter Waits: Typically, living donors are a family member or loved one of the recipient. This means there is no need to remain on a waiting list.
- Faster Recovery: Living donor recipients experience shorter hospital stays and are less likely to require blood transfusions or dialysis after their surgery.
- Improved Outcomes: Recipients of living donor livers have an average 5 percent better long-term survival rate than recipients of deceased donor livers. See the data below.
What is the history of living donor liver transplantation?
Because of their size and relative high rates of liver disease, children under the age of two have typically faced a shortage of donor organs. To address this, living donor liver transplantation was developed.
Dr. Jean C. Emond, Columbia Surgery’s Chief of Transplantation, helped pioneer this procedure in the 1980s and was on the first team to perform a successful living donor liver transplantation in the U.S. Since then, he has helped expand its application to adults. As a result, the Center for Liver Disease and Transplantation is now one of the only programs in the nation that offers living donor liver transplantations for both children and adult patients.
The Center has helped further innovate this procedure by introducing laparoscopy and increasing the use of left lobe grafts, which are smaller and pose less of a risk to the donor.
Due to the Center’s innovative work, nearly half of our living donors can donate the left lobe of their liver, while those donating to children require only a 3-inch laparoscopic incision.
Are they any risks or complications associated with living donor liver transplants?
As with any major surgery, living donor liver transplantations come with risks, including possible complications. For donors, these include:
- Bile duct leakage
- Blood clots
For recipients, the risks are similar to those of a deceased donor liver transplantation. These include:
- Bile duct leakage or shrinkage
- Blood clots
- Failure of donated liver
- Mental confusion or seizures
- Rejection of donated liver
However, because the donated liver comes from a living donor, serious complications occur at a lower rate. In fact, research has shown that the majority of complications that occur during living donor liver transplantations are due to the relative technical complexity of the procedure and are offset when performed by experienced surgeons.
What happens during living donor liver transplantation surgery?
In general, a living donor liver transplantation takes about four to six hours to remove the donor liver, then another six to 12 hours to implant it into the recipient.
The surgeon will begin by making a long incision across the donor’s abdomen to gain access to the liver. (If the recipient is a child, then a smaller laparoscopic incision will be made.) Next, they will remove a portion of the liver that they have previously decided is adequate for the recipient. This portion may make up anywhere from 25 to 65 percent of the liver. After controlling bleeding, they will then close the incision and take the donor to recovery.
In the second half of the surgery, the surgeons will implant the healthy liver portion into the donor recipient. To begin, they will make a long incision across the recipient’s abdomen, much as they did for the donor. Next, they will sever the existing liver’s attachments and remove it. Finally, the donor liver portion will be implanted. This will involve attaching their body’s veins, arteries, and bile ducts to the donor liver. This will reestablish key connections and ensure the donor liver can function properly. When this is done, the surgeon will close the incision.
In both the donor and the recipient, the liver will immediately begin regenerating itself once it has been implanted. This process generally takes between six and eight weeks to complete.
Who is eligible to become a living donor?
To become a living liver donor, you must meet the following requirements:
- Be a willing adult between the ages of 18 and 60
- Be in good general mental and physical health
- Have no history of drug use, liver disease, HIV, or cancer
- Have a blood type compatible with the recipient
- Have a BMI less than or equal to 32
- Have an altruistic motive to donate
How do you become a living donor?
Living donors are on the front lines of helping to alleviate the shortage of donor organs and save the lives of those in need.
If you are interested in becoming a living donor, you can register here.
What is involved in the donor evaluation process?
We closely evaluate all candidates for living liver donation. This allows us to determine whether you can safely donate now and whether you will face any long-term health risks. It also allows us to communicate detailed information regarding the surgery and your recovery period.
The evaluation process includes the following:
- Blood Tests: Determines whether your blood is compatible with the recipient’s blood, as well as whether your liver, kidney, and thyroids are functioning properly. Also screens for transmittable viruses, such as hepatitis and HIV.
- Physical Exam: If your blood types are compatible, then a physician will examine you to determine your general level of health.
- Magnetic Resonance Imaging (MRI): Creates a detailed picture of your internal organs so that surgeons have an anatomical “road map” during surgery.
- Diagnostic Tests: These will include a CAT scan of your abdomen and a chest x-ray.
- Screening Tests: If required, these may include an echocardiogram (EKG), pulmonary function test, and an exercise stress test.
- Additional Consultations: You will also meet with a psychiatrist to assess your mental health and a social worker, who will discuss the donation process with you and your family.
It typically takes two to four weeks to complete the donor evaluation process. However, in rare emergency situations, it can be completed in as little as 48 hours.
For more information on the evaluation process, call (877) LIVER MD/ (877)548-3763).
How long does the donor remain hospitalized?
After their surgery, the donor will typically remain in the hospital for four to seven days.
Their first night, donors will stay in the Surgical Intensive Care Unit, where specialized nursing staff can closely monitor them. If there are no complications, they will usually be transferred to the general surgical floor, where nurses are specifically experienced in caring for liver donors. Most donors will be able to return home when they show stable vital signs, are able to eat and drink, and have a clear incision site, among other criteria.
How long before the liver donor is fully recovered?
On average, most donors are fully recovered after three to six weeks. However, every donor’s recovery time is different.
During this period, donors will return to the hospital for routine visits so that their recovery can be monitored. By carefully assessing their health, hospital staff will help each donor determine when they can resume normal activities and return to work. This decision is informed by data from lab tests, observations of any signs or symptoms, and the judgments of both patient and staff.
What healthcare costs does the donor incur?
The recipient’s health insurance will cover the donor’s medical expenses. This includes:
- Donor evaluation (if performed by the Center for Liver Disease and Transplantation)
- Doctors’ fees
If additional financial assistance is needed, the Health Resources and Services Administration (HRSA) created the National Living Donor Assistance Center. This program will cover all travel, lodging, meals, and incidental expenses incurred by the donor as part of:
- Donor evaluation
- Medical or surgical follow up (within 90 days of the 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.
Visit the National Living Donor Assistance Center’s website to learn more.
Who is eligible to become a living donor recipient?
Because living donor liver transplantation surgery involves the transplantation of only a portion of a liver, rather than an entire liver, patients with severe liver disease are usually not eligible. Other possible disqualifications include:
- Active infections
- Alcohol or substance abuse
- Cancer outside of the liver
- Other diseases or conditions
Before undergoing any surgery, your transplant team will conduct a thorough evaluation in order to determine your eligibility.
How long does it take to receive a living donor liver?
There is no waiting list of live donors. Instead, the majority of recipients rely on a family member or friend for their donor liver. Only in very rare cases will they have no prior relationship with their donor.
Once a living donor is available and all evaluations are complete, the transplantation surgery will take place as soon as possible.
How long does the living donor recipient remain hospitalized?
After their surgery, the recipient will remain in the hospital for about 7 days.
Their first night, recipients will stay in the Surgical Intensive Care Unit, where specialized nursing staff can closely monitor them. If there are no complications, they will usually be transferred to the general surgical floor, where nurses are specifically experienced in caring for liver recipients. After several days of recovery, most recipients will be able to return home.
How long before the living donor recipient is fully recovered?
On average, most recipients are fully recovered after 3 to 6 months. However, this will depend on the severity of their condition, their age, and their general health.
During this period, recipients will return to the hospital for routine visits so that their recovery can be monitored. By careful assessing their health, hospital staff will help each recipient determine when they can resume normal activities and return to work.
According to data compiled by the Organ Procurement and Transplantation Network (OPTN), the national survival rate for living donor transplants performed between 2008 and 2015 was:
- 92 percent one year after surgery
- 88 percent three years after surgery
- 84 percent five years after surgery
As a comparison, survival rates for deceased donor transplants in the same period were:
- 91 percent one year after surgery
- 83 percent three years after surgery
- 75 percent five years after surgery
These statistics are the average survival rate for all ages, including the very old and very young, as well as the critically ill. Those with less severe liver conditions between the ages of 1 and 65 can expect even better survival rates.
If you’d like to learn more about our Living Donor program, give us a call at (877) LIVER MD/ (877) 548-3763 or get in touch using our online request form.