Liver Transplant

A living-donor liver transplant is when a live person donates a part of their liver to a person whose liver is damaged beyond the point of no return. The donated part will grow to full size in the person who receives it. The donor’s liver will also grow back, either to its normal size, or smaller. This usually happens over a short period of time (a few weeks in most cases).

What Are the Functions of Your Liver?

Located in the upper-right portion of the abdomen, the liver is the largest solid organ in the body. It is divided into two main lobes (where the right one is larger than the left one).

The liver performs more than 500 essential functions. One of the most important tasks carried out by this organ is the conversion of nutrients into essential minerals, vitamins, enzymes and hormones. The body needs all of these substances in order to function properly. The liver also stores glycogen, vitamins and other essential nutrients until the other organs in the body need them. Bile is also produced by this essential organ - the fluid that aids the digestion of fatty nutrients.

The liver is responsible for processing toxins in the body before they accumulate to levels that can cause serious illnesses. For example, the liver has to work hard to break down alcohol into less harmful substances. Persistent alcohol consumption can lead to fatty deposits on the liver and serious damage over time.

When Is a Liver Transplant Necessary?

A liver needs to be replaced when it is damaged so badly it can't perform its essential functions properly. For example, chronic hepatitis can cause serious inflammation of the liver. If this can't be reversed, permanent damage can occur. Some people suffer acute liver damage as a result of consuming poisonous substances, while others create damage over a period of many years through alcohol and drug abuse. Other conditions that can lead to liver damage include liver tumours, genetic disorders such as haemochromatosis and non-alcoholic fatty liver disease.

Who Can Be a Donor?

If you choose to donate part of your liver, you will go through a complete medical examination to assess your overall health and make sure your liver is healthy. You will be informed about the procedure and the risks, and will be asked to sign a consent form before starting the procedure.

Requirements to become a donor vary from country to country but in general donors must:

• Be between 18 and 60 years old

• Be in good health, both physical and mental

• Be a non-smoker for at least 6 weeks before the transplant

• Have a compatible blood type

• Understand the possible risks of surgery and undergo the transplant voluntarily

Donors usually have an emotional tie to the recipient (relatives or friends). However, some transplant centers let you donate your liver to someone you don’t know who is on the organ transplant waiting list.

It is really important that you understand the risks and the complications that a liver transplant can cause. Make sure you discuss the whole procedure with specialists and do not feel pressured into making this decision. All donors should donate on a voluntary basis and should not be coerced to do so.

What Does a Living-Donor Liver Transplant Entail?

People can donate part of their healthy liver because it is a regenerative organ. If just a small portion of the liver is taken from the live donor, it can regenerate to its original size in a few weeks or months. The liver transplanted in the patient should also grow over time.

For a living donor liver transplant, the donor and the recipient must go into surgery at the same time. The procedure is performed under general anesthesia for both patients. The damaged liver is removed completely and the patient prepared to receive the donated portion of the liver. Typically, the right lobe of the donor’s liver is removed (around 40 to 60% of the liver). The way the liver's segments are chosen for a liver transplant mainly depends on the size and functionality of the donor's liver. The number of segments that will be transplanted depend on a case-to-case basis, which will have to be evaluated by your doctor. Once the liver has been removed, the surgeon closes the wound with sutures and staples. The surgeon places the donated portion into the recipient and closes the wound with sutures.

The whole surgery takes 5 to 8 hours. Both the donor and the recipient will spend the first 1-2 days in the IC unit.

What Should You Expect?

Most people have to wait several months for a suitable donor to come forward. However, you can ask relatives to undergo compatibility tests. This can be a highly emotional and worrying time, so it's always a good idea to rely on close friends and family for support. This is major surgery and the road to recovery can be long and challenging.

Patients have to take a range of drugs for several months afterwards, and some medicine has to be taken for life. Anti-rejection drugs, in particular, can cause some distressing side-effects, which your surgeon will talk you through at the beginning of the process.

Donors will stay in the hospital from four to seven days. It typically takes around four weeks for donors to completely recover from the surgery and will have to undergo regular checkups during this time.

Are There Different Types of Liver Transplant?

There are two main types of living donor liver transplant.

Living Donor Transplants

A healthy person of the right size and blood type might be able to donate a portion of their liver to someone else. Most living donors are very close friends or relatives who are willing to undergo a very serious procedure in order to save the life of someone they love.

Domino Liver Transplants

This less common type of liver transplant can be recommended for people with a condition called familial amyloidosis. This disease results in abnormal deposits of protein in the major organs of the body. The person with the disease receives a new liver and the liver taken out is given to someone else in need of a transplant. The recipient of the affected liver may develop symptoms of familial amyloidosis, but these usually take decades to present.