Live Donor Liver Transplant

The liver is the only internal organ capable of full regeneration because a portion as little as 30 percent can regrow into a size of the full liver. After you donate, your liver function returns to normal in two to four weeks, and your liver slowly regrows to nearly its full original volume in about a year.

Live donor liver transplantation is an elective procedure which means we are able to schedule the liver transplantation when the recipient is in the best possible health and least likely to have complications. The recipient can avoid the continued physical deterioration that inevitably occurs while waiting for a suitable liver replacement.

Patients are usually able to have a live donor liver transplant sooner than waiting for a deceased donor. In addition, by avoiding the use of a liver from a deceased donor, live donor liver transplantation helps to shorten the waiting list and allows another patient on that list to get an organ. Therefore, a live donor can save two lives with their gift.

If you are considering becoming a donor, our team evaluates you and helps you make an informed decision about the risks. A thorough live donor evaluation process ensures that every live donor is suitable for major surgery, and their liver is suitable for donation. We continue to follow up with you after the procedure to make sure you stay healthy.

Requirements

The specialists at Lahey Hospital & Medical Center can help you understand the requirements for live liver donation.

Living donation is a voluntary process. Donors must have a compatible blood type and liver anatomy that is suitable for donation. Potential liver donors must not have any serious medical conditions, such as liver disease, diabetes, heart disease or cancer.

To become a live liver donor, you must:

• Be a willing adult between age 18 and 60
• Be prepared to commit to the pre-donation evaluation process, surgery and recovery
• Be in good health and psychological condition
• Have a compatible blood type (see below)
• Have healthy liver and kidney function
• Be a healthy weight (BMI less than 32)
• Be willing to abstain from alcohol until fully recovered

Compatible blood types

BMI Calculator

You cannot be a liver donor if you:

• Are under age 18 or over age 60
• Suffer from heart disease or lung disease
• Have an incompatible blood type
• Have HIV or hepatitis
• Are an active substance abuser
• Have an uncontrolled psychiatric illness

Evaluation

As part of the live donor evaluation process, you will meet with all members of our live donor team. In addition, several tests are required to determine if you are fit for major surgery and if your liver is suitable for live donation. Completing the entire donor evaluation may take up to two weeks.

The tests for a potential liver donor include:

• Blood tests
• Chest X-ray
• CT scan
• Electrocardiogram (EKG)
• Physical exam
• Tissue matching

It is important that you are aware of both the benefits and risks of live donor liver transplantation. The specialists at Lahey Hospital & Medical Center can help you understand more about the procedure.

Giving the Gift of Life

By becoming a live donor, you shorten the time a recipient spends on the liver transplant waiting list. You also increase the likelihood of successful transplantation because survival rates are higher when the liver transplant comes from a live donor. Additionally, you help another wait-listed patient because your donation vacates the recipient’s spot on the list for the next person when a deceased liver becomes available.

Liver Regeneration

The liver is the only solid internal organ capable of full regeneration. This means the remaining portion of your liver will grow back after surgery. As little as 30 percent of your liver can regrow to its original volume. After you donate, your liver function returns to normal in two to four weeks, and your liver slowly regrows to nearly its full original volume in about a year.

Low Financial Burden

The entire donation process is typically paid for by the recipient’s insurance company. This includes all pre-transplant evaluations, surgery, in-hospital recovery and follow-up care.

Some qualifying donors can obtain financial assistance from assistance programs that can help with travel and lodging and food expenses related to the live donor evaluation, surgery and follow-up appointments. Our live donor financial coordinator will provide further information during the donor evaluation.

Time Commitment & Personal Risk

Donating a portion of your liver is an invasive surgery. It takes time and effort to recover. The pre-transplant evaluation is a necessary process that takes you away from other activities. Your hospital stay lasts from four to seven days, but you may not be able to return to work or school for six to 10 weeks after hospital discharge.

Pain

Pain is normal after surgery. You will feel discomfort while your incision heals despite your pain medications. You may have fatigue as you recover, but most patients report feeling completely normal after two to three months.

Lifestyle Changes

In preparation for liver donation, you may need to make some modifications to your lifestyle. These changes include avoiding recreational drugs, tobacco and alcohol. You cannot drink alcohol for a full year after surgery to allow your liver to recover. You will gradually be able to return to your normal activities as you recover. We recommend not participating in contact sports for at least 10 to 12 weeks after surgery.

Complications

Complications can range from mild to severe and are related to the amount of liver tissue removed from the donor.

There is a 10 to 35 percent risk of developing a mild complication, such as an infection following donation. Mild complications are easily treatable within our hospital, and our team closely monitors you to detect them early. Being under anesthesia has its own set of possible complications. Our team of anesthesiologists is present during and after surgery to monitor you.

There is a 5 percent risk of developing a serious complication that would require additional treatment or procedures. At Lahey, you are closely monitored for signs of complications and won’t be discharged until these risks have safely diminished. Serious complications include bleeding or injury to your remaining liver, bile leak or fluid in your abdomen, or a hernia at your incision site. There is a rare but real possibility that a liver donor could have a catastrophic complication resulting in the donor needing a liver transplant or death. This risk is estimated to be between one in 1,000 for left lobe donors and one in 200 for right lobe donors.

The specialists at Lahey Hospital & Medical Center can help you understand what to expect during live donor liver transplantation. It is important that you are prepared for this surgery.

We schedule liver donor surgery to take place in the morning. You and the liver recipient are admitted into the hospital’s pre-op area two hours before surgery. Your family may accompany you. You will get an IV, and your abdominal area may need to be shaved.

When you are taken into the operating room, your family waits in the surgical waiting area. The live donor coordinator meets with them there and discusses a plan to keep them updated on the progress of your surgery.

Our anesthesiologists administer sedation through the IV to put you to sleep. Once you are asleep, the team inserts a tube in your throat that connects to a machine (ventilator) that helps you breathe. They also insert a thin tube (Foley catheter) into your urethra and into your bladder to allow urine to drain during the surgery.

We perform our living donor liver surgery using laparoscopic assisted techniques, which reduce the extent of the incision. All your skin stitches are absorbable. You will also have a drain on the outside of your body to allow the escape of fluids that accumulate during recovery. This drain is usually removed prior to discharge.

Your hospital stay may last from four to seven days, depending on the speed of your recovery from surgery. You are discharged after your surgery when you are capable of urinating, walking and eating on your own. You won’t be allowed to drive yourself home, so we require that you arrange for a friend or family member to take you home when the time comes.

Keep in mind that you will need to visit the hospital about a week after your discharge and again about two to three weeks later. If you live far away, we can make arrangements to accommodate you at a nearby hotel.

Here is what you can generally expect during your recovery:

• In two to three weeks: Your liver function normalizes. You are allowed to drive again when you regain your physical strength and stop taking pain medications.
• In six to 12 weeks: Your activity level increases, and you may wish to return to work or school. Some people heal more quickly than others, so this time can vary from donor to donor.
• In two to three months: Your liver volume will have regenerated to at least 80% of its original size. Most patients report feeling “completely normal,” and nearly all donors are back to work or school.

If you are a woman who is planning to become pregnant, we recommend you wait six months before conceiving to allow your body to recover from the donation.