Q: What types of patients are eligible to receive a living donor liver transplant?
Typically we ask all patients that we’re seeing in clinic if they have any potential living donors. We like to consider living liver donation for all patients. However, the patients most likely to benefit from a living donor liver transplant are those who are sicker and having symptoms of liver failure but whose MELD scores don’t favor them to receive a transplant in a timely manner.
Recipient MELD scores must be greater than 12 but less than 25 to receive a living donor liver transplant. In competitive regions like the one UMMC is in (UNOS Region 2), patients with lower MELD scores are patients that are going to be on the wait list for a long time before they have the potential to be transplanted.
While we consider living liver donation for all patients, ultimately the safety of the recipient and donor will determine who is a candidate and who’s not. Donors and recipients can call us and ask all the questions they want. Our Liver Transplant team can be reached at 410-328-3444.
Q: Who can be considered to be a living liver donor?
First and foremost, the living donor should be someone who has an important relationship with that recipient and is coming forward to donate at his or her own free will.
They should be between the ages of 18-55, be of a compatible blood type with the recipient and be in otherwise excellent health. We have posted more details about the donor evaluation process.
I encourage those who are interested in learning more about being evaluated as a living liver donor to contact our Liver Transplant team at 410-328-3444. More living donor criteria is available here.
Q: Many people don’t understand how being a living liver donor is different from being a living kidney donor. What’s different about the selection process and surgery for living liver donation?
Living kidney donation and living liver donation are similar in that both include a selfless act of loving devotion from one human being to another.
But the recovery time and degree of surgery is quite different. Surgeons remove part of the donor’s liver through a sizable incision underneath the rib cage, not laparoscopically, like with kidney donation.
Living liver donation comes with an increased morbidity for recipients – one in 300 living donors around the world has died, and 30% have had complications.
Q: Performing living donor liver transplants requires additional training since the surgery is so complex. How did you and the team train to do living donor liver transplants?
Our two living donor liver surgeons have each spent time working in hospitals in Turkey and Korea, which perform the highest volumes of living donor liver transplants in the world. Our team felt that there was no large volume living donor liver center in the U.S. at which to train, so we sought opportunities in other countries to get the high volume experience we needed.
In addition to our two living donor liver transplant surgeons, we have two other talented liver transplant surgeons, and we only perform living donor liver transplants when we have those four specially-trained liver transplant surgeons available.
We get together as a team the afternoon before a scheduled living donor liver transplant and devise a final surgical plan to follow for the next day’s operation.
Q: What are the benefits to the recipient of having a living liver donor versus a cadaver donor?
There are several advantages of living donor transplants. First, the survival of the graft is greater with a living donor.
Second, the rejection rates of the graft are better or equivalent by every outcome measurement.
Third, recipients have the advantage of spending less time on waiting list.
Q: What are the risks to the donor from the surgery?
The surgical team discusses risks to the donor during the very first meetings. All surgeries have risks. The donor does not need this surgery, but they are willing to step forward and will gain the internal satisfaction of helping a loved one.
Living donors are subject to all the typical risks of surgery, such as wound infections, bleeding, and the need for blood transfusions in the operating room.
We know that donors have lots of questions, so they are assigned a donor advocate from social work to help them privately navigate their best interests outside of conversations with the surgical team. We want them to feel comfortable asking questions during every step of the process.
Q: Explain the donation surgery. What happens in the donor operating room?
Donors are brought to the operating room after undergoing final reviews in the Same Day Surgery unit. Once in the OR, donors are gently put to sleep, and a breathing tube is inserted and monitoring lines are placed.
Surgeons then make an incision under the rib cage and carefully assess the size of the liver with our own eyes after having seen it with a CT scan. Next, we remove the gallbladder and inject dye into the biliary tree to make sure it is safe for division. Then we dissect the portal vein and artery where it divides the different sides of the liver. We isolate the vein that drains that part of liver and then divide the liver in half very carefully with attention to tying all the blood vessels and bile ducts in that plane. And then we close it up.
Q: What is the recovery process like for the donor?
The donor is recovering from a major abdominal surgery. The first few days will require pain meds. The donor will be given as much pain medication as they need to make them feel comfortable.
Our goal is to get them up and out of bed the night of surgery and then walking the hallway the morning after. They can walk down the hallway and see their recipient.
Donors are extubated in the operating room. They typically receive no blood products and go home about five to six days after surgery.