What does it mean to be a liver donor for a living donor liver transplantation?
As a liver transplant and hepatobiliary surgeon, I can never become comfortable in subjecting a perfectly normal person ( you are not a patient, anyways) to major liver resection. But one must understand that you are in a situation to make this decision for a loved one because of limited options.
For the availability of deceased donor livers all over the world always runs short of the patients on the liver transplant waitlist. The reasons may be different in the east and western parts of the world. In the USA, where I trained, only one-third of the patients on the waitlist actually get a liver. In Asia, and in India, the shortage is mainly due to non-availability of the organ donors and many hindrances from the social issues and beliefs that are prevalent here. (I must say that Tamil Nadu is on the forefront of development in the past 8 years). So for the current time, Living donor liver transplantation continues to be a solution that we need to offer our patients with end-stage liver disease, when they reach a point that they need a new liver.
Liver surgery has grown mature that the complications are now minimal and can be easily managed. This combined with the fact that the liver is one of the few organs that regenerate, has led to the use of a part of the liver taken from a living person and transplant it to the patient who needs a new liver. Originally developed for children, it is now one of the standard methods for adult to adult transplantation. In all donors, the liver returns to its normal size within 90 days.
The liver has 2 parts, each with its separate blood supply and biliary drainage, even though from the outside it looks like a single organ. We are able to split the liver into two parts based on the blood supply and the bile duct drainage. The right part of the liver is approximately 60 % and the left part of the liver is about 40% ( We actually assess how much of liver mass is on both sides by preoperative imaging).
We assess our liver donors in a series of steps to ensure the safety of the donor and the appropriate time for the recipient. Our policy is never to hurry to do the evaluation and we take 2 weeks to complete unless it is life threatening for the recipient. Safety of the donor is extremely important for us. There are 3 critical steps for our donor evaluation followed by a multidisciplinary selection meeting.
The first step is meeting with the liver medical and surgical team followed by psychosocial evaluation. This will be done on the morning of the first day. Our key step is to ensure that the donor is not coerced into surgery and that there are no medical contraindications to donation. In the process, you will be evaluated for silent liver diseases, general health and also screened for coagulation ( blood clotting) disorders. The psychosocial meeting also ensures that you understand the whole process and is able to decide regarding your choices with a clear thinking. We take care that our donors are motivated and understand the whole process and make appropriate informed choices to donate a part of the liver.
You will undergo all the relevant blood tests that will look for hidden ailments and ensure that you are in good health. In the evening, if every investigation looks okay, you will undergo a triphasic CT scan and MRI of the abdomen with MRCP. This will allow us to evaluate the blood supply to the liver and the bile duct anatomy to assess the suitability of performing the liver resection.
The third step is the multidisciplinary meeting which meets every Saturday morning and will present the findings and allow all decisions to be made medically. There will be two non-transplant mentors who will approve every donor and living donor liver transplantation. There will also be a non-medical person (legal and political) who will look into the patient's details to look for any coercion.
Results of this meeting will be conveyed to the donor on Saturday evening by the transplant coordinator. The results usually will be one of the three: You are accepted as a liver donor, you are not suitable to donate the liver for the following reasons or it is still unclear whether you will be able to donate and further testing is needed to decide on donation. An appropriate date can be decided at that point of time.
You must be aware of the complications that occur in a liver donor. Obviously, the most serious complication that can occur is death in a living donor. Death rate in this procedure is < 0.5% and though we are striving to reduce this further, it will be a long time till it is made 0%. The second major complication is the need for liver transplantation in the living donor. If the remaining portion of the liver is unable to sustain the donor's life, they may need a transplant themselves. This is also a very rare event.
Approximately, 30% of the donor hepatectomies are associated with complications. Fortunately, 20% of the complications are minor, which are associated with any surgical procedure that ususally delays the discharge by a few days and some additional medications. the most common complication i have seen is constipation, which disturbs the donors so much. There are 2 major complications that require open surgical correction - bleeding and bile leak. Despite all the precautions we take, this complication may still occur, but are easily correctable by surgery.
Late complications like incisional hernia can occur in some donors but remain fortunately rare.
You will be discharged from the hospital by 1 week. You will be able to take care of yourself after 15 days and by two months you can return to simple work. There is no restriction on diet after 1 month and most patients are comfortable resuming sexual activity by the second month after donation.
On the positive note, a lot of the donors I have spoken to feel very elated and felt very positive about the whole process. Even being selected to be a donor means that you are one of the most healthy persons on the planet. And I would add, that you are also a person with a great heart.
For the availability of deceased donor livers all over the world always runs short of the patients on the liver transplant waitlist. The reasons may be different in the east and western parts of the world. In the USA, where I trained, only one-third of the patients on the waitlist actually get a liver. In Asia, and in India, the shortage is mainly due to non-availability of the organ donors and many hindrances from the social issues and beliefs that are prevalent here. (I must say that Tamil Nadu is on the forefront of development in the past 8 years). So for the current time, Living donor liver transplantation continues to be a solution that we need to offer our patients with end-stage liver disease, when they reach a point that they need a new liver.
Liver surgery has grown mature that the complications are now minimal and can be easily managed. This combined with the fact that the liver is one of the few organs that regenerate, has led to the use of a part of the liver taken from a living person and transplant it to the patient who needs a new liver. Originally developed for children, it is now one of the standard methods for adult to adult transplantation. In all donors, the liver returns to its normal size within 90 days.
The liver has 2 parts, each with its separate blood supply and biliary drainage, even though from the outside it looks like a single organ. We are able to split the liver into two parts based on the blood supply and the bile duct drainage. The right part of the liver is approximately 60 % and the left part of the liver is about 40% ( We actually assess how much of liver mass is on both sides by preoperative imaging).
We assess our liver donors in a series of steps to ensure the safety of the donor and the appropriate time for the recipient. Our policy is never to hurry to do the evaluation and we take 2 weeks to complete unless it is life threatening for the recipient. Safety of the donor is extremely important for us. There are 3 critical steps for our donor evaluation followed by a multidisciplinary selection meeting.
The first step is meeting with the liver medical and surgical team followed by psychosocial evaluation. This will be done on the morning of the first day. Our key step is to ensure that the donor is not coerced into surgery and that there are no medical contraindications to donation. In the process, you will be evaluated for silent liver diseases, general health and also screened for coagulation ( blood clotting) disorders. The psychosocial meeting also ensures that you understand the whole process and is able to decide regarding your choices with a clear thinking. We take care that our donors are motivated and understand the whole process and make appropriate informed choices to donate a part of the liver.
You will undergo all the relevant blood tests that will look for hidden ailments and ensure that you are in good health. In the evening, if every investigation looks okay, you will undergo a triphasic CT scan and MRI of the abdomen with MRCP. This will allow us to evaluate the blood supply to the liver and the bile duct anatomy to assess the suitability of performing the liver resection.
The third step is the multidisciplinary meeting which meets every Saturday morning and will present the findings and allow all decisions to be made medically. There will be two non-transplant mentors who will approve every donor and living donor liver transplantation. There will also be a non-medical person (legal and political) who will look into the patient's details to look for any coercion.
Results of this meeting will be conveyed to the donor on Saturday evening by the transplant coordinator. The results usually will be one of the three: You are accepted as a liver donor, you are not suitable to donate the liver for the following reasons or it is still unclear whether you will be able to donate and further testing is needed to decide on donation. An appropriate date can be decided at that point of time.
You must be aware of the complications that occur in a liver donor. Obviously, the most serious complication that can occur is death in a living donor. Death rate in this procedure is < 0.5% and though we are striving to reduce this further, it will be a long time till it is made 0%. The second major complication is the need for liver transplantation in the living donor. If the remaining portion of the liver is unable to sustain the donor's life, they may need a transplant themselves. This is also a very rare event.
Approximately, 30% of the donor hepatectomies are associated with complications. Fortunately, 20% of the complications are minor, which are associated with any surgical procedure that ususally delays the discharge by a few days and some additional medications. the most common complication i have seen is constipation, which disturbs the donors so much. There are 2 major complications that require open surgical correction - bleeding and bile leak. Despite all the precautions we take, this complication may still occur, but are easily correctable by surgery.
Late complications like incisional hernia can occur in some donors but remain fortunately rare.
You will be discharged from the hospital by 1 week. You will be able to take care of yourself after 15 days and by two months you can return to simple work. There is no restriction on diet after 1 month and most patients are comfortable resuming sexual activity by the second month after donation.
On the positive note, a lot of the donors I have spoken to feel very elated and felt very positive about the whole process. Even being selected to be a donor means that you are one of the most healthy persons on the planet. And I would add, that you are also a person with a great heart.
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