Living donor Liver transplant must be resorted to when the patient, given his/her seriously compromised health conditions, cannot comply with long waiting times. The mainstream choice is still cadaveric transplantation, but living donation can be a valid option when no other solutions are available.

Living donor transplantation has a number of advantages, namely the fact that the organ procured is healthy, and there has been no need to artificially balance its hemodynamic instability in the ICU, typical of brain-death donors. Also, the procured liver portion is preserved (cold ischemia) only for a few minutes before it is grafted, as compared to the several-hour long ischemia required with cadaveric donors (the surgery takes place simultaneously in two adjacent operating rooms, so transport and organ preservation play no role). As a consequence, an organ procured from a living donor can ensure a faster post-op functional recovery.

Living donor transplantation also allows performing an elective procedure, i.e. to carry out the surgery when the donor and recipient are in the best possible clinical conditions.

However, a number of risks do exist, since a living donor transplant means that a perfectly healthy person will undergo major surgery. It represents an extreme procedure that exposes the donor to all the surgical risks related to major liver resection and general anesthesia.

According to worldwide data, the mortality risk for the donor is 0.01%. To safeguard the health of the person donating a small portion of his/her liver and to minimize the risks, a strict criteria for selecting donors has been developed at ISMETT.

From a surgical point of view, in an adult living donor liver transplant the right side of the donor's liver is procured and implanted in the recipient, following the removal of the damaged organ. The liver can be split in two portions as each lobe has its own arterial and venous vascularization and drains the bile through two main ducts - right and left - which join up only in the last section, outside the liver. In addition, the liver can regenerate to its original pre-transplant size in just 3-4 weeks after the surgery (both in the donor and in the recipient).

Two teams simultaneously perform the operations, which last approximately 8 hours for the donor and 10 hours for the recipient. The donor's hospital stay after surgery is about 5-7 days, unless complications arise, which may develop in approximately 30% of cases. The donor spends the first night after surgery in the ICU and then, in the second post-op day, is transferred to the In-Patient unit, and immediately begins rehabilitation therapy. Normally, no blood transfusion is needed. The donor can resume an ordinary life after 4-6 weeks.