Living Donor Liver Transplant Program

A living donor liver transplant is a surgical procedure in which a healthy individual, usually a biologically-related or unrelated family member, donates part of his or her liver to a loved one who is suffering a chronic liver disease.

Unfortunately, the number of available organs is far from sufficient to transplant all patients who need one. As a result, many patients may not receive a transplant in time.
Living donor liver transplantation was developed to address this problem. The procedure involves removing part of the liver from a healthy donor and transplanting it into the patient who needs it. This is possible because the liver regenerates after a portion has been removed in the donor and grows to a normal size in the recipient after the transplant.
Living donor liver transplantation allows patients to not remain on the waiting list and risk a deterioration in their condition that could make transplantation more hazardous and increase the likelihood of complications.
Also, because the donor and recipient procedures are performed at the same time, organ ischemia time is kept to a minimum, unlike transplants performed with organs from deceased donors.

From a surgical perspective, living donor liver transplantation between adults involves removing the right side of the donor’s liver, approximately 60% of the entire organ, and transplanting it into the recipient after the sick liver has been removed. When the recipient is a child, the smaller left portion of the liver is donated. The liver can be divided in two because each lobe has its own arterial and venous blood supply and drains bile through two main ducts, the right and left hepatic ducts, which join only in their final segment outside the liver.

The liver has the ability to regenerate: within 3 to 4 weeks after surgery, it returns to its original pre-transplant size in both the donor and the recipient. Two surgical teams perform the procedures simultaneously. Surgery lasts approximately 8 hours for the donor and 10 hours for the recipient. The donor’s postoperative hospital stay is generally 5 to 7 days, unless complications occur, which may happen in approximately 30% of cases. The donor spends the first night after surgery in the ICU and is transferred to an inpatient unit on the second postoperative day, where rehabilitation begins immediately. The procedure does not usually require a blood transfusion.
The donor can generally return to a normal lifestyle after 4 to 6 weeks. According to worldwide statistics, the donor mortality risk is estimated at between 0.5% and 1%.

To protect the health and wellbeing of donors ISMETT has developed strict selection criteria. It is important to remember donors undergo major surgery entirely for altruistic reasons so every possible precaution must be taken. To safeguard the health of those donating a portion of their liver and minimize all potential risks, ISMETT has established rigorous donor selection criteria.

The assessment includes: blood tests, diagnostic procedures, and consults to rule out any contraindication donation, such as anatomical abnormalities of the liver, impaired liver function, or other medical conditions, a psychological assessment consisting of several sessions and interviews, and the assessment by a multidisciplinary team. The evaluation process ends with the meeting of a committee that includes a physician responsible for protecting the donor’s interests, a review of all documentation by a medical committee independent of the specialists involved in the recipient’s care, and the granting of specific authorization by the court.

The procedure performed on the donor is known as “right hepatectomy”. Surgeons make an abdominal incision (see image) large enough to safely identify and remove a portion of the liver (65% of the entire organ).
During surgery, special compression devices are used to maintain blood flow in the legs and prevent blood clots from forming. Drains are also placed in the OR to remove fluids and promote rapid healing. The total duration of the procedure ranges from 6 to 12 hours.

All surgical procedures involve risks, particularly when performed under general anesthesia. For this type of donation, the overall risk of minor and major complications is approximately 30%. Most complications are mild and resolve without treatment. In rare cases, complications may be serious enough to require an additional surgical procedure or medical intervention. The risk of death associated with liver donation is approximately 1 in 200 donors.

After surgery, the donor is transferred to the ICU where he or she is closely monitored. The length of the hospital stay depends on the donor’s recovery and when the physicians consider his or her discharge appropriate. Discharge generally takes place 7 or 8 days after surgery. The healing process continues after discharge. Donors can usually resume their daily activities, including driving, after approximately 4 to 6 weeks. If postoperative complications occur, a longer recovery period may be necessary. During recovery, a medical team continuously assesses the donor’s health. The donor undergoes follow-up visits, lab tests, and imaging to monitor the liver’s condition.

Scientific and Educational Video on Living Donor Liver Transplantation