Director: Salvatore Gruttadauria
Living-related liver transplantation is a surgical procedure in which a healthy individual, usually a family member, donates part of the liver to a loved one with a chronic liver disease.
1) Reasons for proposing this option
Unfortunately, there are not enough organs for all the patients needing a transplant. This translates into many patients not receiving a life-saving transplant when they need it. To overcome this problem, living donor liver transplantation allows surgeons to use a portion of the liver of a healthy donor and transplant it in a patient. This is possible thanks to the ability of the liver to regenerate after a portion is removed, and to grow back to normal size after it is transplanted.
This type of transplant allows transplantation in a patient when a new organ is needed, without having to wait on the waiting list, and without the risk of deterioration and a higher chance of developing risks and complications. Furthermore, since the two operations happen simultaneously, the organ ischemic times are minimized, as opposed to what happens with an organ from a deceased donor.
From a surgical perspective, the living donor liver transplant between adults consists in procuring the right portion of the donor’s liver (approximately 60%) and transplanting it in the recipient. If the recipient is a child, the left part of the liver, which is smaller, is donated. This is possible because each lobe has its own arterial and venous vascularization, draining bile through two main ducts, right and left, which join proximally outside the liver.
Furthermore, the liver is able to regenerate, and after 3-4 weeks it grows back to its original size both in the donor and in the recipient. Two teams perform the surgeries at the same time, the duration is 8 hours for the donor, and 10 hours for the recipient. The donor is usually hospitalized for 5-7 days, unless complications develop, which occur in approximately 30% of cases. The donor spends the first night after surgery in the Intensive Care Unit, and then is transferred to the regular Floor Unit where rehabilitation starts. Usually, the operation does not require a blood transfusion. The donor can return to a normal life after 4-6 weeks. According to statistics worldwide, the risk of mortality for the donor is between 0.5 and 1 %.
3) The donor assessment process
To safeguard the health of the donor, ISMETT has strict donor selection criteria. It should be remembered that the donor undergoes major surgery as an act of generosity, therefore the utmost attention must be paid.
The donor assessment includes specific instrumental and blood tests to rule out any contraindications to the procedure (liver anatomical abnormalities, liver function alterations, other diseases), psychological assessment, and multidisciplinary assessment. An independent committee is established, with a physician defending the interests of the donor, to examine the entire clinical documentation. The process ends with the authorization granted by a Court.
4) Surgery on the donor
The donor undergoes a right hepatectomy. The surgeons make an incision (see picture) to allow the localization and safe resection of a portion of the liver, amounting to 65% of the whole organ. During the operation, specific compression systems are used to maintain the blood flow in the legs and prevent the formation of clots. In the operating room, drainages are inserted to drain fluids and allow for a fast recovery. The total duration of the operation ranges from 6 to 12 hours.
5) The risks of donation
Any surgical operation implies risks, in particular when general anesthesia is used. For this kind of donation, the risk of complications is approximately 30%. Most complications are mild and resolve independently. Rarely, complications are severe and require further surgery or medical intervention. The risk of death associated with donation is 1 in every 200 patients.
After the operation, the donor will be admitted to the Intensive Care Unit for close monitoring. The stay in the hospital will depend on the ability of the donor to recuperate, and usually requires 7-8 days. The recovery process will continue after discharge, and the donor can resume normal activities, including driving, after 4-6 weeks. In case of post-operative complications, a longer hospital stay may be required. During recovery, a team of physicians will constantly monitor the donor’s clinical conditions with specific tests to also monitor the liver conditions.