Why Living Donor Liver Transplantation?
By knowing the facts about liver transplants, you can make an informed decision about being a donor. Approximately 20,000 patents need liver transplants in India every year, yet only about 1500 patients actually receive a transplant. Several adult patients cannot survive the wait times for a deceased or dead donor liver. Because there is a long waiting list for those needing transplants, almost 50% of patients who need a new liver will die before one becomes available. While considering the facts about liver transplants, it should be remembered that liver is one of the few organs in the body that can grow back if a part of it is removed.
What are the benefits of live organ donation?
- Living donor liver transplantation is now an accepted method, used more commonly because of the severe shortage of deceased organ donors.
- A living donor transplant means a patient can have a transplant before their liver failure gets worse and the patient gets too sick. It means that at the time of transplant the patient is less sick and therefore the outcomes may be better.
- The living donor transplant procedure allows transplantation for patients, in some cases, where deceased donors cannot be allocated due to legal regulations, most importantly in the case of foreign nationals.
- Because the surgery can be planned in advance, the chance for a successful transplant is better.
- The quality of the liver is good, because living donors are usually young, healthy adults who have gone through a complete medical evaluation.
Who can donate?
- The donor can be a family member like sister, brother, parent or adult child. The donor can also be a spouse (husband or wife).
- It is illegal in India for people to donate their organs in return for money.
In general, a living donor must:
- Be at least 18 years old
- Be in good health, with no major physical or mental illness
- Be a non-smoker for at least 4 to 6 weeks before surgery
- Be able to understand and follow instructions before and after surgery
- Have a compatible blood type
- Have an emotional bond with the patient
- Not have a selfish motive for donating
- Have a similar body size
- Be able to go through medical investigations like blood tests, CT scan, liver biopsy
- Not be under pressure from anyone to donate part of his or her liver
What are the tests needed for evaluation of a living donor?
People who want to donate their liver undergo a complete medical examination to make sure their liver is healthy and that it is safe for them to donate. Safety is important for both the donor and the recipient. Medical evaluation is done to make sure that
- The donor does not have any health problems, like diabetes or heart conditions, that could increase the risks of problems during and after the surgery.
- The donated portion of the liver is the right size for the recipient.
The general tests performed as part of the evaluation include:
- Physical examination. A complete physical examination is performed as part of the evaluation.
- Blood tests
– Donor’s blood type (should match the recipient’s blood type)
– Liver and kidney function tests
– Complete blood counts
– Thyroid test
– Tests for diabetes and cholesterol
- Ultrasound/MRI/CT scan. These investigative tests are performed to obtain images of the liver to ensure the donor’s arteries, veins, and bile ducts are the right fit for the intended recipient. These tests also measure the volume of the liver that will go to the recipient and make sure that it is adequate.
- Chest X-ray, Cardiac stress test and EKG. These are standard tests done before any major operation to check for heart and lung problems.
- Every donor will meet with a medical physician for a complete assessment. A donor will also have a complete psychosocial assessment to discuss about his/her reasons for donating the liver and to ensure that he/she is in a stable mental condition for the surgery.
What happens during the operation?
An upper abdominal incision, either in the midline or in the shape of an inverted ‘L’ is made to expose the liver. The anatomy of the liver is re-checked, and an X-Ray of the bile ducts is taken (cholangiogram) to confirm patient safety. The donor’s liver is split into two parts. One part is removed for the transplant and then the wound is closed with staples or suture. Donors stay in the hospital for 7-10 days after surgery.
The first night after surgery is usually spent in the intensive care unit (ICU). The next day, the patient may be moved to a private room. The donor starts eating and moving around from the first day onwards. At discharge, the donor is quite normal with no pain, able to eat normally and do routine day-to-day activities.
What are the potential complications of surgery?
As with any major surgery, there are risks. There is a 10% chance that a donor could have mild complications after the surgery. There is a 2-3% risk of a serious complication. Surgical problems include bleeding, infection, or bile leaks. Medical problems include chest infection, deep vein thrombosis and pulmonary embolism. Some rare heart and lung complications may be related to anesthesia. Proper assessment and selection of donors are the best way to avoid complications.
The risk of death in live liver donation is 1 in 500. Once donors recover and are discharged from hospital, complications usually do not happen. In the long term, the liver remnant grows back to its normal size and a donor is not at risk of developing any liver-related problem in the future. Rarely, donors can develop a hernia at the site of the surgery a few months or years later. This can be repaired surgically.
How long does recovery take?
The donor is generally in hospital for 7-10 days. Rest and light work are advised for 4 weeks. Heavy work is restricted for 3 months. Most donors recover fully after the operation and can do normal activities within 2-3 months after the surgery. liver transplant surgeons will inform you when it will be safe to return to normal life.
Liver donors do not require any medications in the long term. Regular blood tests and ultrasound scans are advisable once every 3 months for the first year and thereafter, once every 6 months for the next 2 years.