Living Donor Liver Transplantation

Living donor liver transplantation was first carried out in Japan in 1989. It was initially used for adult to child donations but over recent years, has been successfully used for adult to adult transplantations also. This procedure is also sometimes known as Split-Liver Transplantation.

In this procedure, patients with liver failure receive a segment of liver from a spouse, blood relative or close friend. In some countries, even strangers may donate part of their liver, though the laws governing who can and who cannot donate vary in different countries. The living donor must be healthy and free from any diseases and infections before any consideration can be given to donate. As a result, the donor will go through a rigorous series of tests and evaluations including physical, psychological and psychiatric, well in advance of any surgery. At each stage, the process can only begin if the donor freely consents to the process. Naturally, the donor can withdraw his/her consent at any time, halting the process. The process can also be halted by any member of the transplant team, should they feel that there has been any undue coercion in obtaining the donor’s consent (this includes financial as payment for donations of organs is forbidden in most countries) or the donor has a medical problem which unacceptably increases their chances of a serious complication during or after surgery.

Nevertheless, donating any organ, especially a part of your own liver to help save a relative or friend is a major undertaking. Risks of such a complex operation should not be underestimated by the donor, his/her family or by the recipient. Further information regarding liver donation and other advice for potential donors can be found by reading the page entitled “Guidance for Liver Donors”.

The History Behind Living Donor Liver Transplantation

In the past, such living donations were always deemed too difficult medically as there was a fear of rejection of the transplanted organ from non-related individuals. It was also deemed to be unethical. However, over the past 10 or so years, this situation has changed considerably. In fact, there are now more living donations than cadaveric. The reasons for this are straightforward;

• there are just not enough organ donors to meet the ever increasing demand for organs, especially livers. Living donors can be used to offset this shortage to some degree.

• more effective anti-rejection drugs are now used to prevent the recipient’s immune system attacking the donated liver. Livers which are not matched genetically can therefore be transplanted.

• the whole attitude to what is possible in transplant surgery has now changed. These days, more patients are traveling abroad for all types of surgery compared to even 5 years ago. This includes transplant surgery as it may be too expensive where you live or may not be available at all.

The shortage of livers for transplants is however set to increase. One of the key reasons for this is the rise in prevalence of the Hepatitis C virus. In a minority of cases, this will lead to liver failure. But across the world, this minority still numbers many tens of thousands of patients. Once the liver fails, it becomes increasing difficult to support the sick patient. Unlike patients of severe kidney disease who can be maintained indefinitely by kidney dialysis machines, no such options exist for liver disease victims. As their condition deteriorates, other organs start to fail also, thereby compounding the problem. Unfortunately, many patients still die while on waiting lists around the world due to there being no suitable liver for them. If however a living donor can be found, who is willing to donate a portion of their liver and who can be matched to the patient, then the number of deaths of patients waiting on these lists can be decreased.

The Operation

The details of the operation, recovery and the risks of transplantation are discussed in more detail on the page entitled “Liver Transplantation”. However, a few specific details about the operation for living donor liver transplantation are discussed here.

In cadaveric transplantations, recipients have their own failing liver removed completely at the beginning of the operation. A whole liver from a deceased individual is removed and implanted into the recipient. It is then connected to the blood circulation and the biliary system in exactly the same way as their own failed liver had been previously.

But in living donor liver transplantations, the old liver is completely removed and replaced with a portion of healthy liver from the donor. Approximately half of the liver from the living donor (usually the right lobe which is the larger of the two lobes) is removed and re-connected into the recipient. Remarkably, in both the donor and recipient, their “half” of the liver is able to fully regenerate into a full liver within only a period of 8-12 weeks. If all goes well, both donor and recipient can then live full and normal lives’.

2 separate surgical teams operate in adjoining or nearby theatres, so that once the lobe of liver has been removed, it can be re-connected into the recipient quickly. Thereafter, the process of recovery is similar for both and is summarised on the page entitled “Liver Transplantation”.

Advantages of Living Donor Liver Transplantation

Living donor liver transplantation has clear advantages over cadaveric liver transplantation.

1. Elective surgery: the fact that the donor is alive and well means that the transplant team can carefully plan the timing and location of the surgery. It is therefore not an emergency operation. As a result, the complication rate is reduced for the recipient. If on the day of surgery, the recipient or donor is unwell in any way, surgery can be postponed to another day.

2. Liver transplantation can be considered for many more people since the number of available livers increases as more living donors come forward to be considered for donation.

3. Patients can access transplantation from anywhere in the world. If transplantation surgery is not available locally, they and their living donor can travel to any other country where such services do exist.

4. Preservation time (the time the liver is without blood and therefore oxygen): this time is minimal for living donations and may be only a few minutes. In cadaveric donations, this can be many hours.

5. Quality of the liver: as the donor is screened extensively over a period of several weeks, it is safe to assume that the donor is fit and healthy. It can therefore be assumed that their liver will be in good shape. This level of insight is generally not possible with cadaveric donations as few tests can be done in the limited time available before organs are harvested.

The key disadvantage of living donor liver transplantation is clearly the effect it has on the donor. The donor of course endures a major operation, faces the prospects of possible complications and must take time away from their family and work in order to have the pre-operative evaluations, surgery and then go through the recovery period. Further information about the donor can be obtained by reading the page entitled A Guide For Living Donors.

From Surgery abroad with Globe Health Tours.