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Living Donor Liver Transplant
Traditionally, "deceased" organ donors (i.e., a healthy person who died suddenly after an accident or illness) were exclusively utilized for liver transplants. This is still the case for most liver transplants performed today.
Due to a shortage of deceased donor organs, the number of patients waiting for a liver transplant in the United States has grown dramatically, nearly doubling in the last three years. Transplant candidates are forced to endure longer waiting times and may, therefore, become quite ill before they receive an organ - and in some instances, too ill to withstand transplant surgery.
- What is a living donor liver transplant?
- Who can receive a living donor transplant?
- Who can be a donor?
- How much of the liver is removed from the donor?
- What tests are required for a donor?
- What are the risks to the donor?
- What about insurance coverage?
- What do I do first?
What is a living donor liver transplant?
While living kidney donation has been practiced for many years, the living donor concept has only recently been used in liver transplantation. Now, in certain circumstances, living donor liver transplantation is an option.
In a "living donor liver transplant" a healthy segment of the donor's liver is removed for transplantation into the recipient's body. With a living donor organ, the need to wait for a deceased donor organ is eliminated. This technique has been performed for many years by liver transplant surgeons, whereby a portion of an adult liver is used for transplantation into a child. While the surgical techniques utilized are not new, the application of these techniques for adult-to-adult liver transplants is a recent development.
Who can receive a living donor transplant?
The decision as to whether a patient is a candidate for living donor transplantation is made jointly by the patient and the multidisciplinary transplant team. Factors that will influence the decision are the medical and psychosocial condition of the patient, as well as the availability of a deceased donor organ.
Who can be a donor?
The first requirement is that the donor be an adult, in good health, with a blood type that is compatible with that of the recipient. In addition, the size of the donor's liver must match the size requirement of the recipient. To be a donor, one must donate of their own free will, with full knowledge of the risk and potential complications of the surgical procedure and with only a desire to aid the recipient.
How much of the liver is removed from the donor?
The right half of the liver is removed for transplant, including the gallbladder. The liver will regenerate and in patients who have donated, X-rays taken several months after the donation, show that the liver has regained most of its pre-surgery size. Similarly, the portion of the liver transplanted will "adjust" to the appropriate size required by the body of the recipient.
What tests are required for a donor?
A number of tests, including blood and urine, will be required to verify that a potential donor is entirely healthy and does not show evidence of liver disease or other conditions that may prevent such a donation. A liver specialist, not involved in the care of the patient, is consulted to assess the health and suitability of the potential donor. As with patients undergoing evaluation for a liver transplant, potential donors will be interviewed by a social worker and a psychiatrist. Any medical, social or psychological issues identified may preclude an individual from donating.
If the potential donor successfully passes the initial screening, then he or she will undergo more extensive testing before the transplant surgery is scheduled. A special MRI of the abdomen will be obtained to accurately assess the size of the liver, as well as other aspects of the patient's anatomy. An angiogram (a picture of the blood vessels leading to the liver), and other pre-surgery tests, such as an EKG and chest X-ray, will also be performed.
A very frank discussion of the potential risks and complications of such a donation will occur early in this process and will include further explanation of tests required. If at any time a donor wishes to reconsider donation for any reason, his or her decision will be honored and respected.
What are the risks to the donor?
As with any surgery, there are potential risks and complications. If a blood transfusion is necessary, the donor will be encouraged to donate his or her own blood in the event that they require a transfusion. Infection, a possibility after any operation, is uncommon. The medical team provides a constant surveillance to detect and treat any infection that might occur after the surgery. A complete discussion designed to address all questions and concerns that the potential donor might have will occur before the patient donor makes a final decision.
What about insurance coverage?
Our financial specialist will review each candidate's insurance policy for organ donation benefits. There is a long history of living donor kidney transplantation in the United States and therefore, most insurance carriers are quite familiar with the concept. In addition, many insurance companies have already acknowledged the benefits of living donor liver transplantation and are willing to provide coverage.
What do I do first? Recipient: "Dos & Don'ts"
Do let people know that you are in need of a liver transplant, and that a living donor transplant may be an option for you.
Don't call on behalf of a potential donor. We need to feel confident that the potential donor is under no pressure from you to donate! All communication with potential donors must be directly with the program. All initial contacts should be through our dedicated email address: firstname.lastname@example.org
Don't call to inquire regarding the status of a potential donor. If a donor wants you to know the progress of their evaluation, they can discuss this with you. We must respect patient confidentiality and we cannot discuss such details with you!
Guidelines for Good Potential Donors:
- Family members
- Long-standing close friends
- Over 21 years of age
- Health insurance of their own (even though recipient insurance will likely cover the surgery)
- United States citizen (with case-by-case exceptions)
- Not over the age of 60 (with exceptions)
Individuals interested in becoming a living liver donor can begin the process or obtain additional information by calling the Center for Liver Disease and Transplantation at Cedars-Sinai Medical Center.
If you or someone you know may be interested in living donation, feel free to contact us. For initial contact we strongly prefer our special email address: email@example.com - using this will ensure prompt receipt by the proper liver team member and a quick response for you. Please refrain from calling as this can delay your response. Thank you for your cooperation.