Liver Transplants: Extra Info

More About Live Liver Transplants from the Mayo Clinic

January 25, 2007

The following information about living liver donors comes from the Mayo Clinic.

The number of patients awaiting liver transplantation in the United States greatly exceeds the supply of cadaver donor organs.

More than 15,000 patients are currently registered on the liver transplant waiting list of the United Network for Organ Sharing, while only about 4,500 cadaver donor livers become available for transplantation each year.

Cadaver donor organ availability appears to have reached a plateau despite many initiatives intended to increase organ donation.

The waiting time for liver transplantation has increased steadily each year, rising from approximately one month in 1988 to more than a year in 1999. Currently, more than one-third of patients in the U.S. wait longer than two years for a liver transplant, and more patients die each year while waiting.

There is a critical shortage of donor organs, and this problem will continue to worsen in the foreseeable future.

Living Donor Liver Transplant Success Story

The results of adult-to-adult living donor liver transplants throughout the world are excellent. At least 275 of these operations had been performed in the U.S. by early 2000, and several hundred more in other parts of the world.

The living liver donors are hospitalized about a week after the operation and have only occasionally required blood transfusion. Nevertheless, the donor operative procedure is a major operation and not without risk.

The donor is also at risk for temporary problems related to the surgical incision and the possibility of blood clots. The great majority of donors, however, have enjoyed a complete recovery within a few months of their operations, and tremendous satisfaction from giving a loved one their "gift of life."

A split-liver procedure involves splitting a whole cadaver liver into two parts, allowing transplantation of two recipients. Use of the larger right liver for adult recipients is necessary to provide the patient with enough liver tissue.

With living donor transplantation, the healthy donor's liver regenerates to full size within a few weeks of operation, and there is no long-term impairment of liver function. The transplanted liver portion also regenerates, increasing in size to an appropriate match for the recipient.

Saving More Lives

There are many patients with specific diseases and special circumstances that make it important to proceed with liver transplantation sooner than is possible with a cadaver donor organ. These patients all greatly benefit from a timely operation that becomes possible with a living donor organ.

The shortage of cadaver donor livers has also made it increasingly difficult for foreign national patients to receive a liver transplant in the U.S. Since the early 1990s, UNOS has had limited cadaver organ allocation to foreign national patients. This limit became more restrictive in 1995. Living donor transplants will allow foreign patients new opportunities to undergo liver transplantation.

Living Donor Liver Transplant for Children

Living donor liver transplantation is a popular option for children. An adult-to-child operation, using the left lateral portion of the liver, is safe and effective. The procedure has helped reduce the number of children who die awaiting liver transplant. It also helps avoid family disruption caused by having a child and at least one parent away from home, staying near the transplant center while awaiting a chance for cadaver donor organ transplantation.

Pros and Cons

There are several advantages that a living donor transplant has over cadaver donor transplantation, including transplant opportunities in a more timely fashion, less possibility for complications and death while waiting for a cadaver donor organ, and better opportunity for patients from other countries and those with special circumstances to undergo transplantation.

The disadvantages of this approach include risks to the healthy donor and the period of discomfort and recovery.

Screening for Recipients and Donors

All liver transplant candidates undergo a similar evaluation, whether for cadaver donor or living donor liver transplantation. Patients likely to benefit from living donor procedures are encouraged to consider this option.

The patient and family then ask potential donors to contact the living donor nurse coordinator to begin the evaluation process. The coordinator provides the potential donor with specific information about living liver donation and conducts a preliminary survey to determine whether donation may be possible.

Throughout the evaluation, every possible effort is made to protect the confidentiality of all potential donors' medical and personal matters, including decisions about whether to proceed with donation.

Organ donation is an altruistic gift, and efforts are made to assure that donors who choose to proceed are free from coercion. The transplant team provides recipients, potential donors, and families with counseling and support through every phase of the process, from donor identification through recovery after operation.

Potential living donors undergo an extensive evaluation to assure that they are in optimal medical condition to proceed with organ donation.

The blood types of donor and recipient must be compatible, but not necessarily identical. The anatomy of the donor's liver must also be favorable for donation. Size requirements vary with individual recipients, whether child or adult. Some normal variations in the distribution of blood vessels or bile ducts may preclude or aid the donor operation. Above all, the donor must be in excellent health.

This article posted February 25, 2007.