Liver Transplant

Living Donor Liver Transplant

Each year, people with liver diseases die waiting for a transplant, and the wait time for a deceased donor liver has increased each year. Living donor liver transplant offers an alternative to waiting for a deceased donor liver. Its main benefit is timeliness because it decreases the risk of complications and death while waiting for a match.

Mayo Clinic in Minnesota and Arizona offer living donor liver transplant, and both have high rates of success for living donor liver transplant. For both patient survival and liver function, Mayo Clinic scores above the national average at one year post-transplant.

Screening recipients

All liver transplant candidates undergo a similar evaluation whether they are considered for deceased donor liver or living donor liver transplantation. People who have progressive diseases and disorders can benefit from the timeliness of a living donor liver transplant, including those with:

• Liver tumors
• Bile duct tumors
• Cholestatic liver disease
• Highly symptomatic patients with low priority for transplantation

In addition, it has become increasingly difficult for a foreign national patient to receive a liver transplant in the United States, due to limited deceased donor liver availability and difficulty relocating away from home for a prolonged period. Living donor liver transplantation allows foreign patients a more timely opportunity for transplant.

Screening donors

If your physician determines that you'd benefit from living donor transplant, then potential donors can start their evaluation process with a living donor nurse coordinator at Mayo Clinic.

The coordinator provides information on the procedure and conducts a preliminary telephone survey to determine whether donation may be possible. Blood type and laboratory test results are obtained and, if suitable, a potential donor is invited to come to Mayo Clinic for an evaluation. The evaluation is very thorough and includes:

• Health evaluation. Above all, living donors must be in excellent health and in optimal medical condition for surgery.
• Social and psychological screening. Liver donor surgery involves a major operation and requires time away from work and other responsibilities. Potential donors visit with a social worker and psychiatrist to discuss the potential impact this may have.
• Anatomical assessment. The donor's liver size and unique anatomy, including placement of blood vessels and bile ducts, must be favorable for donation.

Throughout the evaluation process, all potential donors' medical and personal information is protected by confidentiality laws, including decisions about whether to proceed with donation. Organ donation is an altruistic gift, and each living donor candidate is evaluated by an independent living donor advocate to ensure donor safety, informed consent, and lack of coercion. The transplant team counsels and supports recipients, potential donors and families through every phase of the process.

The procedure

During living donor liver transplant surgery, the donor begins surgery first. Using the split-liver technique, the surgeon removes a portion of the donor's liver and prepares it for transplant. Then, another surgical team removes your diseased liver, replacing it with the portion of liver from the living donor.

The living donor's liver regenerates to full size within a few weeks of the surgery, and there is no long-term impairment of liver function. The transplanted liver portion also regenerates, increasing until it's the appropriate size for your body.

The donor spends about a week in the hospital recovering, and should plan for two to three months off work. For the recipient, post-transplant care and follow-up is the same as for deceased donor liver transplant.

Living donor liver transplant for children

Adult-to-child living donor liver transplantation uses the left lateral portion of the adult donor's liver. The procedure has been proven safe and effective, and has helped reduce the number of children who die awaiting liver transplant.

The risks

Although living donor liver transplant has been proven safe and effective for both donor and recipient, it is a major operation and not without risk. Mayo Clinic's transplant team estimates a risk to the living donor's life at 0.3 to 0.5 percent.

The donor is also at risk for temporary problems related to the surgical incision and the possibility of blood clots following the operation. However, the great majority of donors have recovered completely within a few months of their operations.