January 14, 2011
Dear Mayo Clinic:
My brother, who is 40 years old, is on a waiting list for a liver transplant. The list is long, and our family is worried that he won't get an organ in time. I've heard living-donor liver transplants are possible. What's involved? What are the risks?
Although most adult liver transplants use livers from deceased donors, living-donor transplants are an option. Because the number of people waiting for new livers is much larger than the number of deceased-donor livers available, adult living-donor transplants are becoming more common. Outcomes for the organ recipient are similar for both deceased-donor and living-donor liver transplants, but there are risks involved for a living donor that need to be carefully considered.
The liver is the body's largest internal organ. About the size of a football, it's located in the right upper abdomen. The liver carries out several essential functions, including detoxifying harmful substances in the body, purifying blood and manufacturing vital nutrients.
A liver transplant may be an option for people who have end-stage liver failure that can't be controlled using other treatments. Liver failure can be caused by a variety of medical conditions, such as hepatitis C, hepatitis B, alcoholic cirrhosis, cystic fibrosis, hemochromatosis and nonalcoholic fatty liver disease. Liver cancer is another condition where liver transplant may be a treatment option for some people.
During a deceased-donor liver transplant, a surgeon disconnects the liver's blood supply and bile ducts, and then removes the recipient's diseased liver. The donor liver is then placed in the recipient's body and blood vessels and bile ducts are reattached. For a living-donor transplant, the entire liver cannot, of course, be transplanted. Surgeons first operate on the donor, removing a portion of the liver for transplant. Then surgeons remove the diseased liver from the recipient, replace it with the donated liver portion, and connect the blood vessels and bile ducts to the new liver.
What allows living-donor liver transplantation to work well is the liver's unique ability to rapidly regenerate itself in both the donor and the recipient. Within several months, most recipients' and donors' livers grow back to normal size.
Living-donor liver transplant has a number of benefits. First, receiving a living-donor transplant often means the recipient spends less time waiting for an organ. So liver failure may not be as advanced as it might be if the recipient had to wait for a deceased donor. Second, livers transplanted from living donors are usually high quality because donors are typically young and healthy.
In many cases, living-donor liver transplants can be successfully completed without major complications. But there are significant risks you should discuss with your doctor if you are considering liver donation. First, be aware that, for an adult transplant, the portion of the liver that's taken is not small. In most cases, the right lobe — the larger of the two lobes of the liver — is removed for transplantation. Risks of the surgery include bleeding, blood clots, infection, damage to the remaining part of your liver, bile leaks and damage to your liver's system of bile ducts, which drain bile (a fluid essential for the proper digestion of fats) from the liver.
Because becoming a liver donor involves major surgery, it's important that you talk through all the risks and benefits with your doctor before you make a decision. Also, a thorough medical evaluation is required for all potential liver donors to determine if they are healthy enough to donate.
If you or one of your family members becomes a living liver donor for your brother, it is an incredible gift. Organ donors can make a life-changing difference and have a wonderfully positive impact on organ recipients and their loved ones.
— Darrin Willingham, M.D., Transplant Surgery, Mayo Clinic, Jacksonville, Fla.