Transplant Surgery – Living Liver Transplantation
Liver transplantation, or liver transplant surgery, is a highly specialized and effective treatment for end-stage liver disease. The number of liver donors is much less than the number of patients waiting for a liver transplant. Currently in the United States, there are more than 14,000 patients waiting for a liver transplant. Because of the lack of donor organs, there are only approximately 7,500 liver transplants performed each year. In fact, nearly 2,500 people die each year waiting for a liver transplant.
Living donor liver transplantation (LDLT) is one way to address the shortage of donor organs. LDLT allows your health care team to schedule an elective liver transplant operation at a mutually agreed upon time - enabling the donor, the recipient, and their immediate circle of family to plan ahead for absences from work, childcare, and other concerns.
Frequently asked questions
What is a living donor liver transplant?
In a living donor liver transplant (LDLT), a donor provides a portion of his or her liver so that someone—usually a family member or close friend—can receive a needed liver transplant.
Who can receive a portion of a liver from a living donor?
Anyone on the liver transplant waiting list who has a potential donor can be considered. We’ll review the potential recipient’s medical records to ensure he or she is a candidate for living donor transplant.
Who can be a living liver donor?
Living donors must:
- Have a close relationship with the person who will receive the transplant, such as a spouse, family member or close friend
- Be between the ages of 18 and 55
- Have a blood type that is compatible with the blood type of potential recipient (not necessarily the same blood type)
- Be physically healthy:
- No more than one abdominal surgery
- No heart disease
- Body mass index (BMI) less than 30
- Be mentally healthy
What is involved in the donor and transplant operations?
On the day of surgery, the donor is usually taken to the operating room first. While the donor is under general anesthesia, the surgeon makes an incision in the upper abdomen. The surgeon removes the gall bladder, and dye is injected into the liver to show the liver’s anatomy in detail. This is called a cholangiogram.
Sometimes, the cholangiogram reveals a problem with the liver that was not found during previous testing. On rare occasions, the transplant will need to be cancelled, and the donor’s incision will be closed.
If the operation proceeds, one of the lobes of the liver will be removed. The donor’s remaining liver will still be able to do its job. The surgery usually lasts between four and six hours.
After the donor’s cholangiogram confirms the transplant can proceed, the recipient is brought to a nearby operating room and prepared for the transplant. The operation for the liver recipient can last between eight and 12 hours.
Over the next two months, the part of the liver that was transplanted and the part of the liver that remains in the donor will grow to a normal size. Both livers should be capable of functioning normally.
What are the benefits of living donor transplantation?
- A liver transplant is the ONLY CURE and life-saving measure for a patient with end stage liver disease (cirrhosis).
- In our area of the country, 20 to 25 percent of patients will die while waiting for a liver transplant.
- A live donor transplant will allow for the operation to be scheduled prior to the development of more significant liver related issues. It is a planned operation, which can decrease the stress of the patient waiting for a transplant.
For liver transplant recipients
Who can I talk to if I’m not sure a transplant is right for me?
Talk with your hepatologist about the transplantation process. Then call the transplant team at Penn State Health Milton S. Hershey Medical Center (800-525-5395 or 717-531-6092) to set up an appointment. Appointment times are available Mondays from 8 a.m. to 4 p.m. We’ll work with you to schedule further testing.
After you schedule an appointment, you’ll receive a packet in the mail. Please fill in the information requested and return it to our office as soon as possible. If you need to change your appointment time, please call as soon as possible to reschedule.
Someone has offered to donate part of their liver for my transplant. What steps should I take?
Have your potential donor call our office at 800-525-5395 or 717-531-6092, and ask to speak to our living donor coordinator. The coordinator will ask a few questions to see if your potential donor might be suitable. If so, we’ll set up an appointment to see this donor and also ask them to get blood type testing. You and your donor do not have to be the same blood type, but your blood types must be compatible.
How do I get placed on the transplant list?
After your testing is complete, our transplant team will review your records and make a decision about your placement on the list. One of our pre-transplant coordinators will call you to let you know our decision, and you’ll receive a letter in the mail.
What happens after I am placed on the transplant list?
You’ll need to provide blood samples at least every 90 days through your local lab, and you’ll need regular clinic visits. We’ll review your lab values and let you know how often you need to come to the clinic for a visit.
For liver transplant donors
I’d like to donate part of my liver for a friend or family member. What steps should I take?
Call the transplant office at Penn State Health Milton S. Hershey Medical Center: 717-531-6092 or 800-525-5395. Our living donor coordinator will ask some questions about your health to see if you might be a candidate. We may also ask you to have blood tests to confirm your blood type and to make sure you’re healthy enough to be a donor. If tests confirm that you may be a potential donor, we’ll work with you to arrange further testing.
What happens next?
There are two stages to becoming a living liver donor:
The first step is to have a checkup by a Donor Advocate Team (DAT). Your safety is our top priority. You are free to talk to anyone on the DAT about any physical, emotional or family concerns related to the donor surgery.
Next, you’ll meet with a transplant surgeon and hepatologist, or liver specialist. They’ll explain the surgery to remove a portion of your liver and what to expect after the surgery. They’ll also discuss any possible side effects or risks. You will receive a detailed consent form to take home and review. This form explains the operation, risks and care you will receive after your surgery.
If you decide to move forward with donating part of your liver, you will be scheduled for a more thorough evaluation, including:
- A physical exam
- A meeting with a psychiatrist to help you understand how your life might change after the surgery and to talk about any stress you might have now or later
- A chest X-ray and electrocardiogram (ECG or EKG)
- A liver ultrasound, using sound waves to create an image of your liver
- Pulmonary (lung) function tests
- Blood tests
- A computed tomography (CT or CAT) scan or magnetic resonance imaging (MRI) of the liver
You’ll also need to watch some educational videos and meet with a social worker and financial counselor.
If the DAT determines you can be a living donor based on your testing, you’ll move on to stage 2.
The transplant surgical team will perform a comprehensive study of your liver, including blood tests and a liver biopsy. If all tests confirm that you can be a living liver donor, we’ll schedule a time for the operation that works for both you and the transplant recipient.
How long will I be in the hospital and out of work?
You will most likely be admitted to the hospital on the day of the transplant surgery and stay for five to eight days. Depending on your recovery and the type of job you have, you may be able to return to work within six to eight weeks.
How will donating part of my liver affect my life after surgery?
The liver is the only organ in the body that can grow back after part of it is removed. It usually returns to normal function and size within two months. Liver donation should not affect your liver’s long-term function. You will need follow-up care after you’re discharged from the hospital, and you’ll need annual visits to make sure your liver is functioning normally long-term.
What are the risks involved in being a living donor?
Any major surgery has risks. The risk for complications is about 30 percent (2 in 7 cases). The risk of death related to liver donation is very rare at an estimated 0.15 percent (1 in 670 cases).
Most problems related to liver donation are minor and get better on their own. The most common problems are bleeding, infection and pain related to the surgery.
Rarely, a problem might require another surgery or medical procedure. The most common problem is a bile leak (5 to 15 percent of cases). Your liver secretes bile to aid in digestion. Most bile leaks get better without the need for surgery. Sometimes, tubes need to be placed endoscopically to aid in healing of this leak. In rare cases, surgery is needed to correct the bile leak.
Another problem that can require treatment is a biliary stricture (narrowing or constriction of the ducts that carry bile from the liver). Some strictures can be fixed by inserting tubes endoscopically and rarely will require surgical repair.
Am I making the right decision in donating part of my liver?
Only you can answer that question. Find out as much as you can about the operation, its risks, and the effect it may have on your life and family before making a decision. You will need to take time off work for evaluation, surgery and recovery. You’ll need to consider how missing work could affect your job, finances, family and life.
The transplant team can answer any questions and provide any information you need to help you decide. The Donor Advocate Team will also make sure you’re fully informed, so you can make the decision that’s right for you.
How much will it cost to donate part of my liver?
You do not need to pay for your preoperative evaluation, surgery, hospital stay or clinic visits, or for any medical treatment related to the donor surgery within the first three months after the surgery. The recipient’s insurance will pay for all medical costs that are not covered by your insurance. Your only direct costs may be medications such as pain pills after you go home from the hospital. You will also need to pay for transportation and non-hospital lodging costs related to the evaluation and surgery.
Keep in mind that you will need to take time off work for the evaluation, surgery and recovery, so you should plan your household expenses and finances ahead of time. Be sure to check with your company’s human resources department to learn what your options are under the Family Medical Leave Act and to find out about any short-term disability benefits you may have.