Living Liver Donation

When a person is waiting for someone to donate a liver as a deceased donor, there's no telling when — or if — it will come. There are far more people on the waitlist than liver donors.

A liver transplant from a living donor can help them get a new organ quickly. Their new liver is likely to start working right away. And the person who gets it is likely to have a quicker recovery time and improved long-term results compared to getting a liver from someone who recently died.

We do a careful evaluation to make sure you're a good candidate. If you qualify, we help with preparation so that the process will be as easy as possible. This ensures everyone will get the best results.

You could be a donor if you're a family member of the recipient, a friend or an acquaintance. Even if you don't know someone who needs a transplant, you could decide to give a total stranger a portion of your liver. The important thing is that you donate free of pressure or financial gain.

It's best if you have excellent physical and emotional health. Other living liver donor requirements include that you:

• Are between 18 and 55 years of age.
• Be willing to commit to the physical, emotional and financial challenges of the pre-donation evaluation process, surgery and recovery.
• Have a body mass index (BMI) less than or equal to 30.
• Have a compatible blood type.

You also must agree to:

• Abstain from alcohol during evaluation and for 12 weeks after surgery.
• Quit using any hormone therapy four weeks before surgery.
• Stop smoking for at least eight weeks before surgery.

Some medical conditions might affect your ability to be a donor include:

• A history of cancer.
• Autoimmune disease.
• Chronic infection, such as hepatitis B or C, or human immunodeficiency virus (HIV).
• Heart disease.
• History of blood clots or a clotting disorder.
• Liver disease.
• Upper abdominal surgery.

We carefully consider your medical history when deciding if you could be a donor.

Knowing the potential risks you face as a donor is important.

About 30% of living donors have some type of complication. Minor complications include:

• Pneumonia.
• Skin breakdown.
• Temporary nerve injury that may cause numbness or tingling in your fingers or arm.
• Urinary tract infection.
• Wound infection.
• More serious complications include:
• Bile leak.
• Deep vein thrombosis (a blood clot in one of the body's deep veins, usually in the legs) or pulmonary embolus (a blood clot in the lung).
• Hernia of the incision site.
• Liver failure resulting in your own need for a liver transplant.
• Need for additional surgery due to bleeding or injury to a surrounding organ.

Rarely, death is possible.

We do all we can to minimize your risk and help your surgery go well. Most donors feel like they're back to normal within a few months and able to do their usual activities.

If you're interested in becoming a living liver donor, before surgery you go through a thorough medical and psychosocial evaluation. This takes place at the BIDMC Transplant Institute in Boston. If you're from out of town we can expedite the evaluation, given your need to travel.

If there are several people in your family considering donating to a relative, we encourage everyone to begin the evaluation process. We review all potential donors to determine who's best suited to complete the donor evaluation.

Our evaluation determines if it's safe for you to have a major elective surgery that offers you no clinical benefit. We focus only on your best interests, even if that means the intended liver recipient won't get a liver. About 25% of people who express interest in living donation end up having donor surgery.

Testing to become a donor begins with a telephone health screening conducted by a donor nurse coordinator. The testing occurs in phases. Advancing to the next phase depends on acceptable results in the previous phase.

We bill the recipient's insurance for the evaluation and hold all information we learn about you in strict confidence. We don't share it with the potential liver recipient or any third parties.

Phase 1

• Consultation meetings with:
• A hepatologist (a doctor who specializes in liver care).
• A live liver donor coordinator.
• A living donor social worker.
• An electrocardiogram – A heart test that records electrical signals.
• Imaging tests such as a chest X-ray and ultrasound of your liver.
• Laboratory tests to determine if you have obvious liver problems, unknown medical conditions, a blood clotting disorder or an incompatible blood type.

Phase 2

• An echocardiogram – A test that evaluates how well your heart is functioning.
• An MRI to determine the liver volume in various segments of your liver.

Phase 3

• A hepatic arteriogram (an imaging test that shows blood flow to your liver).
• Consultation with a surgeon.

This phase also includes consults with an independent living donor advocate (ILDA). ILDAs are professionals who promote and protect your best interests as a potential living liver donor. ILDAs:

• Address any questions or concerns you might have.
• Confirm that you are voluntarily willing to donate.
• Help you understand the living liver donation process, its benefits and risks.
• Provide the chance for you to opt out of the process in a way that is confidential and without consequence.

Depending on your health history and what we learn during your evaluation, we may require these steps:

• Chest CT
• Infectious disease consult
• Liver biopsy
• Meeting with a transplant psychologist
• Pulmonary (lung) function testing

If you choose to become a donor, your liver donation surgery and the transplant surgery take place on the same day. You and your recipient can schedule surgery when it's convenient for you.

Because of the liver’s anatomy, both surgeries are quite long. We start the donor surgery first, using robotic technology to enhance precision, control, and flexibility. This approach allows for smaller incisions, which can lead to faster recovery, less pain, and reduced scarring. The donor surgery can take 10 to 12 hours. During the operation, we remove 50% to 60% of the liver, typically the right lobe. The amount we take depends on the recipient’s weight.

We time the start of the recipient's surgery based on the progress of your surgery. The transplant operation usually takes about six to eight hours.

Everyone recovers from surgery at a different rate. No matter how long your recovery takes, we support you the entire time.

In the Hospital

On average, after surgery you can expect a five- to seven-day hospital stay on Farr 10, our dedicated transplant unit. You will have some pain and may have nausea related to the anesthesia you received. We manage these conditions with medicine. You won't need long-term medications as a result of surgery to donate part of your liver.

To prevent blood clots, we give you a shot of blood-thinning medication and teach you how to give the shot to yourself. You continue the shots for about six to eight weeks at home.

After Discharge

Typically, full recovery takes from eight to 12 weeks. If you traveled from out of town to donate your liver, we ask that you stay in the area for at least the first two weeks after surgery.

Within two to three weeks, your liver should start to work normally again. We allow you to start driving again once you get your strength back and no longer require pain medication.

By six to 12 weeks, you're likely to be more active and may wish to return to work or school. By two to three months, your liver will have regenerated to at least 80% of its original size. By this point, most people feel back to normal. You can go about everyday life with no restrictions. However, if you're a woman hoping to become pregnant, we recommend that you wait for at least a year after liver donation.

Follow-Up Care

To make sure that you're recovering well and staying healthy, we conduct follow-up appointments at these intervals:

• One week
• Two weeks
• Four to six weeks
• Three months
• Six months
• One year
• Two years

The organ recipient's insurance pays for these visits as well as for your evaluation. It also pays for your hospital care.