South Florida Sun-Sentinel (Sunday)
Living transplants are possible because the liver can regenerate
Q: A colleague of mine shared that he was listed for a liver transplant. He then mentioned that he was hoping to find a suitable donor for a living liver transplant. I thought organ donors had to be deceased. Can you explain living liver donation and who is eligible?
A: More than 100,000 people in the U.S. are on the national waiting list to receive a donor liver, kidney, lung, heart or pancreas for a transplant. Of those people, 12,000 to 13,000 people are waiting for a new liver. However, about 1 in 5 patients — or approximately 2,500 people — who are waiting for a liver transplant will die or become too sick before an organ becomes available.
Traditionally, most organ donations come from a deceased donor. However, there has been a growing role in transplants from living donations, specifically with kidneys and now with liver transplantation.
Over the past year, the number of living donor liver transplants has doubled, now accounting for about 6% of all liver transplants nationwide. A liver transplant from a living donor is a surgical procedure where a portion of the liver from a healthy living person is removed and placed into someone whose liver no longer works properly.
Many people are surprised to learn that the liver can regenerate itself. That is one reason why we are able to perform these transplants. Liver tissue regenerates in the donor and recipient. Up to 70% of the donor liver can be removed for transplantation,
and the liver regenerates in the donor and recipient to nearly full size in about three to four weeks.
Survival outcomes are generally similar for recipients who receive a liver from a living donor or from a deceased donor. Technical issues during a living liver surgery can be somewhat higher for the recipient because it’s more difficult to transplant a partial organ. For instance, there can be increased risk of bile duct complications and arterial thromboses, which are blood clots that can develop in arteries. However, living donor liver transplants typically occur before the recipient becomes dangerously ill awaiting transplant, which improves the outcome for the patient.
Potential liver donors must be in good physical health. Donors are usually younger than 60. People interested in donating undergo blood tests to determine if their blood and tissue types are compatible with the organ recipient.
While it is a significant operation for the donor, recent improvements have aided in recovery. In the past, the surgery required
a larger incision, but over the past four years, a hybrid procedure has been used that reduces the size of the incision, and that translates into better pain control. The time in the hospital is about four to six days, and typically, it takes about four to six weeks for donors to have a full recovery.
I always encourage people who wish to become an organ donor to make their wishes known to their family and take advantage of the opportunity to highlight that choice on your state-issued driver’s license or identification card.
If you have a desire to give to a family member or friend, or donate altruistically to a stranger, speak to your primary health care provider about next steps for a referral to an evaluation center.