Harvey's Blog

The principal risk to the live donor when performing a live donor transplant, is the actual removal of part of their liver. Advances in surgical techniques have dramatically reduced the operative risk. The risk of death due to part of the liver being removed is less than 1%. The growth capacity of the liver is large.  The liver function remains normal and the liver returns to near normal size.

Presently more than 2000 living donor operations have been performed worldwide and there has been seven reported deaths.Complications resulting from the operation are bile duct problems and bleeding, but the requirement for blood transfusion is uncommon.

The usual hospital stay after donor operation is 6-10 days. Normal physical activity and return to work is expected after 3 months. in some surveys, 70% of donors develop new symptoms ehich persist for a long time. These include persisting mild abdomen pain in up to 50% donors

A  further ethical concern is the potential for coercion. There is the risk that family members may apply emotional pressure for a decision regarding donation from a potential donor. This pressure for a decision may also come from the Liver Transplant Team. The participation of a psychiatrist, and a gastroenterologist not involved with the recipient or liver transplant team is essential to guard against this occurring.

It is important that potential donors understand that they can withdraw consent at anytime, however late in the proceedings.

Choosing The Donor

Potential donors will usually be biologically related to the recipient or may be an emotionally close person. Donors should be between the age of 18 and 60 years and their blood is to be compatible with the recipient. A donor must have no history or evidence ofliver disease or other major medical illnes, eg cancer, heart, kidney or lung disease which would prevent safe donation. The potential donor will undergo a scan of the liver to assess liver volume, blood vessel and bile duct anatomy. 

The Process of Adult Live Donor Donation

In summary, the person who is to be the recipient of the liver will have all their diseased liver removed - the person daontaing has about 20% of their liver removed and then it is inserted in to the donor.

There are a number of points to consider in the decision making and prior to initiating the liver donation workup:

1. Why is it sometimes preferable for the potential recipient to have an adult live donation,rather than await a liver from someone who has died. There are three main reasons.

   1. There is a shortage of livers from donors who have died, resulting in long waiting lists for patients awaiting liver transplantation. It is possibel that some may never receive a liver
   2. A liver from a live donor usuallly has less damage, haaving been removed from one body and transplanted into another in a very short period of time -  this may help survival of the liver.
   3. Surgery may be planned for a convenient time in both the donor and recipients life.

2. There are risks associated with the adult live liver donation operation

   • The usual risks associated with anaesthetic and surgery, eg allergic reaction, bleeding, chest infection, bllod clots in the leg veins.
   • Risk of wound infection and hernia.
   • Risk of urinary tract infection.
   • specific risks related to liver surgery which include:
     • Haemorrhage (bleeding)
     • Bile leak or bile duct stricture (narrowing of the bile duct)
     • Infection
     • Blood vessel damage or blockage -resulting in liver failure.

Pre Operative

Pre-Operative Investigations.

Blood tests:

• Blood type
• Full Blood Count
• Iron Studies
• Alpha 1 anti-trypsin levels
• Erythrocyte sedimentaion rate
• EUC, calcium,phosphate (Electylyte/Urea/Creatinine) LFT's (Liver function tests)
• Cholesterol/lipids
• Fasting blood glucose
• Thyroid Stimulating hormone
• Uric acid
• Thrombotic screen
• INR, APPT
• Factor V Leiden
• Antithrombin III
• Protein C and S
• Serology- HIV
• Hepatitis B
• Hepatitis C
• Cytomegalovirus
• Epstein-Barr Virus
• Herpes Simplex Virus
• Varicella Zoster Virus
• Pregnancy test

•  Triple Phase abdominal CT Scan
• MRI or aniogram
• Chest Xray
• Pulmonary function
• ECG
• Fundoscopic examination-(eye test)
• Echocardiogram
• Carotid duplex
• Lower limb Dopler

Donor Operation

The operation takes about four hours

Why not be a Living Donor?

The biggest problem faced by families considering liver donor for a child, is that one of the parents is usually the donor.  This removes them from the usually supportive role that they play in the family, at a time when the support is highly desirable. There are sometimes financial considerations, because there will be a necessary period of time off work. Ther is also the risks of surgery to consider.

Hospitals general policy is to use split livers for child transplants whenever possible, reserving living donors for children who are deteriorating while waiting on the list.

Source: Royal Prince Alfred Hospital Patient Information