Living Donor Liver Transplant: Risks, Procedure, And Overview

A living-donor liver transplant is a life-saving surgery in which a deceased liver is replaced with a portion of the liver from a healthy person. In the United States, more than six thousand liver transplants are performed annually, and around seventeen hundred patients die each year waiting to receive a liver transplant. Potential liver donors are meticulously screened for their surgical, social, medical, and psychological fitness. Medical conditions like lung disease, heart disease, kidney disease, and underlying liver disease must be assessed to minimize the benefit-risk ratio of the organ transplant as much as possible.

During a living donor liver transplant, the larger right-side lobe is removed from a healthy individual and transplanted to adult donors, and the smaller left lateral lobe is removed and transplanted to children. After the surgery, the donor's remaining liver regrows to its normal size and capacity within a few months. The transplanted liver portion also restores normal liver function in the recipient. But your body will consider the new liver a stranger, and you'll have to take medications to boost your immune system. These medications can have certain side effects, like diabetes, high blood pressure, and high cholesterol.

How Is Living Donor Liver Transplantation Performed?

Living Donor Liver Transplantation is conducted by skilled surgical teams in operating rooms. An experienced surgeon removes a portion of the liver from the donor. This portion of the liver is then transplanted into the recipient in an operating room. Surgical teams use a laparoscope to perform these surgeries. Laparoscope is an imaging instrument that is used to see what is happening inside the body. This procedure is called keyhole liver transplant surgery. Since it is new, not all hospitals may offer it. The doctor provides the recipient and donor with enough liver to carry out their normal lives and maintain bodily functions. In a few months, both livers will regrow to their original size and start functioning normally.

Living Donor Liver Transplant Risk

Since a living donor liver transplant is a critical surgery, there are a few risks for both the recipient and the donor. The donor may experience these risks-

• You'll take time to recover. Donors are hospitalized for five to seven days after the surgery, and they take more than two to three months to fully recover.
• The donor can get complications like bleeding, blood clots, bile leaks, or infections. There are also rare chances of getting a hernia. 
• Sometimes, the portion of your liver left after the donation could stop working, leading to life-threatening consequences.
• After the surgery, you'll have to be in touch with your health expert regularly. They will counsel you on lifestyle changes personalized to your needs.

The recipient may experience these risks-

• You'll have to take medicines to boost your immune system throughout your life. These medications can sometimes cause side effects like diabetes, high blood pressure, and high cholesterol.
• After you get your new liver, you'll have to stay in an intensive care unit for a few days. In the ICU, the surgeons will monitor your overall health and well-being. 
• If you have received a new liver, you may get a narrowed bile duct. The doctors will have to treat this condition later.

Who Can Be a Living Donor?

You can be a living liver donor if you're healthy and fit and have no medical complications. Your liver should also match with the recipient. The doctor will check your body size and blood type to know if you are an ideal candidate for liver donation. Adults can donate their liver to children regardless of size because a child's body keeps on growing. Here are a few other requirements you need to fulfill to become a living liver donor.

• You must be between the age group of 18 to 60 years. 
• Your liver should be functioning properly. Some people don't even know they have liver disease until they get the required tests.
• You should also have good psychological and mental health. If the doctors find that you are psychologically or mentally unwell, they won't deem you fit for liver donation. The doctors need to ensure that you understand the commitment and the risks involved in liver donation.
• You should not have heart or kidney disease, hepatitis, ongoing malignancy, or chronic and active infections. 
• If you have a history of substance abuse, you are not an ideal candidate for donating your liver. Drugs and alcohol damage your liver and cause other side effects.  
• The healthcare team will ensure that you have not decided to become a living liver donor in exchange for money. You should donate your liver voluntarily without any pressure. 
• Your body mass index should be less than 35.

What Happens After Living Donor Liver Transplant

After a living donor liver transplant, you'll spend a few days in the intensive care unit under close observation. You'll be transferred to the recovery wing when your condition is stable. Various tubes will remain attached to your body, including a catheter in your bladder, tubes in your abdominal cavity and stomach, and IV lines in your neck or arm. After a few days, the tubes will be removed, and you'll be asked to move around. Once you feel better, your IV pain medication will be stopped, and you'll be given an oral prescription. After your discharge, you'll have to come for follow-up check-ups one month, one week, three months, two years, and one year. 

Can Donating a Portion of Your Liver Shorten Your Life?

No, under normal conditions, your life doesn't shorten after donating a part of your liver as the liver regrows to its normal size in a few weeks. The surgery is moreover safe, but there can be a small risk of death or complications. The risk of death is 1 in 500 in living liver donors.