Liver transplantation is a surgery to remove the diseased liver of the patient and place a part or whole healthy liver from a donor. This can be a life-saving operation for people with end-stage liver failure that cannot be managed using other treatment methods, or for some specific types of liver cancer.
A healthy liver can be received from two sources:
- A deceased person has agreed to donate his liver after his death.
- A living person who has agreed to donate his/her Liver to his loved ones or anyone who require donated liver
Living donor liver transplant entails removal of a part of the donor’s healthy liver for transplantation into a recipient with a deceased liver. Usually, a family member or a person who is emotionally close to the patient can volunteer to donate a portion of their healthy liver for transplant surgery.
This procedure is possible because of the liver’s unique ability to regenerate itself. After the transplantation surgery, the portion of livers in both the donor and recipient grows in size (usually in four months) to form complete organs. An adult can donate a part of his/her liver to a child or another adult.
Why is living donor liver transplantation more desirable?
The number of people waiting for a donor’s liver exceeds the number of deceased donors available. The living donor liver transplant, much like living kidney donation, provides an effective alternative to waiting for the availability of a deceased donor organ.
Moreover, receiving a transplant sooner may, in fact, help the recipient avoid other health complications that may occur due to the long waiting time.
Another major advantage of living liver donation over deceased liver donation is an improved survival rate for transplant recipients.
A living donor undergoes a careful medical evaluation to assess the health and condition of the liver for transplantation into a recipient. Livers from living donors are immediately transplanted after being extracted from the donor.
The short ischemia cold time (the amount of time the liver is without blood and is artificially preserved) is also an important reason behind the excellent success rates of living donor liver transplantation.
With living-donor transplantation, the timetable of the transplant operation can be planned and the headway of the recipient’s liver disease and its life-threatening complications can be avoided.
Who can be a living donor?
The government and the transplant centers have organ transplantation guidelines about who can be a suitable donor of an organ. The potential donors must fulfill all the necessary requirements to be considered for living donor transplants.
Liver transplant surgeries in India are globally renowned for their excellent results and long-term success rates. Living donor liver transplantation is offered by many of the top hospitals in India.
Some of the liver transplant programs in the country are considered to be amongst the best ones in the world. These transplant centers follow international and national rules for organ transplantation surgery.
Criteria for Living Transplant Donor
One must meet the following criteria to be a live donor for a liver transplant:
First and foremost, the donor must want to donate the liver with their own free will. It’s against the law to sell organs or to force anyone to donate an organ.
- A Family Member or Friend: If a blood relative of the patient wants to be a donor, it’s more likely that their blood type will be a good match for the patient. A friend who is emotionally attached to the patient may also have a match with the patient and can donate part of their liver. In some cases, the donated liver may be given by someone who is not known to the patient.
- Right Age: the donor must be between the age group of 18 and 60. This range may vary for some centers as older donors are more likely to have complications than younger donors.
- Right Weight: The donors must have their body mass index (BMI) less than 35
- Blood Type Match: A person must have a compatible blood type with the recipient in order to donate a portion of their liver.
People with Blood O type are called universal donors as they can donate blood and organs to anyone. However, blood type O liver transplant patients can receive organs from donors with Type O blood group only.
- With Type A blood, the liver can be donated to people with blood type A or Type AB.
- Type B blood people can donate to others with Type B or ABs.
- People with AB blood type people can donate to those with the same blood type (AB).
- The Rh factor (positive or negative) doesn’t play a role in incompatibility.
5. Overall health: the physical and mental health of the patient must be good for being able to donate.
The person should not have any of the following conditions:
- Significant diseases of heart, kidney, or lungs
- Currently have or previously had cancer
- Liver disease, such as hepatitis
- Gastrointestinal disease, neurologic disease, autoimmune disorders, or certain blood disorders
- Diabetes or a firm family history of diabetes
- High blood pressure that’s not under the control
- Ongoing or long-term liver infections, including hepatitis C
- Substance abuse or long-term use of alcohol or recreational drugs, such as marijuana
- A donor must not smoke for at least six weeks prior to surgery.
- Living donors also need a strong support system to rely on for emotional and physical needs during recovery.
Once the blood type is matched, a detailed medical analysis is carried out to check the overall health of the person. The family medical history, lifestyle, and other information are noted by the doctor and assessed. A category of tests are done including:
- Abdominal ultrasound or CT scan
- MRI of the abdomen with IV contrast
- Echocardiogram (EKG/ECG)
- Chest X-ray
Treadmill stress test: for males > 35 y/o and females > 45 y/o, active smoking within 5 years, diabetes, hypertension, hyperlipidemia
Psychological evaluation and consultation (depending on medical history).