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Donating part of your liver can be a priceless gift. The liver's remarkable ability to regenerate allows the donor's and recipient's partial livers to regain complete functionality. However, becoming a donor is not to be undertaken without serious thought. We recommend you begin the evaluation with an open mind, and remember, this is a completely voluntary procedure. At no point should you feel coerced or obligated to undergo surgery.

Initial Inquiry

If you are interested in becoming a liver donor, the first step to begin the evaluation is to contact the center by submitting an inquiry online or by calling and speaking with a Living Donor coordinator. It is required that the person who is interested in donating initiates the contact with our center.

Learn more about live donor liver transplantations below.

How do I become a liver donor? What criteria do I have to meet?

In order to be evaluated for living donation the potential donor must meet the following requirements:

1. A person between the age of 20 and 60.
2. The donor must have a compatible blood type to the recipient.
3. They must be medically healthy and physically fit.
4. They must not have a liver disease or active hepatitis.
5. They must not have severe psychological disorders or active substance abuse.
6. They must not be morbidly obese or have significant fat in their liver.
7. They must not expect to receive payment or material compensation from anyone for their gift.
8. They must not feel coerced or forced to donate.

If you are interested in becoming a living liver donor, the first step to beginning the evaluation is to contact the center online or call and speak with the Living Donor Coordinator.

It is required that the person who is interested in donating initiates the contact. Only one donor is evaluated at a time. A comprehensive medical and psychosocial evaluation with our living donor team will be scheduled.

The living donor team will be concerned solely with your well-being and is not involved in the care of the potential recipient. Only after you are deemed medically well enough to undergo this type of surgery will a surgery be scheduled.

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What is the live liver donation process?

Evaluation of the live liver donor is done as an outpatient and is outlined below:
1. Transplant Coordinator Evaluation & Consultation: A nurse with training in liver transplantation and donation ensures that all concerns of the potential donor and the donor advocate team are addressed and that the overall process is carried out properly. They will review the Informed Consent with you and answer any questions you may have. Afterward you will be asked to sign the consent if you wish to proceed.

2. Medical Evaluation: An independent donor advocate who is a medical doctor, and a hepatologist who is not the primary hepatologist of the recipient will evaluate the potential donor.

3. Psychiatric Evaluation: The donor psychiatrist evaluates the potential donor for psychiatric illness. Your care partner will accompany you to this appointment.

4. Social Work Evaluation: The transplant social worker assesses the donor's social support, education level, relationship to the recipient, financial status, health insurance, and ability to understand the impact of the donation. Your care partner will accompany you to this appointment.

5. Surgical Consultation: The donor surgeon assesses the donor's surgical risk and reviews the surgery with the potential donor.

6. Independent Internist: A medical doctor, who is outside of the department of surgery, will medically evaluate the potential donor.

7. Laboratory Evaluation: There are extensive blood tests to rule out medical illnesses, liver diseases, clotting disorders, viral illness, and HIV.

8. Chest X-Ray

9. Electrocardiogram

10. MRI/MRA of liver or CAT Scan Angiogram of the abdomen with oral and intravenous contrast: These tests show the structure of the liver, its size, anatomy and its blood supply to help the surgical team plan and decide how risky the surgery will be.

For more detailed information about the process, "A Patient's Guide to Liver Donation."

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Are there benefits to donating part of my liver?

A living donation will not provide any benefit to you except the knowledge that you have tried to save a life, although occasionally the evaluation process may uncover an illness that you may not have known about. The benefit to the recipient is that he or she can be transplanted sooner in a controlled situation prior to the development of acute life-threatening complications and further progression of the liver disease. The outcome of the living donor liver transplant is not guaranteed. Its benefit is the timing of the operation, which is likely sooner than waiting for a deceased donor.

Having a living donor evaluation will in no way affect the recipient's placement on the waiting list.

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How long will it take to recover after donation?

A donor is typically hospitalized for 5-7 days after the donation and will be able to return to work in approximately 4-8 weeks. 

Post Op Day 1: The donor will be very sore, nauseated, and slightly groggy.

Post Op Day 2-3: The donor will still have some pain and some nausea as they are switched from IV to oral pain medication and encouraged to walk a little. Donors are encouraged to take their pain medication at least twice a day.

Post Op Day 4: Donors will start to feel like themselves again. They are allowed to eat clear liquids and bowel function will start to return.  After a bowel movement, donors can begin eating regular food, and have the drainage tube removed from their abdomen.  At this time the donors may be discharged from the hospital.

Discharge: Donors are given a prescription for oral pain medication to take as needed, and should expect to be moderately fatigued for several weeks. 

Donors must not lift greater than 15 lbs. for 4 weeks and must avoid heavy lifting for 12 weeks (>30lbs).  Otherwise, they are encouraged to slowly resume normal activity at their own pace, making sure that they walk daily and stay active.  Donors are strongly encouraged to avoid alcohol and any medications or herbal remedies that can be toxic to the liver for six months.  Women should avoid pregnancy for one year.  Donors should eat a normal, healthy, well-balanced diet to improve healing.  It is best to avoid fatty foods which may cause stomach pain.

The transplant center follows donors closely as they recuperate. They will be seen one week after discharge to assess their condition and check blood tests. Six weeks after surgery they will return to see the donor team and at three months they will have an MRI of the liver to assess for regeneration.  The six month follow up can be done over the telephone with labs done locally as long as there are no issues.  One-year post donation donors come in for a follow up appointment and final MRI to assess the liver’s regeneration.  We request that they follow up annually thereafter which can be done with us at the Center for Liver Disease or arranged to be done locally with their primary care physician. New York State requires us to follow up for two years and the transplant team strongly encourages donors to comply with these follow up recommendations.

 

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What are the risks of liver donation?

The donor surgery is called a partial hepatectomy, meaning "the surgical removal of a part of the liver." This surgery is most commonly used to remove benign or malignant liver tumors. Partial hepatectomy can be done safely, and partial hepatectomy in a well person carries less risk than when it is done to treat someone who is sick with liver disease. It is a major surgery, and there are still risks involved, including the risk of death.

With any major abdominal surgery, chronic pain, internal bleeding, infection of the wound or other organs of the body, and injury to other areas in the abdomen, as well as death, are potential risks. Other risks include postoperative fevers, pneumonia, and urinary tract infection.

Patients who have major surgery are also at risk to form blood clots in their legs. These blood clots can break free and travel to the lungs where they cut off the blood supply to a portion of the lungs. This is called pulmonary embolism. Blood clots in the legs occur in about 2% of all major surgeries; 2% of these blood clots will break off and cause pulmonary embolism. We try to prevent blood clots with inflatable sleeves that fit over your calves to keep blood flowing in the legs during surgery. When they do occur, blood clots and/or pulmonary embolism are treated with blood thinners that you need to take for several months and require you to have frequent blood tests. However, a large pulmonary embolism can be fatal.

Major abdominal surgery carries a risk of later bowel obstruction and/or pain due to adhesions. Adhesions are like scars in the abdominal cavity, which can form tight bands or make areas of intestines stick together and get twisted. Obstruction due to adhesions occurs in 5% of major abdominal surgeries and can occur years after the surgery. Sometimes adhesions can cause strangulation of the intestines and life-threatening gangrene. Obstruction from adhesions sometimes fixes itself, but often requires another surgery.

There are also risks that are specific only to this surgery. For the living liver donation, 25-65% of the liver will be removed. Removal of a portion of the liver may cause the remaining liver to not work as well for a short period of time, but it will soon recover and begin to grow back within a few weeks. However, in rare cases, liver failure can result and may require the donor to need a liver transplant. This is a very rare event (about 2 transplants per 1000 living liver donor surgeries). This has never happened at this center. If a living donor has liver failure and in need of a liver transplant they will be placed at the top of the liver transplant waiting list.

If you are having your right lobe removed, your gallbladder will also be removed during this surgery. The gallbladder is not needed for normal function. Some people who have their gallbladder removed have periods of diarrhea, cramping and intolerance to fatty foods, which may last for several months. Think of your gallbladder as a storage unit for bile which is produced in your liver and flows through bile ducts to your gallbladder. Bile is ultimately secreted to your small intestine help digest food. Without your gallbladder, bile will be secreted directly from your liver to your small intestine.

The most common liver complication after surgery is a bile leak. A bile leak occurs when one or more ducts from the liver have not closed entirely after surgery. Bile is irritating to the inner lining of the abdomen and can cause inflammation and scarring. Most bile leaks heal themselves, but occasionally a leak may require another tube to be placed through the skin to the liver to drain bile into a bag while the liver heals. In rare cases, surgery is required to close the leak. The rate of bile leaks happening across the country ranges from 5-15%.

A long-term complication that can occur is a biliary stricture which is a narrowing of the remaining large ducts that carry bile from the liver to the intestines. Early data shows that such strictures will be rare. They can usually be fixed without surgery by dilating the stricture with a stent (plastic tube) via an endoscopic procedure (through the mouth) or a percutaneous procedure (through the skin).

There are rare complications that can occur involving the blood supply to the liver, both in the arteries and veins. These include strictures and blood clots in these vessels that may occur long after surgery. The MRA or CAT scan that you have before surgery will help the donor surgeon to gauge how risky the surgery might be in this regard.

The most common late complication is the formation of incisional hernias. A hernia forms when the skin has healed, but the underlying muscles and connective tissue have not knit together well. This creates a bulge or "bubble" under the skin when standing. While this can be unsightly, more importantly, it has the potential to trap a loop of intestine and strangulate it, which can cause gangrene. For this reason, we often recommend surgery to correct hernias when they occur; in some cases, more than one surgery has been necessary. Hernias can occur in 5-7% of donors. If you are overweight, you may be more likely to develop a hernia. We believe that some hernias may be prevented by avoiding activities that put pressure on the abdomen, such as heavy lifting or straining at stool. The surgeon may place a mesh at the time of surgery to lower the risk of developing a hernia.

Nationwide, the risk of having some type of problem, minor or major, from this surgery is 15-30%. These include infection, hernias and swelling (about 2 in 7 cases). Most problems are minor and get better on their own. Rarely do they require another surgery or procedure.

So far in the United States, the mortality rate (death) has been about 0.2% or 2 deaths in about 1000 donors.

General Anesthesia

This surgery will be done under general anesthesia. There are a number of known possible risks with
any surgery performed under general anesthesia. An anesthesiologist will explain these to you in
detail.

Blood Transfusions

You may need blood transfusions during this surgery, although this is uncommon. The incidence of transfusion is about 1 in 100 cases.

Post-Surgical Course/Discomforts

Drains will be placed in your body to help you heal, to be removed before you are discharged from the hospital. There is a chance that you could be placed on a machine to help you breathe after surgery. You will feel pain (for example: gas pains, sore throat, soreness, backaches, etc.) after the surgery.

Regeneration

The success of living liver donation is partially due to the liver's natural ability to regenerate. Regeneration occurs rapidly in both the donor and the recipient. Even within the first seven days after surgery significant regeneration has occurred and within six weeks the liver sections in both the donor and recipient have grown to 80% of the size of a normal liver. However, growth then slows down and eventually stops, so that at one year the liver is still about 10% smaller than its original size. Liver function in the donor returns to normal levels within four weeks, with complete normalization of blood liver function tests by 12 weeks post-donation. 

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What happens during surgery?

Liver donor operations involve either donation of the right lobe or the left lobe. The lobe for donation to an adult, either the smaller left lobe or the larger right lobe, depends on your size and the size of the recipient. The surgery last approximately 4-6 hours and donors will be placed under general anesthesia.

Diagram of a right hepatectomy

Right Hepatectomy

Diagram of a left hepatectomy

Left Hepatectomy

In some situations, the surgery is performed laparoscopically with 5 ports placed into the upper abdomen. The incisions for each port are less than half an inch. The liver graft is removed through a 3-inch incision at the bikini line (see Figure 1). In other situations, the surgical incision runs from the breastbone to 1 inch above the navel, which in most people leads to a 6-inch incision (see Figure 2).

Illustration that shows where the liver is located in the abdomen

Figure 1



Diagram that shows where an incision may be made when donating a liver

Figure 2



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How do I prepare for a donor evaluation?

Considering living liver donation is a huge decision and should not be taken lightly. Thoroughly educating yourself on living liver donation beforehand is the best way to get the most out of your evaluation with the donor team.

The following lists can help you prepare for your evaluation.

You can also download a printable version of these lists.

Evaluation Checklist

1. Educate yourself
2. Adopt a healthy lifestyle
3. See your primary care physician and have recommended screenings done
4. Discuss with family and friends
5. Decide on a care partner
6. Review your health and life insurance status. Understand your coverage!

What to Bring

1. Medical records (pap smear, colonoscopy, mammograms)
2. Insurance cards
3. Identification
4. CARE PARTNER!!
5. Questions

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