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FAQs

Living Donor Liver Transplant



What is Living Donor Liver Transplantation? 
Why Consider Living Donor Liver Transplant?
Advantages to Living Donor Transplantation:
Disadvantages to Living Donor Transplantation:
Who is a Good Donor?
We would prefer that you call and ask before you assume that someone is not a good donor.
Donor Evaluation:
Living Donor Surgical Procedure
Referrals:


What is Living Donor Liver Transplantation? 

Instead of waiting for a cadaveric donor to become available for transplantation, the recipient identifies a living donor. This is a relative or a close friend who is willing to consider donation. They must be willing to have a portion of their liver surgically removed, and placed into the recipient. The liver is a regenerative organ and it grows to normal size rapidly in both the donor and the recipient. The resection of a portion of the liver from the donor is a major surgery, and requires a commitment from the donor to thoroughly complete the evaluation process and follow up after surgery. All family involved with both donor and recipient should attend the education session and have all of their concerns addressed. You may call Karyn Marks, R.N. at (310) 825-8138 with new concerns or issues at any time in the process. For the recipient and the donor, the difference between a living donor and a cadaveric donor is discussed under Why consider Living Donor Transplantation. This process involves a liver resection (donor), and a liver transplant (recipient). The UCLA Liver Transplant Program has vast experience, gained in over 3000 liver transplants performed at our center. This process has been performed in the pediatric population successfully for years at UCLA. The application of living donor liver transplantation in the adult population is new. We are very cautious in our screening of both donor and recipient.


Why Consider Living Donor Liver Transplant?

The number of patients listed for liver transplantation in the United States has increased annually. There are currently more than 16,000 patients listed. Approximately 4,500 cadaveric livers are available for transplantation annually. Therefore, there is a marked discrepancy between supply and demand. Because of this, patients are getting sicker before they are transplanted. We are therefore transplanting more patients when they are critically ill, which results in a less favorable prognosis.


Advantages to Living Donor Transplantation:

  • The surgery is elective, when the recipient is stable, and the prognosis is more favorable
  • The recipient receives an optimal liver graft
  • The ischemic time (cold time) on the organ is minimal (less damage to liver tissue)
  • It increases the available donor pool


Disadvantages to Living Donor Transplantation:

  • Risk of death to donor is present (it is minimal, but not negligible)
  • Risk of bile leak
  • Psychological impact if graft fails (both donor and recipient)
  • Surgery has not been performed long enough to determine the long term impact on the donor


Who is a Good Donor?

  • is the same size or larger than the recipient
  • is the same blood type as the recipient (Rh factor is insignificant)
  • is not obese
  • is healthy, without major medical or psychological problems
  • has no substance abuse
  • is comfortable with donation (the donor may back out at any time)


We would prefer that you call and ask before you assume that someone is not a good donor.

The evaluation process is extensive. Each test must be reviewed by a physician before we proceed to the next. If the surgeons feel at any point in the process that the donor is unsuitable, we may inform you that we will not consider this donor for a liver resection. This can be upsetting for both the donor and the recipient, but the conditions must be ideal to safeguard the donor. The donor evaluation is more extensive than the recipient evaluation for the transplant!


Donor Evaluation:

  • Formal Education process for donor, recipient, and respective family members
  • Complete History and Physical
  • Psychiatric and social work evaluations
  • Cardiac evaluation
  • Labwork is performed
  • Chest x-ray
  • Volumetric abdominal Cat scan
  • Hepatic angiogram (liver arterial blood flow)
  • MR cholangiogram (liver bile flow)
  • Liver biopsy

The recipient must be evaluated and accepted by the Liver Transplant Patient Selection Committee to first determine that they require a transplant. When the recipient is cleared for the surgery, we may begin the evaluation of potential donors. We evaluate one donor at a time for each recipient.



Living Donor Surgical Procedure

A date is chosen by the patient, donor, and the surgery team. The donor resection surgery takes place simultaneously with the recipient transplant. The liver is resected from the donor at the same time that the bad liver is being resected from the recipient. The surgery for the donor takes approximately 5-6 hours. The recipient surgery is longer, taking approximately 8-10 hours. The donor is observed in the ICU for approximately 24 hours and is usually home within 5-7 days. The recipient stay is longer because of their disease state prior to surgery. The possible complications for both the donor and the recipient will be discussed thoroughly with you in a teaching session before the process is even begun. We are happy to address your questions as they arise at any time in the process. We suggest that you list your questions before you come (or call) so that you are not distracted by the physicians responses and forget issues that are significant to you.


Referrals:

A physician must call UCLA to refer a patient for a liver transplant evaluation. We must first determine that the patient requires a liver transplant. The doctor should call 310-825-8138 to submit the referral. Identify the donor at the time of the evaluation so that preliminary considerations may be addressed and discussed with the patient. Karyn Marks, R.N. is the Transplant Coordinator working with the living liver donors. Dr. Johnny Hong is the Surgical Director of the Living Liver Donor Program. Thank you for your consideration of our living donor liver transplant program.


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