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
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.
back
to table of contents
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.
back
to table of contents
-
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
back
to table of contents
-
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
back
to table of contents
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)
back
to table of contents
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!
back
to table of contents
-
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.
back
to table of contents
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.
back
to table of contents
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. Mark Ghobrial is the Surgical Director of the Living Liver Donor Program.
Thank you for your consideration of our living donor liver transplant program.
back
to table of contents
