Patient Education & Diseases

All about liver donation

Who can donate liver?

For a deceased donor liver transplant, if a family is willing to donate the organs of their near and dear one, who is brain dead, they need to approach the hospital. Anyone, who is declared brain dead, is eligible for organ donation, provided the organs are good to use. The deceased organ donation is generally directed to a recipient of the same blood group.For a living donor liver transplant, there are some criteria for organ donation. The donor should be blood group matched with the recipient. The donor should be, preferably from the family. The donor should be at least 18 years of age at the time of donation. The upper age limit is generally 50-60 years. The donor is extensively evaluated before the surgery. The liver function tests should be normal. The liver should not be grossly fatty. The liver anatomy should be acceptable. The liver volumes should be safe for the donor and the recipient. The donor should be found fit for surgery, from physical and psychological point.Blood group compatibility chart for liver transplant

Blood group compatibility chart for liver transplant

Evaluation of liver donor

A liver donor is exhaustively evaluated for the donor surgery. The tests comprise of blood tests, radiological tests, and evaluation for surgical fitness. The blood tests include blood group, liver function tests, complete blood counts, viral markers, thyroid function tests, lipid profile, and others. The radiological tests include Chest Xray, CT scan, and MRI. The preoperative evaluation comprises of tests for cardiac, pulmonary, gynecological (in case of a female donor), and psychiatric fitness.

Donor surgery

The donor and recipient surgery are performed simultaneously. Usually, the right lobe (60-70% of the whole liver) or left lobe (30-40% of the whole liver) are taken and implanted in the recipient. The portion of liver remaining with the donor, generally regenerates and achieves normal size in 2-3 months. Smaller portions of liver may be required for pediatric recipients. The surgery generally takes 5-7 hours to complete. The donor is kept in ICU for 2-3 days after surgery and then shifted to room. The total hospital stay is approximately 5-7 days.

Donor safety

  1. Introduction
Liver has a peculiar ability to regenerate. The Greeks knew about it. According to the Greek mythology, Prometheus was punished by Zeus by being chained. Zeus’ eagle used to come and eat a part of Prometheus’ liver. The liver regenerated till being eaten again by the eagle. It is because of this regenerative ability of liver, living donor liver transplantation is possible and safe.

Prometheus’ liver being eaten by Zeus’ eagle

  1. How much of the liver can be safely removed from the body?
The part of liver which remains with a donor is called remnant liver. Approximately, 25% of healthy liver or 35-40% of diseased liver is essential for survival. Any remnant volume less than that puts a person to risk of liver failure, which may be life-threatening.
  1. How much liver is donated?
The volume required for donation is calculated based on graft-recipient weight ratio (GRWR).

GRWR = the weight of liver being donated (graft liver)/weight of the recipient

The weight of the graft liver and the remnant liver are calculated before the surgery using advanced software based on CT imaging. A GRWR of more than 0.8 is desirable to achieve good outcomes after liver transplant. A remnant liver of more than 25% is desirable for donor safety.The right lobe of liver forms approximately 60-70% of the whole liver while the remaining 30-40% is contributed by the left lobe. Usually, the right lobe is taken for donation for adult recipient, while the left lobe or smaller than that (left lateral section, segment 2 or segment 3) is taken for a pediatric patient.

Segmental Anatomy of liver

  1. Complications after donor surgery
The donor surgery is relatively very safe. But, being a major surgery, it is associated with approximately 0.2-0.5% risk to life. There can be surgical complications like bleeding, infection, bile leak and development of hernias. Most of these complications are uncommon and can be managed well in a good surgical unit.
  1. Long-term outcomes and quality of life after donor surgery
The remnant liver regenerates to normal size in 2-3 months. The donor does not have to be on any long-term medications. One can have a normal quality life after liver donation. One can pursue laborious work, participate in sports activities, go to gym, and can marry and have a normal sexual life.  Female donors can have normal pregnancy. The surgery does not affect the long-term life in any way.