Liver donor safety – learning the facts and busting the myths

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.

Fig 1. Zeus’ eagle eating Prometheus’ liver

Liver is an important organ in the body. It performs many essential functions. Unlike kidney, there is no effective dialysis system for liver. So, when liver becomes diseased, liver transplantation is the lifesaving and curative option. The liver can be donated in two ways:

1) Living donor

2) Deceased donor

The living donor is a person who voluntarily donates a part of his liver, while he/she is healthy. A deceased donor is a person who is brain dead and donates his/her whole liver, with consent of the relatives.

Unfortunately, the deceased organ donations do not happen in adequate numbers in India. So, we rely more on living donor liver transplantation so that the patients can timely get healthy liver, which can save their lives.

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.

The volume required for donation is calculated based on graft-recipient weight ratio (GRWR).

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.

Fig 2. Lobar anatomy of liver

The donor liver surgery starts with mobilisation of liver, porta dissection and proceeds with transection of liver, finishing with disconnection of blood vessels and removal of the donor liver (the graft liver). The surgery usually lasts for 5-6 hours.

Postoperatively, a liver donor is generally kept in ICU for 2-3 days. Ambulation and oral feeds are started from 1st postoperative day. The donor is generally discharged from the hospital in 6-8 days.

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.

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.