Liver Transplant Living Donors

Ila Chakravarthy is a living donor liver transplant recipient

Our Pediatric Liver Transplant team has been performing living-donor transplants since 1995 with excellent results.
 
According to Scientific Registry of Transplant Recipients (SRTR) data from January 2012, the living donor transplant program at Lucile Packard Children's Hospital had:

• A one year post-transplant patient survival rate of 100 percent. The national average was 94.24 percent. 
• An observed one year post-transplant organ (graft) survival rate of 100 percent. The national average was 89.80 percent.

Living adult donors can donate a portion of their liver. That donated portion is replaced by new, fully-functioning liver tissue within six to eight weeks. The liver is the only solid organ that can grow and regenerate in both the donor and recipient.
 
All donors to our patients are currently alive and well. Past donors have included parents, grandparents, aunts, uncles and close family friends.
 
One of the advantages of living-donor transplantation is that the procedure can be scheduled at a time that works best for both donor and recipient:

• For the donor, the major issue is his or her work and family schedule. 
• For the recipient, timing depends on the child’s health.  

Living Donor Criteria

A suitable living donor is an individual who:

• Is in good physical and mental health
• Is older than age 18 and younger than 55
• Is a suitable ABO match
• Does not have:
  • HIV infection
  • Chronic viral hepatitis
  • Active alcoholism or heavy alcohol use
  • Psychiatric illness under treatment 
  • Recent history of malignancy
  • Diabetes mellitus of greater than seven years’ duration
  • A body mass index (BMI) > 30
  • Any issue that the transplant team agrees makes a risk of donation outweigh the benefit to the donor
  • Any evidence of coercion, financial gain, or any other issue identified by the Living Donor Advocate that would raise ethical concerns
• Is free from any other serious chronic medical illness

Other factors are also important in selecting a donor:

• The donor should be a relative (close or distant) or emotionally connected to the recipient; in special circumstances, the donor can be unrelated.
• The donor must be mentally competent and freely willing to donate. Potential donors who are believed or known to be forced or pressured into donating must be excluded.
• No financial gain can arise from the donation. It is against the law to sell organs.
• The decision to be a donor should be made after carefully considering and understanding the procedure and accepting its risks and complications.
• The donor liver portion must be relatively close in size to the recipient’s liver. 
• Donors need to be willing and able to comply with medical follow-up.

Living Donor Evaluation Process

The donor candidate will be asked to complete tests and evaluations to ensure a proper match for the recipient. This process generally includes:

1. Completing an extensive questionnaire and providing blood type to confirm whether the blood type is identical or compatible with the recipient’s
2. Laboratory studies, including a complete blood count, liver panel, and blood tests for hepatitis B and C
3. A chest x-ray and electrocardiogram (EKG) to make sure the donor can safely receive anesthesia
4. An appointment with an adult hepatologist (liver specialist), who performs a complete physical exam
5. A volumetric computed tomography (CT) scan to calculate the volume of the liver and determine whether the portion being donated will fit the recipient 
6. A social worker’s comprehensive psychosocial evaluation to make sure that the candidate:
   • Understands the risks of the procedure
   • Is donating from his or her own free will
   • Has adequate support to be cared for after surgery
7. A meeting with Independent Donor Advocate

A committee of liver transplant team members discusses the evaluation and decides on the suitability of the candidate. One of the transplant team members, usually the transplant coordinator, communicates the decision to the candidate. If the candidate is not selected as a donor, he or she can contact the doctors on the team for an explanation.
 

Recovery from Transplant Surgery

The donor usually spends five to seven days in the hospital. Most patients are up and out of bed (with assistance) by the second or third day after surgery. The donor usually needs to stay home from work and suspend usual home activities for a month full-time and two to four weeks part-time, depending upon the speed of recovery.
 
 

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