Living liver donation has higher probability of success

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Dear Doctors: My husband wants to see if he qualifies to be a liver donor for his cousin. They’re both 44-years-old and have been best friends their whole lives. I’m trying to be supportive, but to be honest, I’m very worried. What happens in a liver donation?

Dear Reader: A liver transplant becomes necessary when someone’s existing organ is diseased or injured and is no longer able to function well enough to keep them alive. Unlike with kidney disease, where dialysis can often give a patient some extra time, there is no interim therapy for a failing liver. And just as with kidney donations, there is a shortage of available organs.

One of the many remarkable things about the liver is that, when it is healthy, it can regenerate. That means that just a portion of a liver can grow into a complete organ when surgically transplanted into another person. The remaining portion of the donor’s liver will also regenerate into a complete organ.

This regenerative ability makes it possible for someone to become a living donor. Having a living donor frees the recipient from the uncertainty of being on a waiting list. It also allows both patients, along with the transplant team, to choose an optimal time for the surgery. Data shows that when an organ comes from a living donor rather than from a deceased donor, the period of recovery is shorter and outcomes are improved.

The process begins with detailed physical and psychological evaluations of both the donor and the recipient. These are done at the selected transplant center.

A range of factors, including age, blood type, medical history and organ size — as well as stress, financial issues and the availability of post-surgical support — help determine if a donor and recipient are a good match.

The actual surgeries, which may be done laparoscopically, take place at the same time in neighboring operating rooms. Both donor and recipient have their own transplant teams. The donor surgery, in which a portion of the liver is removed, takes four to six hours. The recipient’s surgery, which includes removing the diseased organ, replacing it with the donated liver, and then reconnecting all of the blood vessels and bile ducts, takes 10 or more hours.

The transplant recipient typically remains in the hospital for another two to four weeks, depending on the specific case. Donors are often able to return home after about a week. Complete recovery takes another six to eight weeks. During that time, donors are advised to go for walks several times a day and to avoid lifting anything over 20 pounds. Livers regrow rapidly. Within a few months, both the donor and recipient will have livers of normal size.

Potential risks associated with the procedure include adverse reactions to anesthesia, infection, blood clots or bleeding, nausea, hernia, bile duct problems, scar formation, and pain and discomfort. In very rare cases, the donor can develop liver failure.

If you and your husband decide that he will move forward, the first step is to make an appointment for an evaluation with his cousin’s transplant facility.

Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.

Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided. Copyright 2021 UCLA Health

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