The uncertainty of spending many months — or even years — on the United Network for Organ Sharing (UNOS) national waiting list can be worrisome. Fortunately, many liver transplant candidates have another option: living-donor liver transplant.
Not everyone who needs a liver transplant will qualify for a living-donor organ. But, for those who do, this type of surgery can mean a faster path to surgery.
In living-liver donation, doctors remove part of a healthy donor’s liver. Then they immediately transplant the partial liver into a patient with end-stage liver disease after removing the diseased organ. The liver’s unique ability to regenerate makes this life-saving surgery possible.
Here’s a look at the living-donor liver transplant process from start to finish.
Getting the Diagnosis
People with end-stage liver disease may be eligible for transplant if doctors can no longer successfully manage and treat their disease. UPMC liver transplant candidates may have one of these conditions:
- Hepatitis C.
- Hepatitis B.
- Alcoholic liver disease.
- Non-alcoholic steato-hepatitis or fatty liver disease.
- Primary liver cancer.
- Primary biliary cirrhosis.
- Autoimmune hepatitis.
- Primary sclerosing cholangitis.
- Acute liver disease from toxins (including acetaminophen/Tylenol).
- Alpha 1 Antitrypsin deficiency.
- Polycystic disease.
- Hemochromatosis.
- Veno-occlusive disease.
- Wilson’s disease.
- Failed previous liver transplant.
Evaluation for Liver Transplant
UPMC, which leads the nation in total number of living-donor liver transplants performed, considers this form of transplant as a first-line treatment. Patients who come to UPMC for transplant evaluation should expect to hear about living-donor liver transplant early in the process.
The transplant process begins with a referral from the doctor who treats your liver disease. UPMC also accepts self-referrals if you can provide the information requested on the liver transplant referral checklist.
Once the liver transplant team receives your information, they will review it. If you seem to be a good candidate for transplant, financial staff will verify your insurance coverage.
A staff member will then call you to schedule a three-day, in-depth transplant evaluation. During this visit to Pittsburgh, the transplant team will perform testing, bloodwork, and consultations regarding your physical and mental status.
During your evaluation, you can expect to meet a variety of experts, including:
- A transplant hepatologist.
- Liver transplant surgeons.
- A liver transplant nurse coordinator.
- Nutritionists.
- Pharmacists.
- Social workers.
- Behavioral health nurses or psychiatrists.
- A financial coordinator.
You and your caregiver will also meet with a living-donor transplant nurse coordinator while in Pittsburgh. This nurse coordinator will answer any questions you have about living donation and the transplant waitlist process.
After the evaluation, the transplant team reviews each patient’s case.
Help Finding a Living Donor
If your doctors tell you that you’re a good candidate for living-donor liver transplant, your next step will be to find potential donors.
The most likely donors may be someone in your group of family or friends. Strangers are also eligible to donate part of their liver. Either way, asking someone to be your living donor can seem overwhelming.
To help, UPMC offers the Living Donor Champion Program. The program helps you to:
- Learn more about who can be a living donor.
- Speak to family and friends about living donation.
- Identify resources and strategies to successfully find a living donor.
The Living Donor Champion Program can also help a trusted family member or friend take the lead in finding you a living donor.
You and your Champion may want to:
- Attend a Living Donor Champion Workshop.
- Host a Living Donor Information Session.
- Use the Living Donor Champion Toolkit to learn donor identification strategies.
When you find a potential donor, that person can fill out a questionnaire to register as a living donor. A UPMC transplant staff member will contact them within a few days.
Before the Living Donor Transplant
Once you identify a living-liver donor, that person will undergo a one- to two-day evaluation in Pittsburgh much like you did. The living-donor evaluation includes bloodwork, CT scans, an echocardiogram, and psychiatric and social-work visits.
Your donor will meet most of the transplant team members. In addition, UPMC will assign an independent living-donor advocate who will act on your donor’s behalf. The living-donor advocate will help your donor by:
- Making sure the donor fully understands what it means to be a living-liver donor.
- Answering any questions on liver donation.
- Discussing the benefits and risks of living-donor liver transplant surgery.
- Sharing any concerns with the liver transplant team.
On the day before surgery, you and your donor will meet with the transplant team together to review the surgery. Your family and friends may attend this appointment, too.
During the Living Donor Transplant
Once you and your donor are under general anesthesia, the transplant surgeons will:
- Make an incision in your donor’s abdomen to remove anywhere from 25% to 65% of the donor’s liver. The exact amount the doctor removes depends on the size and needs of the recipient.
- Remove the donor’s gallbladder, which is attached to the liver.
After the donor’s surgery begins, a second team of surgeons will start your operation. Your surgeon will:
- Make an incision in your abdomen.
- Cut off the blood vessels to your diseased liver.
- Remove the diseased liver and replace it with the healthy donor liver.
- Reattach the bile ducts and blood vessels.
- Close up the incision.
After surgery, your donor will recover in the hospital for about four to seven days before heading home. You will wake up in the transplant intensive care unit (ICU). When your condition stabilizes, you will move to a regular hospital room.
You and your donor will both stay in close touch with your transplant teams during recovery. You will each have many visits with the team during the initial weeks and months following surgery.
If all goes well, your donor will return to their active lifestyle within a couple months. And a successful surgery and recovery mean that you will have a healthy new liver, a renewed sense of good health, and a better quality of life.