Who can be a live liver donor? What are the risks?

A potential donor must first volunteer to donate a portion of his or her liver to a family member or someone with whom he or she shares strong emotional ties. Not all volunteers, however, are deemed suitable. The donor’s blood type must be compatible with the recipient’s blood type (see Table 6), and his or her liver must be large enough relative to the recipient’s body size. Many live donor transplant centers also enforce age and weight limitations. Typically, donors must be at least 18 years of age. This not only increases the likelihood of an adequate donor liver size but also ensures that the donor is of legal age to consent to the procedure. It would certainly be awkward—if not unethical—for a cirrhotic parent to consent to both his or her own operation and the donor’s operation. Careful screening tests must be performed to evaluate the health and suitability of the donor. These tests include basic laboratory tests, a full medical evaluation, and imaging (CT or MRI) of the liver to determine the size of each lobe and the vascular (blood vessel) anatomy.

The decision to donate part of one’s liver can be extremely difficult. By definition, the donor is healthy and, therefore, does not need major abdominal surgery and its attendant risks. Many factors must be considered in this decision, including the medical issues mentioned previously. Does the donor have something to gain from the operation—specifically, more quality time with the healthy recipient? How would the donor feel about the surgery if he or she developed a complication? What about if the recipient had a complication or died? Psychiatric evaluations are conducted to ensure that the donor does not feel unduly pressured by other family members and is truly willing to undergo the procedure.

As with any surgical procedure, there are risks involved in donating a part of the liver. Living donors receive general anesthesia for the operation, and live donor liver transplantation is considered major surgery. All patients experience some discomfort and pain after an operation. Living donors may develop complications such as infections, bleeding, or even death.

Although most donors report an overall positive experience, it is possible to have negative psychological consequences from such a donation. There may be pressure from family members or even from themselves to donate. If there is any ambivalence on the donor’s part, he or she may feel guilty. If the donor evaluation determines that the potential donor is not suitable, feelings of resentment from the recipient or his or her family may arise. Similar feelings may occur if, after donation, the recipient has an episode of rejection. It is important that potential donors, recipients, and their families be aware of these issues and have adequate support available if any occur. These supports come from the transplant team, mental health professionals, and close friends and family

Of course, there are also many positive aspects to living donation. Although donating a part of the liver offers no direct medical benefit for the donor, it has significant advantages for the recipient. The surgery can be scheduled at a time when the recipient is in fairly good physical condition (timing is very important—the recipient should neither be too sick nor too well). Because LDLT is an elective operation, the surgery can be scheduled at a time that is convenient for both the donor and the recipient. A live donor transplant shortens the length of time the recipient must wait for an organ, usually shortens the hospital stay, and eliminates the stressful period of waiting for a suitable organ to become available.

Living donation also offers the donor and the recipient more time together, once the recipient becomes healthy again. This extra time enhances both parties’ lives. The recipient can experience positive feelings, knowing that the gift came from a loved one. The donor can be comforted, knowing that he or she has helped not only a loved one but also another person on the waiting list, who can now receive a deceased donor organ that might have otherwise gone to the living donor recipient.

There is an extremely small risk of donor death due to the operation. This risk is estimated to be less than 0.2%, or 1 in 500. To date, three deaths have been reported in adult right lobe liver donors in the United States. Additionally, one live donor required transplantation soon after donation. There were no known similarities in the donors who died.

The average donor will be in the hospital for 7 to 10 days and will need to stay near the transplant program for approximately 1 week after discharge. The donor can recover at home but will need some assistance from friends and family as he or she recuperates from this major abdominal surgery. During the first few weeks after the surgery, the donor can accomplish many of the activities of normal living but will need help performing tasks that require lifting more than 5 pounds. Activity can be gradually increased over the next few weeks. The donor is typically out of work for 6 to 8 weeks depending on the type of work he or she does. For example, donors with sedentary jobs may be able to return to work at least part time in 6 to 8 weeks. Donors who perform manual labor usually need 8 to 12 weeks to recover.

Much like the recipient, the donor can expect some indirect expenses related to the evaluation and hospitalization. The donor’s—or, more likely, the recipient’s—health insurance will cover the donor’s tests and physician and hospital expenses. Insurance companies rarely pay for the donor’s transportation costs, food, lodging, child care expenses, or lost wages. Additional sources of funding, such as savings accounts, fundraisers, and the recipient, may be necessary to cover these costs. Coverage for postdonation complications varies from one insurance plan to the next and should be investigated before donation.