Living Donation

The liver is the only solid organ that can grow and regenerate! Living donation is an option for a healthy, living person to donate a portion of his or her liver to another person in need. The first living donation for liver transplant in the U.S. took place in November of 1989.  Since this time, many centers have performed living liver donation for the benefit of children and more recently, adults with liver failure.

As there are currently not enough organs donated for the number of people who need transplantation, living donation means that more patients have access to organ transplantation when they need it. Other advantages include:

• The transplant surgery can be planned for the best time for the child.
• Because the surgeries are performed in the same or nearby hospital and organ travel time is not a factor, liver “cold time” (time without blood flowing through the organ) is decreased. This increases the chance for good liver function after the transplant.

All potential donors will work closely with our living donor coordinator who will guide you through the process and answer any questions. Potential donors will need to have medical and life insurance and a compatible blood type. To get started, please fill out this form.

What to Expect

When an adult is interested in becoming a living donor for liver transplant, he or she must first contact the liver transplant coordinator. This is a nurse who coordinates the process of transplantation for the child. The transplant coordinator will meet with this person to educate him or her about living liver donation. The possible donor is informed of any alternatives to transplant for the child during this phase. If he or she is still interested in donation, that person will then begin evaluation as a donor. During the evaluation, the physical and psychosocial status of that person is examined to decide if he or she would be an acceptable donor. During the evaluation it must be decided that the donation surgery will be relatively low risk for the adult. It must also be decided that the piece of liver donated will function well for the child receiving the transplant.

During this process the possible donor can make an informed decision as to whether or not they wish to undergo liver donation surgery. At any point during the evaluation, the donor can decide to not continue with donation or the doctors may deem it inappropriate to donate due to findings from the evaluation process. If the possible donor decides that he or she would like to continue with plans for surgery and the medical evaluation results are good, the transplant surgery is scheduled. The donation surgery will be performed at Primary Children’s Hospital or Intermountain Medical Center, and the donor will stay at the hospital for approximately one week following surgery to recover.

Evaluation

Evaluation begins with an interview with the transplant coordinator.  During this interview, the coordinator will ask questions about the possible donor’s health history and current medical condition.  Any concerns that arise from this interview will be discussed with the liver transplant team for further recommendations.  If the blood type is not known, this will be drawn to find out if the blood type is compatible with the child who will receive the transplant.  

The rest of the evaluation includes a number of tests and consults with physicians.  A computed tomography (CT) angiogram of the abdomen will be scheduled.  When the possible donor arrives for this test, an IV will be started and dye will be given.  Pictures are then taken of the liver to measure the size of the liver and to look at the liver tissue with x-rays.  The liver piece must be big enough to work for the child, but small enough to fit into the child’s abdomen. The angiogram is the part of this test that examines the blood vessels of the liver.  From the CT pictures, the physicians can estimate the size of the blood vessels and see how the blood vessels branch as they provide blood to the liver.  About 30% of all people have a type of blood vessel branching that will not allow them to be a living liver donor.  

Blood samples will be drawn from the possible donor that will give the transplant team an idea of the overall health of the adult.  Some of these tests will give the transplant team information about infections that he or she may have had in the past.  A chest x-ray and EKG (an electrical tracing of the heart rhythm) will be done.  An appointment will be scheduled with an internal medicine physician for a complete physical exam.  This physician will perform a physical examination and review the test results to decide if the risk of the surgery is about average or greater than average for that adult.  The possible donor will also talk with a psychiatrist or psychologist to discuss the thought process which has gone into the wish to donate, social support that will be available after surgery, psychological ability to undergo transplant donation, and understanding of the risks of donation surgery.  One of the final procedures is called an MRCP or Magnetic Resonance Cholangeopancreatogram.  This test gives the surgeon information about the bile ducts of the liver.

The possible donor will also meet with the Living Donor Advocate during the evaluation.  This is a professional who is responsible for representing and advising the possible donor throughout the evaluation process.  The donor advocate’s job is to protect the rights of the donor and to assure that the possible donor’s interests are being addressed.  He or she also ensures the possible donor is well informed about donation and that the decision to donate is free from outside pressure to donate.  

Results

When all of the results of the evaluation are available, the team will review and discuss those results. They will discuss whether the risk of the surgery is acceptable for the donor and if the piece of liver is appropriate for transplantation in the child. If the possible donor feels at this point that they wish to go ahead with the donation, a surgery time will be scheduled.

Surgery

The donor will be asked to have blood drawn the day before the surgery, and he or she will also be asked to take some medications to clean out the intestines that day. Donation surgery and transplant surgery will take place on the same day. The donor will come to the hospital on the morning of the transplant. He or she will be prepared for transplant through the outpatient surgery department and will enter the operating room through this area. Usually, the donor surgery will begin 1 to 2 hours before the child’s surgery.

The incision will be a large incision on the front of the abdomen. Donation for a small child involves taking a part of the liver called the left lateral segment from the donor. This is about 25 - 30% of the liver. Larger children will need a larger portion of the liver, either the full left segment or the right segment of the liver. Surgeons carefully tie off blood vessels and bile ducts as they remove this part of the liver from the donor. The donation surgery lasts between 5 and 7 hours. It may be necessary for blood to be given during or after the procedure, but this is not common.

Recovery

When the surgery is complete, the donor will be taken immediately to the Intensive Care Unit where they will recover for the first night. The donor will have a number of tubes and wires attached when he or she arrives in the unit. IVs (intravenous catheters) will be in place to aid in the delivery of fluids and medicine while the donor is unable to drink or eat. Pain medicines and antibiotics will be given through these IVs. A nasogastric tube (NG) will be in place through the nose and into the stomach and will be attached to suction to drain the stomach fluids while the stomach and intestines recover from the anesthesia. A foley catheter will be in place to drain urine from the bladder while the patient is unable to get out of bed. Surgical drains may be in place around the abdominal incision to drain fluids from the abdomen. Wires will be attached to the skin with ‘stickers’ that will allow the nurses and physicians to monitor the patient’s heart and respiratory rates. Oxygen may be provided by a small tube under the nose. Inflatable ‘boots’ will be wrapped around the feet and will be automatically inflated every few minutes to keep blood flowing in the legs and prevent blood clots from forming.

If the donor is stable overnight, he or she will be transferred to the medical or surgical unit for the remainder of the hospitalization. The total hospitalization is usually about one week. The patient will be asked to begin getting out of bed the day after surgery to decrease the risk of complications such as blood clots and infections. They will also be asked to perform breathing exercises many times each day to decrease the risk of pneumonia. Tubes will be removed one by one as the recovery continues. The patient will be released from the hospital when he or she is able to drink enough fluids by mouth and pain is controlled by pills that are swallowed. Discharge from the hospital usually occurs about 1 week after surgery.

Returning Home

The donor will need help at home. He or she will be unable to lift more than 10 pounds for several weeks. Energy levels will be very low in the beginning and may not return to normal levels for several months. Appetite is usually quite low for many weeks. Many donors say that they feel they have to force themselves to eat in order to heal and recover. The donor will be unable to return to work for 6 to 8 weeks. A surgical follow-up clinic appointment will be scheduled for 2 weeks following discharge from the hospital. Other follow-up appointments will be made according to the need of the donor. You will receive calls from the transplant coordinators from time to time to ask about how you are doing after the surgery.

Risks and Complications

Pain is a major factor following living liver donation. The donor will be given either a Patient Controlled Analgesia (PCA) pump from which they can control their own pain medication within limits, or they will be placed on an epidural medication system that will deliver pain medication directly into the spinal cord space to nerves that affect the surgical area.

Depression has occurred in some people who have donated a part of their liver. We encourage the donor and his or her family to be aware of this risk and to let the transplant team know if there are any signs of depression.

It has been reported that physical complications (including major and minor complications) occur in 15 - 20 % of cases. Some of the reported complications include pain, bleeding, bile leaks, cholestasis (reduced flow of bile out of the liver), biliary strictures (narrowing of the bile ducts), injury of the blood vessels of the liver, fluid collections, gastritis, problems with digestion, pancreatitis (inflammation of the pancreas), muscle weakness, hernias, infections, spleen injury and pulmonary embolus (blood clot in the lung). It has been estimated that about 50% of the complications require an additional procedure, surgery, or prolonged hospitalization for treatment. The risk of major complications including death is less than 1%, however deaths have been reported as a result of living liver donation.

Other Considerations

Some insurance companies will not cover the costs associated with donation evaluation or surgery. The transplant team will assist the family to investigate their insurance benefits for living liver donation. There is a possibility that future health problems related to the donation may not be covered by your insurance, and your ability to obtain health, disability, or life insurance may be affected.

The sale or purchase of human organs is a federal crime. It is against the law to knowingly get, receive, or otherwise transfer human organs in trade for anything of value.

As there are currently not enough organs donated for the number of people who need transplantation, living donation means that more patients have access to organ transplantation when they need it. Other advantages include:
The transplant surgery can be planned for the best time for the child.Because the surgeries are performed in the same or nearby hospital and organ travel time is not a factor, kidney “cold time” (time without blood flowing through the organ) is decreased. This increases the chance for kidney liver function after the transplant.All potential donors will work closely with our living donor coordinator who will guide you through the process and answer any questions. Potential donors will need to have medical and life insurance and a compatible blood type. To get started, call our kidney transplant office at 801-662-6800.

What to Expect

There are several phases in the donation process, including evaluation, surgery and recovery. As with any surgery, it is also important to be aware of the risks associated with kidney donation.

Evaluation

The evaluation helps determine if, as the donor, you match the recipient. In the first stage of evaluation, you’ll undergo tissue typing and lab screenings. Blood and tissue typing checks to see if you and your recipient are compatible, and how well the kidney will be accepted by the recipient. Comprehensive lab testing may include, but is not limited to, the following:

• Blood test
• Urine test
• Gynecological exam
• Colonoscopy (if over age 50)Cancer screening
• Antibody screen

If these lab results are suitable, you’ll next meet with transplant physicians to discuss the procedure and its risks. The physicians and surgeons will review your results and will require additional testing, such as X-rays, electrocardiograms, or radiologic testing. This testing will include a full day of appointments and diagnostic testing. During this time, you will also meet with our psychologist, Donor Advocate, and nurse coordinator. Further testing may also be required.

Results

Once the work-up is completed, your case will be presented to the multidisciplinary transplant team. This team includes surgeons, nephrologists, psychologists, donor advocates, and nurse coordinators. They represent you and make decisions that are in your best interest regarding the transplant.

It is important to note that, as a donor, you will have a different transplant team from your recipient. Your team cares for you exclusively. It is a common fear that donors are viewed as a kidney and not as a person; however, at Primary Children’s Hospital and University of Utah Medical Center, organ donors are given the same considerations and respect as all of our patients.

At any time during the evaluation process, up until the moment of surgery, you are entitled to change your mind about the donation. This decision is made with your physicians and is kept completely confidential.

Surgery and Recovery

If you are approved for the donation after all the tests are completed, the surgery will be scheduled. The surgery is usually scheduled six to eight weeks in advance. Typically, a living kidney transplant donor spends two days in the hospital and will have an additional four to six weeks of recovery time. Donors who are from out of town should plan on spending an 2 weeks in town after they discharged from the hospital.

During recovery, you will experience some pain and discomfort. This should be easily relieved with either a prescribed medication or over-the-counter pain relievers. For two weeks, you should avoid driving, and you should avoid picking up anything that weighs more than ten pounds for six weeks following surgery. You are encouraged to walk several times a day. If you have children, you may need initial help in caring for them.

Depending on the type of work you do, you may be able to return to your job as soon as two or as long as eight weeks after surgery. There will be follow-up tests to monitor your health.

Post-Donation NSAIDs Restrictions

Donors should not take non-steroidal anti-inflammatory drugs (NSAIDS). Tylenol is the only over the counter pain reliever that should be used post donation. 

Risks and Complications

As with any surgery, live kidney donation has its risks:

• Anesthesia, and possible allergic reaction to anesthesia
• Pain and discomfort
• Infection
• Bleeding and blood loss which requires transfusion
• Blood clots
• Fever
• Nausea
• Urinary tract infection
• Pneumonia
• Injury to surrounding tissue and other organs
• Scarring
• Death

Other Considerations

Some insurance companies will not cover the costs associated with donation evaluation or surgery. The transplant team will assist the family to investigate their insurance benefits for living kidney donation. There is a possibility that future health problems related to the donation may not be covered by your insurance, and your ability to obtain health, disability, or life insurance may be affected.

The sale or purchase of human organs is a federal crime. It is against the law to knowingly get, receive, or otherwise transfer human organs in trade for anything of value.

Donate Life >

Donate Life America assists in mobilizing the transplant community to educate the American public on the need for organ, eye and tissue donation and motivating the public to make an actionable donor designation. The organization publishes brochures, program kits and other materials; provides technical assistance and referral services; coordinates the national campaign for organ, eye and tissue donation; identifies measurable best practices and leads the Donor Designation Collaborative.

Living Donors Online >

The online community for living donors, potential donors, their families, and the medical community.

National Living Donor Assistance Center >

Providing financial assistance to those who want to donate an organ, priority is given to individuals not otherwise able to afford the travel and subsistence expenses associated with living organ donation.

Transplant Living >

Transplant information website provided by the United Network for Organ Sharing (UNOS), a nonprofit organization that maintains the national Organ Procurement and Transplantation Network (OPTN) under contract with the Health Resources and Services Administration of the U.S. Department of Health and Human Services.

Primary Children's Hospital is committed to outcomes management and performance improvement. Learn more about our outcomes for each program from the Scientific Registry of Transplant Recipients. 

Liver Disease & Transplant Outcomes >

Kidney Transplant Outcomes >