Living donor liver transplant at Erasmus MC

What is living liver donation?

During the living liver donation procedure, part of a living person's healthy liver is removed and transplanted into a patient to replace an unhealthy liver. This surgery is possible because the liver has a unique ability to grow back to its original size. We call this the ability to regenerate.
The donor is the person who donates the liver, for example part of the liver. The recipient is the person waiting for a liver transplant.
The waiting time to receive a liver after a donor's death (post-mortem liver transplant) is unpredictable. While waiting for a donor organ, liver disease can worsen and the recipient may even die.
Living liver donation is one of the ways a recipient can receive a liver transplant. This form of donation is planable and can prevent the death of the potential candidate for liver transplantation.

Benefits and risks!

Living donor liver transplantation has several benefits, including:

• the greatest chance of a successful transplant result;
• the possibility of preventive transplantation;
• avoiding a long wait on the waiting list for post-mortem liver transplantation;
• better planning of donation and transplant surgery; because the transplant date is known in advance, the operation can be scheduled at a time convenient for both parties;
• an overall faster recovery and better long-term outcomes, as a healthy part of the liver is transplanted;
• increase in the number of organs available to people on the waiting list.

There are risks associated with every surgery. Our living donor liver transplant team has extensive experience in living donor liver transplantation, reducing and minimizing risk to both donors and recipients. It is rare for a donor to develop a complication that requires further medical or surgical treatment.

Potential Risks Of Living Liver Donation

• Bile leakage – this occurs in a small number of living donors and usually resolves on its own. Sometimes the insertion of a drain into the liver is necessary for recovery.
• Infection - infection of the surgical site occurs in some donors. If this happens, you will be closely monitored by our transplant team to minimize health problems.
• Organ damage or other problems - living liver donation can in very rare cases result in organ damage or failure, other complications or even death of the donor.

How can I learn more about living liver donation?

We understand that it can be a very difficult decision to become an organ donor. Our transplant team supports you every step of the way in the donation process.

We provide you with comprehensive information about:

• the requirements to become a donor;
• the process of living liver donation;
• benefits and risks of living donor liver transplantation;
• Frequently Asked Questions;

Who can become a donor?

Criteria and Requirements for Living Liver Donation

A potential donor must meet the following criteria and requirements:

• age between 18 and 55 years;
• excellent physical and mental health;
• a BMI below 33;
• no active drug use or substance abuse;
• altruistic desire to make a positive contribution to someone else's life;
• suitable match with the receiver.

How can I become a living liver donor?

Living donors can donate part of their liver to a known patient with whom they may or may not be related. We call this related or unrelated targeted donation. An altruistic donation to an unknown recipient is called an unrelated, undirected donation. The liver grows back to its original size in about three months after donation. Every donation is different. Our experienced transplant team will guide you through the entire donation process.

A potential donor can withdraw from donation up to the last minute before the operation and without stating reasons!

Assessment prior to donation

The living donor liver transplant team coordinator can provide information about living donation and the assessment process.

During the living liver donation process, you will have appointments with the following doctors and other members of the transplant team:

• liver transplant surgeon;
• transplant hepatologist (liver doctor);
• living donor liver transplant team coordinator;
• advocate of the living donor liver transplant team;
• transplant social worker;
• transplant psychologist;
• anesthesiologist.

Other necessary investigations include:

• radiological images of the liver;
• ultrasound of the heart (echocardiogram) and an electrocardiogram (ECG);
• X-ray of the lungs and lung function tests, both non-invasive;
• liver biopsy;
• blood tests to rule out the following conditions:
  • communicable diseases (such as hepatitis, HIV);
  • underlying liver diseases (such as fatty liver);
  • other serious medical conditions that could make liver donation unsafe for you or the recipient.

The assessment phase takes approximately two weeks but can be accelerated in special circumstances.

Surgical procedure of liver donation

On the day of the operation, you will be admitted to the hospital and meet the surgeon and anesthesiologist who will perform the liver transplant. Family members can wait in the hospital and will be informed of the progress after surgery. The full surgical procedure generally takes five to seven hours.

The surgeon makes an incision in the abdomen to safely locate and remove part of the liver. Up to 70% of the liver can be donated, depending on the recipient's body size. The gallbladder is also removed.

If at any time prior to surgery you are unsure whether you wish to proceed with the donation, you can withdraw your consent to the surgery at any time. If at any point during the surgery the surgeons judge that you are at risk or that your liver is not suitable for transplantation, the surgery will be aborted.

Stay in the hospital

Every donor is different but the usual length of hospitalization is five to seven days. After surgery, a drain is left in the abdomen to drain excess fluids for the first three to four days after surgery. Most donors are able to resume normal light household duties after a week and generally return to work after four to six weeks.

Post-donation checks

After discharge from the hospital, you will have a number of appointments with your surgeon and general practitioner.

After discharge from the hospital, you will have a number of appointments with your surgeon and general practitioner.

• one week and four weeks after hospital discharge;
• three months after discharge;
• six months after discharge;
• one year after discharge;
• appointments thereafter as required.

The liver starts to regenerate a week after surgery and is fully recovered within two to three months.
The Erasmus MC living donor liver transplant team is at hand to provide comprehensive information to potential living liver donors before, during and after liver donation. Our goal is to perform living donor liver transplants to the highest standards, safely and successfully, for both potential donors and recipients.

Donor safety comes first!