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Jean C. Emond, MD, the Vice Chairman and Chief of Transplantation for the Center for Liver Disease and Transplantation (CLDT), was a leader in developing this procedure – first performed in children in 1989 and later expanded to adults. The CLDT now is one of the largest and most successful living donor programs in the world and one of the only programs in the nation offering living donor transplantation in post-adolescents. Today, approximately 30 percent of CLDT's transplant patients receive portions of livers donated by living donors. The CLDT also is one of nine centers in a National Institutes of Health (NIH)-funded study of living donor transplantation in adults.
Becoming a Living Donor
The general criteria for a liver donor include good general health, a blood type that is compatible with the recipient's, and an altruistic motivation for donating.
Potential liver donors are evaluated carefully to ensure they can safely donate a portion of their liver that will function immediately following transplantation. The primary concern throughout the evaluation is the safety of the donor. Therefore, the CLDT's physicians will not allow anyone to donate if the estimated the risk of death for the donor exceeds 1 percent. The CLDT's living donors have experienced few complications after surgery and during recuperation and all currently are alive and well – although there are risks involved in this procedure. Those risks include, but are not limited to bleeding, infection, bile leakage, and possible death.
As a living donor, your medical expenses – including evaluation (if performed by the CLDT team), physicians' fees and hospitalization – will be covered by your recipient's insurer.
Evaluation
If you are interested in becoming a living donor for a family member or someone emotionally close to you, it will be necessary for you to be evaluated. The standard time required to complete the donor evaluation process is two to four weeks. If necessary, however, it can be completed in as little as 48 hours. During your evaluation, you will have the opportunity to talk to the living donor transplant team to learn more about what is involved in being a living donor
Most of your medical evaluation will take place at the state-of-the-art Beverly & Arthur Shorin Comprehensive Transplant Outpatient Center located at NewYork-Presbyterian/Columbia.
The tests include:
- Blood tests – The first testing will determine if your blood type is compatible with that of the recipient's. Additional blood tests are performed to test for healthy functioning of the liver, kidneys, and thyroid, and to screen for exposure to transmittable viruses such as hepatitis and HIV, the virus that causes AIDS.
- Physical examination – One of the CLDT physicians will further assess your overall health if it is determined that your blood type and the blood type of the recipient are compatible.
- Abdominal ultrasound – This testing is performed to screen for abnormalities of the liver and other abdominal organs and blood vessels.
- Magnetic resonance imaging (MRI) – This is performed to create a detailed anatomical "road map" of your internal organs to aid the surgery.
- Social work and psychiatric consultations – These are scheduled to ensure that you totally understand and are psychologically and emotionally prepared to be a living donor.
The Living Donor Surgery
The surgery will take place at NewYork-Presbyterian/Columbia. While you are under general anesthesia, your surgeon will remove the right or left lobe of your liver, depending on your size and the size of the recipient as well as the blood supply to the liver – although the larger right lobe usually is transplanted into adult recipients. Depending on which part is removed, the incision either is straight up and down or in the shape of an inverted "T." During the operation, the surgical team uses sophisticated intraoperative ultrasound to reveal the anatomy of all your liver's vessels. This is very important because it is crucial that the surgeon preserves all blood vessels in the liver graft to ensure its viability after being transplanted into the recipient. An ultrasound surgical aspirator enables the surgeon to dissect your liver meticulously with limited blood loss. So far, no CLDT living donor has required a blood transfusion following surgery. As soon as the graft is removed, it is flushed and then iced, and then taken to the adjacent operating room where the recipient will receive your very generous gift. Your surgeon will close the incision with self-absorbing sutures or with staples that later are removed during a follow-up visit to the surgeon's office.
You will spend your first night after surgery in the Surgical Intensive Care Unit for close monitoring by specially trained nurses. The following day, you probably will be transferred to the general surgical floor where the nurses are specially experienced in caring for liver donors.
The pain you will experience after your surgery, as well as back pain associated with the length of time spent on the operating table, can be treated by the transplant team with appropriate pain medication.
You will be encouraged to get out of bed and sit in a chair the day following your surgery and, as soon as you are able, to walk the corridors of your surgical floor. You probably will remain in the hospital for four to seven days after surgery.
Recovery
Your liver will begin to heal and it will regenerate itself six to eight weeks following surgery. Every donor's recovery time is different, but most spend four weeks recuperating. For the first post-operative month, you will return weekly to the Beverly & Arthur Shorin Comprehensive Transplant Outpatient Center for monitoring. How soon you will be able to return to work will depend on how soon you recover and your occupation – the average time is about three to six weeks.
