If you’re in need of a liver or thinking about donating, you probably have lots of questions. How much does it cost? Who can donate? What are the risks? Here’s everything you need to know about the process.
What Is a Living-Donor Liver Transplant?
A surgeon can take out the part of your liver that doesn’t work. They replace it with a piece of healthy liver from someone who’s alive. Your liver is the only organ that can regenerate, or grow back. Eventually, both the donor and recipient will have full-size livers again.
It’s different from a traditional liver transplant. That’s when a surgeon replaces your whole liver with one from someone who has died.
Does COVID-19 Affect the Transplant Process?
Some hospitals are still doing living-donor transplants. But others may hold off for a bit. Talk to your transplant team to find out. If they’re not doing them for a while, reach out to the Organ Procurement and Transplantation Network. They may be able to help.
What Are the Benefits of a Living-Donor Transplant?
There are a few reasons why this kind of liver transplant may be better for you. You can:
Skip the wait list. It’s typically faster to get a transplant through a living donor. A lot more people need livers than can get them from a deceased donor. More than 12,000 people waited for a new liver in 2020. But in 2019, fewer than 9,000 received one through a traditional transplant program
Schedule surgery when you feel good. You have to wait until you’re really sick to get a traditional liver transplant. But living-donor transplants can be done before you start having serious health problems.
Heal faster. You’ll likely leave the hospital quicker than if you have a traditional transplant. You’re also less likely to need a blood transfusion or dialysis after the procedure.
Have a better outcome. Your liver may last longer if it comes from a live donor. Studies show people who got a living-donor liver transplant lived a little longer than those who got a liver from someone who died. But that might be because people who get living-donor transplants usually aren’t as sick when they go in for surgery.
Who Can Be a Living Donor?
Most of the time, donors are friends or family members. But you can donate your liver to someone you don’t know. That’s called nondirected or anonymous live liver donation.
Every donor has to meet certain conditions. They include:
- You must be at least 18 years old
- Your liver must be in good condition
- You can’t have a serious health condition
- You must have a blood type that works for the recipient
- Your body mass index (BMI) must be less than 35
- You can’t have an alcohol or other substance abuse problem
Right now, you can’t donate your liver if you’ve tested positive for COVID-19. That could change in the future as experts continue to learn more about how the virus affects the body. You also can’t get paid for donating. The National Organ Transplant Act makes that illegal.
If you’re interested in donating during the pandemic, you may be able to start the process through a phone call or video visit.
Who Is Eligible for a Living-Donor Transplant?
You need a transplant when your liver doesn’t work the right way and no other treatments can help you get better. That can happen with certain end-stage liver diseases.
Adults and children can get a living-donor liver transplant. But kids get the surgery more often. They only need a small part of an adult liver, which can make recovery a lot easier on the donor.
Who Isn’t Eligible for a Living-Donor Transplant?
You may not be able to get this transplant if you have:
- A really serious liver disease
- An ongoing infection
- An alcohol or substance use disorder
- Nonliver cancer
- Another serious medical illness
What Are the Risks?
Living-liver donation is generally safe for the donor and it’s often life-saving for the recipient.
Your doctor will go over all the pros and cons. Like any surgery, there are risks and possible side effects. Some are mild, while others are more serious. Rarely, the donor or recipient’s liver could fail or they could die.
If you’re the donor or recipient, some possible risks include:
- Bile leaks
- Blood clots
- Hernia (when part of an organ sticks out of an incision (where the doctor cut you open)
- Bacterial infection
If you’re the recipient, it’s possible your body could reject the donated liver.
How Do You Prepare for Surgery?
You’ll stay in touch with your health care team. That might include a preoperative transplant coordinator. You can also reach out to a support group for people who’ve gone through the same procedure. Ask your doctor or a social worker at the hospital to help you find the right group.
You should also give up recreational drugs, smoking, and alcohol. Ask your doctor how long you should avoid aspirin or nonsteroidal anti-inflammatory (NSAIDs) drugs.
What Happens During Surgery?
If you’re the donor, the surgeon will make a long cut in your belly. Then they’ll take out part of the left or right side of your liver. That could be 25% to 60% of the organ. The surgery will take about 4-6 hours.
If you’re the recipient, the surgeon will also make a long cut in your belly. They’ll take out the bad part of your liver and replace it with the healthy donor liver. The surgeon will connect veins, arteries, and bile ducts to the donor liver. This could take 6-12 hours.
What Happens After Surgery?
You’ll leave the operating room with some tubes and drains in your body. Some are in your belly to let out trapped air and catch extra fluid and blood. You’ll also get hydrating fluids and medicine through an IV. You may also have a tube in your urethra to drain pee from your bladder.
How Long Will You Be in the Hospital?
Donors usually stay in the hospital for about 4-7 days. Recipients usually stay closer to a week, sometimes longer. No matter which one you are, you’ll spend the first night in the hospital’s surgical intensive care unit (ICU). That way your doctors and nurses can keep a close eye on you to make sure you don’t have any problems.
What Is Recovery Like?
Donor. Everyone is different, but most people get better in 3-6 weeks. But you’ll need go back to the hospital during recovery so your doctor can make sure everything is OK. Your health care team will let you know when it’s safe for you to return to your presurgery activities. Expect to go back to work in 2-3 months.
Recipient. It can take 3-6 months to recover. But it depends on several things, like your age and how healthy you are when you get the surgery. You’ll check in with your doctor regularly while you heal. They’ll let you know when it’s safe to go back to life and work as usual.
Who Pays for the Surgery?
The recipient’s health insurance provider will cover their medical costs and usually the donor’s.
If you travel to donate your liver, you may have to pay for things like gas, plane tickets, lodging, or food. Your recipient may cover those. If not, you can ask for help from the National Living Donor Assistance Center (NLDAC). They’ll also pay a certain amount of additional costs if your stay is affected by COVID-19.