Living liver donation

The first living liver transplant was performed at the University Hospital Zurich in 2000. By the end of 2020, 74 liver transplants from living donors had been performed at the USZ.

In the case of a living liver donation, the recipient does not have to wait indefinitely on the waiting list for an organ. This means that the transplant can be carried out at an earlier stage before the recipient is weakened by an advanced stage of the disease. The fact that the time of the operation can be planned precisely means that the recipient is optimally prepared for the operation.

What are the requirements?

  • Potential donors should be no older than 55 and in good health, which must be assessed by an independent, interdisciplinary team of specialists in psychology/psychiatry, hepatology and surgery.
  • Potential donors must be fully informed about the operation and the associated risks.
  • Potential donors must have reached the age of majority and be intellectually capable of understanding the procedure.
  • Potential donors must be related to the recipient or have been friends with them for a long time.
  • Potential donors must be willing to participate in long-term follow-up care.
  • The blood groups should be compatible, but do not have to be identical. The Rhesus factor plays no role in liver transplantation.

What are the risks?

Living liver transplantation is showing very good results worldwide. These are equivalent to those of liver transplants from brain-dead donors.

Nevertheless, there is a small residual risk for both the recipient and the donor.

Donor surgery, which is performed by highly experienced transplant surgeons, is now considered a very safe operation. However, as with other liver operations, complications can also occur here.

Living liver donation is associated with a mortality rate (mortality risk) of 0.3 %-0.5 %. This risk is minimized as much as possible through extensive preoperative clarifications. Bleeding occurs in 1%-3% of patients, which may necessitate a repeat operation. In around 5% of patients, a bile leak or infection develops in the surgical site, which prolongs the hospital stay. As a rule, these complications are treated by inserting a drain under local anesthesia. Furthermore, temporary liver dysfunction occurs in about 7% of patients. Other rare complications are blood clots in the leg veins (thromboses), which can lead to pulmonary embolisms and are rarely fatal.

The liver is the only solid organ in the body that has the ability to regenerate itself. The livers of both donors and recipients return to their normal weight after around four weeks. Half a liver is enough to live on and the donor’s liver function will have normalized after just a few days. Normalization of liver function may take longer for the recipient.

Based on our experience with liver resections that have to be performed on patients with liver tumors, we know that 25% to 30% of the remaining liver volume is tolerated by the donor without any problems.

Why voluntariness is so important

A living organ donation is probably one of the most meaningful gifts that one person can give to another. Since far too few organs from deceased people are available, living liver donation can help liver patients to receive an organ more quickly. For legal reasons, liver donation must be on a voluntary basis and without financial compensation. The costs for the extensive preliminary clarifications and the procedure as well as the aftercare are borne entirely by the liver recipient’s insurance company.

The medical costs incurred for the assessment, operation and aftercare of the donor are covered by the recipient’s insurance. Loss of earnings is also compensated, but not travel costs, risk insurance premiums or household help.

What clarifications are necessary?

In order to minimize the risks of a living liver donation, thorough clarification is required:

  • A psychological examination is carried out on an outpatient basis to check whether the liver donation is voluntary. The suitability of the potential donor is assessed by an independent team of liver specialists, internists and psychologists. If there are no objections to a living liver donation, the potential donor will be invited back to the USZ for an outpatient day.
  • During this day, heart and lung function tests are carried out. In addition, the blood flow and the size of the liver are checked using angiography (angio MRI) and magnetic resonance cholangiopancreatography (MRCP) with 3D imaging. In addition, a liver biopsy can optionally be performed to rule out liver disease.
  • In addition, the donor is examined by various specialists from the fields of anesthesia and intensive care medicine during the stay.
    The main aim of all examinations is to keep the surgical risk for the donor as low as possible.

After the donor is discharged, a joint decision is made on the possibility of a living liver transplant in a transplant colloquium. If there are concerns about the safety of the donor, the living liver transplant will be rejected.

What happens during the operation?

One day before the operation, the donor is admitted to the Department of Visceral and Transplant Surgery at the USZ.

The operation is performed under general anesthesia. In an operation lasting around 6 hours, either the left or right half of the liver, including the associated blood vessels and bile ducts, is removed. The remaining half of the liver with its bile ducts and blood vessels is not affected. They are then taken to the intensive care unit. Depending on your degree of recovery, you will be transferred back to a ward as soon as possible.

How are living donors cared for afterwards?

The surgical wound may still hurt in the first few days, but this can be treated with painkillers. Patients are mobile again within 2-3 days. The living liver donor can eat normally after the initial recovery phase and does not require any medication. If there are no complications, the hospital stay lasts approx. 7-10 days. The patient is then given the opportunity to fully recover from the operation during a rehabilitation stay. Finally, the patient is discharged home. In the first week after discharge, the donor is examined in our transplant consultation. No heavy lifting is allowed for a total of 6 to 12 weeks after the operation. 6 months after the operation, liver regeneration is monitored using ultrasound or CT/MRI. If there are no problems, annual check-ups are then planned at the university hospital.
Experience shows that almost all liver donors are able to work again after two to three months.

What are the results?

Living donor liver transplantation has very good results worldwide. The results of living donor transplants and liver transplants from brain-dead donors are to be regarded as equivalent.

The 1-year survival rate for both forms of transplantation is around 90% worldwide.

Living liver transplantation has the following advantages:

  • Only perfectly healthy people are admitted for living donation, which is clarified very precisely in various examinations.
  • The partial liver removal and transplantation take place directly after each other, so that the organ is only outside the body for a very short time.
  • The procedure can be planned and takes place under optimal conditions.
  • Living donation is a chance at life for the recipient.

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