Journey for Living Liver Donors
Before the Donor Operation
Once your transplant recipient has consented to have living donors considered for his or her transplant surgery, you (the potential donor) will need to call the liver transplant office to start the journey to becoming a donor. You will be asked to sign an initial consent form and a potential donor candidate profile form. Once the liver office receives and reviews these forms, you will be called so that the liver donor nurse practitioner can discuss the next steps with you and answer any of your questions. Remember, you are always encouraged to call the liver office if you have any questions along your journey. The liver transplant office can be reached at (410) 614-2989 or 1 (800) 706-1046.
If you are an appropriate live donor candidate, the nurse practitioner will ask you to complete an initial donor candidate questionnaire form and bring it with you when you meet with her. You
will also be asked to complete a series of medical evaluation work-up tests. During this time, you will be seen by a team of specialists who are not involved in the care of the potential transplant recipient. They are there to look after your health, safety and interests throughout the donation process. Going through the medical work-up for a donor surgery does not guarantee that you will be able to donate your organ. You may choose to stop the donation process at any time or, based on your medical history, your team of specialists may also decide that it is in your best interest not to proceed.
The Live Donor Operation
Your medical team will work with you and your transplant recipient to schedule a date for surgery. You will have a pre-operative visit close to the day of your surgery to conduct additional testing/screening and discuss the upcoming operative procedure.
On the day of your operation, you will need to come to the check-in area (the Osler Building, seventh floor) in the main hospital at the requested time. You will be given your check-in time and instructions at your pre-operative visit. During the time that you are preparing for the donor operation, your surgeon will visit you to review the surgery and to answer your potential questions. You may have a few members of your family visit with you before the surgery.
The Live Donor Recovery
The live donor surgery usually takes anywhere from 4 to 6 hours. Immediately after your surgery you will be taken to the Surgical Intensive Care Unit (SICU). Your family will be able to visit with you there once you are fully awake and your vital signs are stable. Typically, after one night in the SICU, you will be transferred to your hospital room (usually on Nelson 7). Your family and friends will be able to visit with you there, as well. The in-hospital recovery usually takes from 4 to 10 days.
When the transplant team discharges you from the hospital, you will need to have someone pick you up and take you home. Your recovery will continue when you go home, so you will be asked to avoid certain activities and follow living donor post-operative guidelines. Your Hopkins medical team will schedule you to meet with your surgeon at clinic the week after your operation and at regular clinic visits for the year after that, as outlined in the post-operative guidelines. Your transplant team will also need to see you annual check-up visits.
Frequently Asked Questions
Who can donate?
Who can you ask to donate?
What are the matching requirements between a donor and the recipient?
What are the physical requirements for the donor?
What are the advantages of a living donor procedure for the recipient?
Do the donors benefit in any way from this procedure?
Testing and preparation
What tests will take place?
Will my insurance company cover this procedure?
What are the risks for the donor?
Surgery and recovery
What portion of the liver is donated?
How does the operative day progress?
How long is the donor in the hospital?
What if the transplant doesn't work?
At home
How long does it take for the donor's liver to regenerate?
How long before the donor can return to work?
Who can donate?
Who can you ask to donate?
Anyone between the age 18-50 can be asked to donate. Potential donors might be found among your family, close friends and coworkers. Compatibility will be determined by your transplant team.
What are the matching requirements between a donor and the recipient?
The donor needs to be a compatible blood type, but not necessarily the same blood type. Some blood types are compatible with others and do not hae to be an exact match. In addition to the blood type, a cross match is performed. This is a test to look for the presence of antibody in the recipient's blood, directed towards the donor's cell types.
What are the physical requirements for the donor?
The living liver donors can be either male or female, and must be in excellent physical condition. The donor candidates undergo a physical exam by a hepatologist and a transplant surgeon, with tests for any evidence of liver disease. In addition, radiological tests are performed to detemine the donor's liver anatomy, as well as the exact anatomy of the blood vesses and the bile ducts. At this point, our team can determine any potential incompatibilities.
What are the advantages of a living donor procedure for the recipient?
There are many positive aspects of living donation. The early function of a living liver donation is excellent in that these portions of the liver are removed from donors who are entirely stable. The time for surgery can be agreed upon, rather than performed as an emergency operation when a cadaveric donor becomes available.
Do the donors benefit in any way from this procedure?
Although this procedure will not benefit the donor in any medical sense, the generosity of this gift can bring great personal rewards. This is one of the few chances in life to become a real hero through this expression of care and love. This donation must be an individual choice, a decision the donor makes without the pressure of family members or other outside influences. Once the decision is made with comfort and confidence, the donor gives with the knowledge that the recipient has a renewed hope for a healthy life. Many donors say it is one of the most fulfilling and meningful events in their life.
Testing and preparation
What tests will take place?
After determining tht the donor and recipient's blood types are compatible, the donor will undergo a medical history and complete physical examination. Tests include tissue typing, crossmatching and antibody screening, urine tests, chest x-rays, an electrocardiogram (EKG), liver biopsy and an arteriogram. The donor and recipient may also undergo a psychological evaluation. The transplant team will review these tests in detail and address any questions or concerns.
Will my insurance company cover this procedure?
Health insurance coverage can vary for living donation. Many insurance companies have agreed to provide coverage. Attempts will be made to have the recipient's policy also cover the cost of the donor's procedure. If the recipient is covered by a private insurance plan, most insurance companies pay 100% of the donor's expenses.
What are the risks for the donor?
As with any major operation, risks are involved with donation. All living donors can expect to experience some pain and discomfort after the operation. The donor can bank up to three units of his or her own blood pre-operatively for use during the surgery, however the possiblity exists that more than this will be needed. Although the blood general blood supply is usually very safe, there is a one in 500,000 chance of developing HIV as a result of a blood transfusion. Risks include the possibility of losing blood and having to receive transfusions, a well as risks of infection either in the operative wound or abdomen. Other risks include injury to the bile duct or other organs such as the bowel, although these risks are slight. The native bile duct splits into a left and right component. If the right lobe of the liver is removed, the right duct is taken out with the donated portion of the liver. The left duct and the common bile duct, which then proceeds down to the intestine to drain the bile into the intestine, must be well preserved so as not to develop a closure. If a closure or other problems develop, the loop of the intestine would have to be brought up and connected to the left bile duct in order to bypass this difficulty. Various risks associated with the use of general anesthesia should be considered, including the risk of having a heart attack, a stroke or even the risk of dying under general anesthesia. The likelihood of mortality in a healthy donor has an upper maximal risk of 1%. Before consenting to donate an organ, the potential donor should also consider the emotional consequennces, and discuss his or her thoughts and concerns with a physician, transplant coordinator or social worker.
Surgery and recovery
What portion of the liver is donated?
How does the operative day progress?
How long is the donor in the hospital?
What if the transplant doesn't work?
At home
How long does it take for the donor's liver to regenerate?
How long before the donor can return to work?
Other links in the living liver donor pages:
About Live Donor Liver Transplants
Medical Evaluation Work-up
Other Donor's Stories
Forms
