Assessment of Potential Donors
As a potential living liver donor, you’ll got through an in-depth assessment of your health. It’s your health that is of utmost importance to the transplant team. What they want to know is that:
- Your blood and tissue types are compatible with the recipient.
- You are healthy enough to withstand major surgery and recover completely.
- You have a healthy liver.
With these three primary goals in mind, here is how donor candidates are medically evaluated.
1. Blood and Tissue Compatibility
Blood type. The first step is to determine your blood type. There are four blood types designated by the presence or absence of two antigens—the A antigen and the B antigen. Blood type A means you have the A antigen. Type B means you have the B antigen. Type AB means you have both antigens. Type O means you have neither antigen.
You must have a blood type compatible with the recipient or you will not be able to donate. Here is who can donate to whom:
- Type A can donate to types A and AB.
- Type B can donate to types B and AB.
- Type AB can donate to type AB.
- Type O can donate to types A, B, AB, and O.
The blood type is determined by drawing your blood and testing it.
Tissue type. Whether tissue typing is done appears to vary; some transplant centers mention it and others don’t. Tissue compatibility looks at the match of human leukocyte antigens (HLA). Your antigens are determined by drawing blood and testing it. A similar test is run for the recipient, and the antigens are compared. The closer the match the better because the recipient is less likely to reject the donated organ. However, developments in anti-rejection drugs have made tissue matching less important.
Crossmatching. The third blood test is an important one. Crossmatching is a further testing of antigen compatibility. In this test, white blood cells from you are mixed with blood from the recipient. If the white blood cells are attacked and die, then the crossmatch is “positive,” which is a negative as far as your ability to donate. It means the recipient is “sensitized” to you—the recipient has antibodies to some of your antigens—so the recipient’s immune system would turn on the donated organ. If the crossmatch is negative, you are compatible with the recipient.
2. Your General Health
At some point in the screening process, you will have a complete physical exam. When this occurs varies. You will share your medical history and possibly have a series of tests, such as a chest x-ray, electrocardiogram, blood tests, urine tests, and so on. Female donor candidates may also undergo a gynecological exam, pregnancy test, and mammogram. The purpose of the exam is to ensure you don’t have any health conditions that would rule you out as a donor.
In the case of liver donation, there are specific health criteria for potential donors. The criteria depends on the transplant center, but here’s a list of considerations:
- No heart, renal, or liver problems or abnormalities.
- No history of deep vein thrombosis or history of bleeding problems.
- Negative for Hepatitis B and C and for HIV.
- No history of diabetes.
- No prior liver surgery.
- No alcoholism or frequent and heavy alcohol intake.
- No history of cancer.
- No psychiatric illness under treatment.
- Your height and weight compared to the recipient is “appropriate.”
- There may be an age limit. One center places it at 45, another at 60. Check with your transplant team.
3. Health of Your Liver
Following a general assessment of your health, the testing focuses on the integrity of your liver with these tests:
- Hepatic angiogram. This test identifies the blood vessels of the liver. The procedure is done in a hospital and is relatively invasive. For this test, you will change into a hospital gown and lay on a gurney. A dye is injected into an artery—some people feel pain or heat temporarily after the dye is released—and X-rays are taken to determine the mapping of your liver’s blood vessels. After this test, you are required to remain immobile for several hours. Because the test was done via an artery, the physician wants to be absolutely sure the wound is completely healed before you leave.
- Computed tomography (CT) angiography. The test, commonly called a CT scan, is a sophisticated form of X-ray. In this case, a dye is injected into a vein, you lay flat on a table, and the table moves through a special machine shaped like a giant doughnut. The machine projects a thin x-ray beam through your body and measures the output. The dye helps give more contrast to the blood vessels making them easier to identify. A computer takes the information from the x-ray scan and generates a three-dimensional image of your liver and surrounding anatomy.
The information from these tests is used by the surgeon to determine the anatomy of your liver and to decide which lobe is best for donation.
Because these tests use x-rays, female donor candidates should inform the medical technician if you are pregnant or think you’re pregnant. Also, the tests use a dye that some people may have an allergic reaction to. Let the technician know if you have had allergic reactions in the past, especially to iodine.
4. Other Assessments
Depending on hospital guidelines and transplant team protocol, there may be other assessments, such as psychological and financial reviews:
- A social worker or psychiatrist may evaluate your state of mind. What are your motives? What is your relationship to the recipient? Are you committed to donation or were you pressured?This interview is an opportunity to explore any concerns you have about donation. Often, the transplant team will arrange to give you an out without embarrassment if you decide donation isn’t for you.
- You may also be asked about financial considerations. Can you get off work for testing, surgery, and recovery? Medical expenses are covered by the medical insurance of the recipient, but lost wages are not. What kind of paid sick leave and vacation do you have from your employer? Do you have other financial resources available if you need them? Do you need help raising money?