If you pass the assessments, then you are ready to schedule a date for surgery. The date will be contigent on the recipient, since he or she must be available and healthy enough for major surgery. In the case of children, it is often the health of the child that determines when surgery is possible.
You and the recipient are admitted to the hospital the morning of the surgery. You change into a hospital gown and receive an IV. You’ll be moved by gurney into the operating room where you’ll be greeted by the surgeon and the surgical team. The anesthetist administers the anesthesia through the IV, and you become unconscious.
While unconscious, the surgeon will remove a portion of your liver. How much and which part of your liver is donated depends on the results of your earlier testing and on the needs of the recipient. In general, these guidelines apply:
- If you are donating to a child, a portion of the left lobe is taken.
- If you are donating to an adult of similar or lesser size, all of the left lobe is taken.
- If you are donating to a larger adult, the right lobe is removed.
For purposes of this discussion, we’ll assume the left lobe is to be donated. The donor is placed on his or her left side (the liver is on the right side of the body) with the right arm raised above the head. A large incision is made along the flank and access to the liver is gained by using rib spreaders. The veins, bile ducts, and arteries of the left lobe are clamped and cut. The left lobe is removed, flushed, and placed in a cold preservative solution. It is transported to the operating room of the recipient for transplantation.
Note that, with a living donor, some parts of the liver such as veins and arteries are not sufficiently large for transplantation. (This is not an issue with cadaveric donations where preserving veins and arteries in the donor are not important.) Consequently, a portion of the sapheous vein in your leg is also removed and used to connect the donated liver to the recipient.
You are then sewn up. Because of the large number of blood vessels in the liver and the large exposed area created, the surgery can take several hours.
The procedure as a whole takes five to eight hours. You are placed in the Intensive Care Unit of the hospital overnight for observation. Assuming all goes well, you will be moved to your hospital room where you will stay for about a week.
You will be able to return to work in about six weeks—a bit longer if your work is physically demanding.
As with any major surgery there are risks. These risks are small and manageable. In the interest of full disclosure, here are the risks of living liver donation surgery:
- Pain. This is a certainty. But the pain is managed through medication after surgery.
- Infection. The wound from the incision could become infected, delaying the healing process, causing scarring or herniation. Antibiotics are used to treat any infections.
- Pneumonia. You will be asked to cough and breath deeply following surgery to combat the risk of pneumonia as a consequence of the anesthesia. You may be given a device to encourage deep breathing—inhaling deeply to suspend some balls in chambers of the device—and told to use it several times a day.
- Blood clotting. As with any surgery, blood clots in the legs can be a problem. To prevent clotting and related complications, circulation in the legs is aided at first by special stockings you wear while in bed. The stockings are hooked up to a machine which inflates the stockings periodically, applying pressure to your legs and improving circulation. Once you are able, you will be encouraged to walk around, which also stimulates circulation.
- Allergic reaction to anesthesia. Part of the screening process includes identifying allergies you may have. In the event of an allergic reaction to anesthesia, the anesthestist will take immediate corrective action.
- Injury to bile duct or other organs. The surgical process of removing a portion of the liver creates the risk a bile duct will be damaged. There could also be damage to surrounding organs and tissues, such as the spleen or bowel. In such cases, follow-up surgery will be needed to repair the injury.
- Death. It happens. Fortunately, it is rare. Known deaths include one in North Carolina, one in New York, and some in Europe, but reporting has been sketchy. News articles have quantified the risk at 0.5% to 1.0%.
In a University of Chicago study (Grewal, H.P., et al.), 100 living related liver transplants were reviewed to assess the surgical complications. The findings reveal there were no donor deaths. There were 14 “major” complications, the most common (half) being bile duct injury or leaks. Complications were more common in left lateral resections than left lateral grafts. Minor complications occurred in 20% of the cases, with obstruction of the intestine and urinary tract infection being the most common (four cases each). The study also showed the incidence of complications was smaller for donors whose surgery was in the latter half of the group, suggesting the likelihood of problems diminishing as the transplant teams gain experience. It also suggests you, as a potential donor, will want to know the experience level of your transplant team.
Additional studies of the impact on living liver donors are desperately needed.
The liver possesses amazing regenerative properties. Within two months of the surgery, the remaining portion of your liver grows back to full size. Note that the liver does not assume its former complete anatomy. Instead, the remaining portion (e.g., the right lobe) simply enlarges.
Scientific research on the long-term effects of living liver donation is not available due to the relative recency of this procedure and the relatively small number of donations each year.