Why Living Liver Donation?
There is a tremendous need for liver transplants that isn’t being met through deceased donation. UNOS figures show 11,000 people in the USA are on the waiting list for a liver transplant, but there are only 8,000 transplants from deceased donors each year. There is a big gap.
Living donation is a possible answer. The special characteristics of the human liver make living liver donation unique. While each of us has only one liver, it is a large, segmented organ that regenerates. Therefore, it is possible to donate a portion of the liver to someone in need, with the donor keeping the rest of the liver. Then both the portion in the recipient and the portion kept in the donor grow larger within a few months. The result is functioning livers for both the recipient and the donor.
Living donation has important advantages over deceased donation:
- The waiting time for a transplant recipient can be significantly reduced.
- The procedure can be scheduled at a time convenient for both the donor and recipient.
- The time between procurement of the organ and transplantation to the recipient is minimized.
One additional advantage of living liver donation is that the donated liver has a slightly better chance of survival. It’s not a big difference but every little bit helps. The graft (donated organ) survival results for deceased and living liver donors (2008 – 2015) are shown in the table below:
Liver Graft Survival Rates
Time after donation
From deceased donors
From living donors
Since 1988, there have been nearly 9,000 living liver donors. The number per year has increased steadily since 2009. Currently, there are more than 500 living liver donors per year. Here are the characteristics of living liver donors:
- Almost half (48%) were between the ages of 18 and 34.
- Most (78%) were white, 5% were black, and 13% were Hispanic.
- About half were male and half were female.
- For donations to children, 67% of donations come from parents and 15% from other blood relations.
- For donations to adults, 34% came from a child, 16% from a sibling, and 24% were from unrelated donors.
1989. Living liver donation grew out of experience with deceased donations using “reduced” or “split-liver” donations. Physicians learned that only a portion of a donated liver is needed for a successful transplant. Therefore they discovered it would be possible to take a portion of the liver from a living person, leaving a functioning portion with the donor and donating the other portion to the recipient. The first living liver transplant was from an adult to a child performed in Australia in 1989. The procedure is now common at major pediatric centers.
1995. Techniques were developed for adult-to-adult donation, which requires a larger portion of the donor liver. The first such donation occurred in 1995.
1999. As with kidney donation, there has been an increase in “nondirected” or living unrelated donation from strangers. The first such donation in the US occurred in 1999.
2002. The first successful laparoscopic living liver donation surgeries were performed in France in 2002.
2014. “Paired donation” was first arranged for living liver donation in 2014. The number of this type of donation is still small (24 in 2022) but the number has been increasing every year.