Pediatric Liver Transplant

Living Liver Donation

If you decide to explore the possibility of donating a portion of your liver, a living donor coordinator will guide you through the process. The living donor coordinator will provide information about the evaluation process and surgical procedure, talk to you about the risks and benefits of being a donor, and follow up with you after surgery to check on your well-being.

The living donor coordinator works closely with the living donor advocate. The advocate’s job is to give social and emotional support, and make sure the potential donor understands what is involved with living liver donation and can provide consent. Both the living donor coordinator and advocate work with the entire donor team to promote and protect the best interests of the potential donor.

Living liver donation is a major surgery, and it poses the same types of risks as many other major surgeries. The living donor team evaluates potential donors thoroughly to identify and minimize these risks.

Some risks related to surgery and anesthesia include:

• Infection
• Pain
• Bleeding and blood clots
• Bile duct problems, including leaks
• Pneumonia
• Gastrointestinal symptoms
• Psychosocial (social and emotional) symptoms, such as anxiety and depression
• Side effects from anesthesia or other medication
• Death (a very rare occurrence)

After liver donation, donors are also at risk for emotional concerns, such as:

• Depression and anxiety
• Feelings of guilt, distress or grief if the person who received the liver graft does not do well
• Body image concerns

Our team will provide potential donors with a complete list of the eligibility criteria. But in general, living donor candidates must be between the ages of 18 and 50 and be in good physical and mental health. Also, their blood type and blood vessel anatomy must be compatible with the recipient’s.

Problems that may prevent living donation include:

• Medical problems such as obesity, liver disease, a bleeding or clotting disorder, active infection, serious reactions to anesthesia in the past, or cancer (current or past)
• Abnormal laboratory tests
• A positive HIV blood test
• Abnormal electrocardiogram (EKG) results
• Psychosocial risk factors
• And any other situation or condition that makes living donation inadvisable

When a person decides to explore the possibility of donating part of a liver, the first step is to call the Living Donation Office at Cincinnati Children’s at 513-636-7201. The next steps include:

• Undergoing a preliminary health screening
• Having blood tests to confirm blood type and other details related to compatibility
• Undergoing imaging tests, such as computed tomography (CT), to evaluate the health of the donor’s liver
• Having medical, surgical and psychosocial evaluations
• Undergoing additional tests, as needed
• Review by the living donation team (sometimes called “committee review”)

After the evaluation is complete and all tests results are in, the living donation team will review them and discuss whether the transplant process may proceed. The donor candidate can withdraw consent for the evaluation or donation at any time. Also, the evaluation process may stop at any time because of health concerns for the donor or recipient.

A living liver donation evaluation will include most or all of the following:

• A preliminary health screening
• Blood and urine testing
• Chest X-ray
• An electrocardiogram (EKG) to test the electrical activity of the heart
• A test called a computed tomography (CT) angiography, used to assess the blood vessels
• Magnetic resonance cholangio-pancreatography (MRCP), an imaging technique that helps doctors assess the bile ducts
• Consults with multiple providers, including a(n): Transplant surgeon, Anesthesiologist, Registered dietitian (who will do a dietary evaluation), Psychologist
• A physical exam by an adult care physician who is not affiliated with Cincinnati Children’s
• A psychosocial evaluation by the living donor advocate

Lab tests help the living donation team determine whether the donor and recipient are a good match. These tests look at blood typing to make sure the red blood cell type of the donor and recipient are compatible.

The surgery to remove a portion of the donor’s liver takes place at Cincinnati Children’s Hospital Medical Center. Prior to surgery, the donor will have a “preoperative surgical evaluation” with the surgeon who will perform his or her procedure. During this evaluation, the surgeon will share a great deal of information about the surgical procedure and incision, risks and benefits, potential complications, recovery and follow-up care.

The surgery to remove part of the liver involves:

• Making a lengthwise incision in the upper belly
• Assessing the size and the blood vessel anatomy, then freeing the blood vessels from surrounding tissues
• Injecting dye into the gallbladder to view the bile duct anatomy
• Dividing the liver tissue to separate the portion that will be transplanted into the recipient
• Dividing the bile duct and removing the gallbladder
• Dividing the blood vessels that supply the portion for transplant, and removing the liver graft for transplantation

The operation usually takes approximately five hours and is done under general anesthesia.

Living liver donors will experience discomfort and pain during their recovery. The pain varies from person to person. The care team strives to make donors as comfortable as possible, while ensuring they are alert enough to participate in activities that promote recovery, such as eating, drinking, walking, coughing and deep breathing.

After the surgery, the donor typically stays in the hospital for five to seven days, depending on their recovery. When donors return home, their activities will be limited for about six weeks after surgery. The care team will explain this, and provide information about scheduling follow-up appointments.

The discharge instructions and follow-up appointments are important for a healthy recovery and to reduce the risk of complications. Full recovery typically takes 10–12 weeks.

Follow up after living donation surgery

All donors must have a follow-up appointment with the surgeon two to three weeks after surgery, and at 6, 12 and 24 months after surgery with the surgeon or a primary care physician. Cincinnati Children’s is required to report information about the follow up to UNOS, the United Network for Organ Sharing.

The recipient’s health insurance covers medical expenses for the evaluation, surgery and routine follow-up tests. However, some expenses are not covered by the recipient’s health insurance. These include:

• Travel, lodging and meal expenses before and after hospitalization
• Lost income from not being able to work during recovery
• Childcare costs
• Medical expenses due to long-term complications from the liver donation that occur after the surgeon clears the donor medically.

We encourage donors to discuss all of the potential financial implications with their family, employer, insurance carriers and the living donor advocate.

The National Living Donor Assistance Center offers financial help for people who want to donate an organ. Learn more by calling 1-888-870-5002 or visiting www.livingdonorassistance.org.