Liver transplantation

Liver transplantation is a surgery to remove a diseased liver and replace it with a healthy liver from an organ donor. A liver transplant is necessary when disease makes the liver stop functioning. The most common reason for liver transplantation in adults is cirrhosis, a disease in which healthy liver cells are killed/ replaced with scar tissue. The most common reason for transplantation in children is biliary atresia, a disease in which the ducts that carry bile out of the liver are missing or damaged.

There are three options for liver transplantation: cadaver donor transplantation, living donor transplantation and auxiliary transplantation.

Cadaver donor: The donor liver is obtained from a person who is diagnosed as brain dead whose family volunteers to donate the organ for transplantation. People who receive cadaver donors wait on the national computer list until a suitable donor becomes available. The waiting times vary.

Living donor: A healthy family member, usually a parent, sibling, or child, or someone emotionally close to you, such as a spouse, volunteers to donate part of their liver for transplantation. The donor is carefully evaluated by the team to make sure no harm will come to the donor or recipient.

Auxiliary transplantation: Part of the liver of a healthy adult donor (living or cadaver) is transplanted into the recipient. The patient’s diseased liver remains intact until the auxiliary piece regenerates and assumes function. The diseased liver may then be removed.

Liver transplant surgery takes between six and twelve hours. During the operation, doctors remove the diseased liver and replace it with the donated liver. Most patients stay in the hospital for up to three weeks after surgery. The common side effects are caused by the drugs that treat or prevent rejection. These side effects can include fluid retention, raised blood pressure, headaches, diarrhea and nausea. The severity of these side effects varies among patients.

Once a transplant center determines that you are an appropriate candidate for transplantation, a suitable donor becomes available, and you have successfully completed the surgery, you have a good chance to lead a normal, healthy, active, life. However, to help insure successful outcomes, it is vital that you closely follow your physician’s recommendations. This will include taking immunosuppressive medications and monitoring your blood tests regularly.

There are many more people who need a liver transplant than there are livers available for donation. Patients are examined by a team of specialists to determine if a liver transplant is appropriate and likely to succeed. If so, they are placed on a national transplant waiting list. This waiting list is prioritized so the sickest people always go to the top of the list.

Potential living donors undergo an extensive evaluation to assure that they are in optimal medical condition to proceed with organ donation. The blood types of donor and recipient must be compatible, but not necessarily identical. The anatomy of the donor's liver must also be favorable for donation. Size requirements vary with individual recipients, whether child or adult. Some normal variations in the distribution of blood vessels or bile ducts may preclude or aid the donor operation. Above all, the donor must be in excellent health.

The donor is also at risk for temporary problems related to the surgical incision and the possibility of blood clots. The great majority of donors, however, have enjoyed a complete recovery within a few months of their operations, and tremendous satisfaction.