Living-Donor Liver Transplant
Living-donor liver transplant is an option that is offered by Lurie Children’s — working with Northwestern Memorial Hospital — to the parents of infants and young children who require a liver transplant. Living donation, in general, will only be considered for recipients who weigh 20 kilograms (about 44 pounds) or less.
First performed in the United States in November 1989, living-donor liver transplants have steadily increased each year. At Lurie Children's, approximately 29% of all liver transplants performed to date have been living-donor operations. Donors have included moms, dads, a grandmother, a great-uncle, aunts and uncles. All donors are currently alive and well.
Selecting a Donor
The potential living liver donor must meet certain age and health criteria, as well as have the same or compatible blood type as the recipient.
- In good health: The donor should be of overall excellent health without significant medical problems such as diabetes, heart disease, hypertension, asthma or a history of hepatitis.
- Age limit of 50 years: We generally do not consider individuals over the age of 50 as potential donors.
- Donor willing and able to donate: Most importantly, the donor must be willing and able to withstand the stress of donation and recovery from major surgery.
- Blood types checked: We encourage parents to have their blood types checked to determine if one, or both, match. If both are a match, the family needs to decide who would make the most suitable donor. Some issues for consideration are: employment (who is the primary breadwinner), work demands (sedentary or physical), sick-leave limitations and available support systems.
The donor work-up is initiated when a suitable donor is identified. The donor evaluation consists of:
- Laboratory testing
- Medical exam
- CT scan of the liver to measure size and rule out abnormalities
- Liver biopsy
- Mesenteric angiogram
- Additionally, the donor usually will donate at least two units of blood for the procedure.
The testing is accomplished over three to four days, but can be compressed into one day in special circumstances. Because living donors are adults, all donor evaluation and testing procedures are performed at our adult partner hospital, Northwestern Memorial Hospital. Once the donor work-up is complete and the potential donor deemed suitable, the transplant teams from Northwestern and Lurie Children's work together with the family to select a date for the transplant.
The infant or child is admitted to Lurie Children's transplant unit the night before the scheduled surgery, and the donor will report to Northwestern Memorial by 6 a.m. on the day of surgery. The donor operation begins about 7:30 a.m., and the two transplant teams are in constant communication thereafter.
Once the donor segment is removed, the team at Lurie Children's starts the recipient procedure.
While the donor operation normally takes four to six hours, the recipient procedure may last up to 14 hours.
Pros & Cons
The Elective Basis
The most important advantage to living-donor liver transplant is the ability to schedule the surgery on an elective basis. This allows the transplant team, along with the family, to decide on the optimum time for the procedure. The recipients are healthier and stronger at the time of transplant as well.
Shorter Hospital Stays; Less Rejection
Living-donor recipients have shorter hospital stays and may have fewer episodes of moderate to severe rejection.
It is Major Surgery
On the other hand, the family must endure two procedures rather than one. The living-donor operation, while very safe, is a major surgery with significant risks. These risks include bleeding (the most common), infection, bile leak, gastric motility problems and digestion problems.
Typical Donor Hospital Discharge & Return to Work Status
Most donors are discharged from the hospital within three days and back to work within six to eight weeks.