Liver Transplant FAQ

What causes liver failure?

It could be a number of things such as the following:

  • Hepatitis B & C
  • Autoimmune Hepatitis
  • Cirrhosis
  • Alcoholic Cirrhosis
  • Primary Biliary Cirrhosis
  • Cryptogenic Cirrohosis
  • Primary Sclerosing Choalangitis
  • Hepatocellular Carcinoma
  • Wilson’s Disease
  • Primary Hemochromatosis
  • Non Alcoholic Steatohepatitis ( NASH)
  • Budd- Chiari Syndrome
  • Acute Liver Failure
  • Metabolic Disease

How does the waiting list work if I can’t find a match on my own?

A person’s spot on the waiting list depends on the patient’s medical urgency, blood, tissue and size match with the donor, time on the waiting list and proximity to the donor. Under certain circumstances, special allowances are made for children. For example, children under age 11 who need kidneys are automatically assigned additional points. Factors such as a patient’s income, celebrity status, and race or ethnic background play no role in determining allocation of organs.

Contrary to popular belief, waiting on the list for a transplant is not like taking a number at the deli counter and waiting for your turn to order. In some respects, even the word “list” is misleading; the list is really a giant pool of patients. There is no ranking or patient order until there is a donor, because each donor’s blood type, size and genetic characteristics are different. Therefore, when a donor is entered into the national computer system, the patients that match that donor, and therefore the “list,” is different each time.

The other major guiding principal in organ allocation is: local patients first. The country is divided into 11 geographic regions, each served by a federally-designated organ procurement organization (OPO), which is responsible for coordinating all organ donations. With the exception of perfectly matched kidneys and the most urgent liver patients, first priority goes to patients at transplant hospitals located in the region served by the OPO. Next in priority are patients in areas served by nearby OPOs; and finally, only if no patients in these communities can use the organ, it is offered to patients elsewhere in the U.S.

How long will the transplant surgery take?

It will last up to 8 hours, but it can take up to 6-14 depending on complications.

What happens if my body rejects the liver?

There are different levels of rejection preceding transplant. A recipient can function quite well if there is a small amount of rejection in the liver. However, if the new liver is failing fatally, then a second or even third transplant may occur.

What are my chances of surviving a liver transplant?

It all depends on a number of factors, but generally 60 -75 percent of adult patients and 80 – 90 percent of children survive and are discharged from the hospital.

What are the risks in Liver transplant surgery?

Before the surgery, risks include acute liver failure and complications, such as internal bleeding, coma, kidney failure, or other complications that would make the patient unsuitable for surgery. Other risks before surgery include intestinal bleeding, severe abdominal fluid, confusion, as well as severe infections.

Risks associated with the surgery are the same risks common with any other major surgeries. These include: technical difficulties in removing the diseased liver, difficulties implanting the donor liver, and complications with the patient being without a liver for a brief amount of time. However, doctors monitor the patients very closely and do everything in their power to keep the patient safe and perform all preventative methods to keep these complications from occurring

Living Donor Liver Transplants FAQ

What is the process for determining if I am a candidate to donate?

The first step is determining whether or not you are the same blood type as the recipient. The blood work is the only test that you may need to pay for out of pocket, though your insurance or transplant center may cover it.

After the blood work, there are psychological and physical tests administered that are used to determine if a donor is a good match (the recipient’s insurance will pay for all additional tests and for the surgery). It is important that you are healthy and can withstand the surgery and recovery and that the specific organ you are donating is a good match for the recipient. Extremely overweight individuals or those with high blood pressure, diabetes, fibromyalgia, heart disease or cancer are not eligible to donate. How do I begin the living donor evaluation process? If you are interested in being a living donor, you should contact the transplant hospital where the patient is listed to request a questionnaire. Once the questionnaire has been completed, it will be reviewed by a nurse coordinator to determine if you may proceed with initial blood testing.

Once your blood type is known, the living donor nurse coordinator will discuss the results and the donation process with you. The nurse coordinator will answer any questions you may have, so that you can make an informed decision about proceeding with donation. This conversation is strictly confidential and is not shared with the recipient. If you decide to continue with donation, you must then complete a comprehensive evaluation.

What are the requirements to be a living donor?

The donor must be between 18 and 60 years of age, in good physical and psychiatric health, a non-smoker for at least 6 weeks prior to surgery, and fully able to understand the risks and medical procedures involved in liver transplantation. Additionally, you must be a family member or close personal friend of the recipient.

Can I donate to someone who is not related to me?

In the case of a liver transplant, it is unlikely. A liver transplant is a risky surgery, and many transplant centers will not allow altruistic donations. Generally a liver donor must be a family member or close friend of the recipient.

Does insurance cover living donation?

The majority of insurance carriers will approve a Living Donor Evaluation once the recipient has been accepted as a candidate for liver transplantation. Since most recipient insurance carriers will cover the donor’s medical expenses only for a short period of time, we strongly encourage you to have your own medical insurance coverage before becoming a living donor. You may, however, incur some expenses for travel and for pain medication after the surgery. If you receive any medical bills related to the evaluation, surgery, hospitalization or immediate follow-up, you should forward them to the Living Donor Coordinator.

As a living donor, will I be at a significantly greater risk of developing a liver disease?

No. Based on OPTN data from 1998 through 2007, of the 3,086 individuals who were living liver donors, at least four have been listed for a liver transplant due to complications related to the donation surgery.

What are the long-term effects of being a living liver donor?

The risk of death from the surgery is extremely low. Possible complications for living liver donor surgery are very similar to possible complications from any general surgery. These include: blood clots in the legs or lung, fluid retention (edema), bile leakage or bile duct complications, and hernia. You will have a scar from the donor operation on your abdomen, which will fade over time but will always be visible, and the area around the scar will likely feel numb. Donors are expected to return to normal activities within three months post-surgery, provided there are no complications.

Will I be able to have children after I donate a liver?

There is no evidence that donating a liver impacts the ability to have children. Usually, doctors recommend that women wait at least 3-6 months before getting pregnant to allow the body time to heal after donating. Donors who become pregnant should notify their obstetrician or gynecologist that they have donated their liver.

What happens if I change my mind about donating halfway through the process?

A potential donor will never be forced to donate. A doctor often carries the burden of stopping the process and informing the recipient. For example, the doctor may tell the recipient that the donor is no longer a good match. At the end of the day, it is the potential donor’s decision whether or not they are comfortable donating. If you choose not to donate, the recipient will remain on the liver transplant list and will be able to look for another living donor.

What is the donor surgery like?

You will be admitted to the hospital the morning of surgery and you will go through a physical examination, including blood work, chest X-ray, and EKG (this can also be done the day before). If all goes well, you will be approved for surgery. If you pass the physical exam, the doctor will administer IV fluids and answer any remaining questions. You will then be escorted to surgery and the anesthesiologist will sedate you. Once you are fully asleep, you will be given a breathing tube to help you breathe during surgery and a catheter will be placed into your bladder. Then the surgery begins.

How can I prepare for the surgery?

It is important to have support systems in place before surgery. You’ll need help caring for yourself for a week plus after going home. Having someone in place to help with meal planning, child and pet care, running errands, and other day-to-day activities requires planning.

What is the pain like?

Because the donor is recovering from major abdominal surgery, the donor has access to as much pain medication as needed for comfort in the first few days following surgery.

What happens if my donor liver is rejected?

It is possible, though not exceedingly likely, that the new organ will be rejected. In this scenario, the transplant recipient will be placed at the top of the liver transplant list and receive the next available organ.

Post-transplant, what must I do to take care of my health?

You will have check-ups with the transplant center to make sure that you are healing well after surgery. After recovery, you will return to the care of your regular physician. You won’t need to take any specific medication as a living donor.