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How Living Donor Liver Transplant Works

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How Living Donor Liver Transplant Works

Feb 17, 2016
Traditionally, a liver used for transplant came from a deceased donor. Now, a handful of hospitals in the United States have the ability to do what’s called a “living donor” liver transplant. It’s a very complex procedure where a piece of the donor’s liver is put into the recipient. After a short time, the segments in the donor and the recipient naturally increase in size and serve as two functional livers. It is a way to provide patients with a liver before they get really sick. To learn more about this procedure, we asked Dr. Robin Kim, executive medical director of transplants at University of Utah Healthcare, about how it’s done, what makes it complicated and how safe it is for the donor.

Episode Transcript

Interviewer: Donating your liver for a living donor liver transplant. That's next on The Scope.

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Interviewer: So the problem is there are more people waiting for livers than there are deceased donors, but the solution is a procedure that allows a living person to donate part of their liver.

Dr. Robin Kim is the Executive Medical Director of the Transplant Service Line at University Utah Health Care. So a living liver donor transplant, how common is this procedure?

Dr. Kim: The living donor liver transplant between one adult to another is not commonly done in North America. Perhaps 10 to 20% of all transplant centers in North America who perform transplants in adults have the ability to do adult-to-adult living donor liver transplantation.
Interviewer: The standard way of doing a liver donation is from somebody who is deceased and then you transplant that organ.

Dr. Kim: Yes, it's a cadaveric donor who donates their whole organ or part of their whole organ after they have passed away.

Interviewer: And it's a pretty safe procedure?

Dr. Kim: Living donor liver transplant is a technically demanding procedure, but it's deemed to be very well-accepted throughout the world. Parts of Asia where it is not in their culture to donate after being deceased, they rely almost solely on live donor liver transplant. We've learned lessons from these centers, and in North America we do it very well, and we take opportunities to learn from each other, and that is what we have done at the University of Utah.

Interviewer: So what's the advantage to this type of procedure?

Dr. Kim: The great advantage of this procedure is we are able to offer life-saving transplantation to adults in a more timely fashion before these recipients get too sick or wait too long with their liver disease.
Interviewer: Plus, there are a lot more people waiting for livers and donors, so if you can add some new people to that donation pool that has to help.
Dr. Kim: That's absolutely right. The whole purpose of live donor liver transplantation is to get organs to folks who would normally not be able to get one, and thereby expand the donor pool.
Interviewer: Briefly, just kind of take me through the procedure. What happens?

Dr. Kim: In a live donor liver transplant our primary goal is to advocate for the donor. The donor must come of his or her own accord, and after a very lengthy evaluation, a lot of education for them, they deem that this is something they want to do.

Specifically, we have a person called an Independent Live Donor Advocate. The ILDA is a social worker that is tasked to make sure that they are there to protect the donor's best interests, and at any given time, if the donor doesn't feel comfortable they can stop the procedure at any given time.

Essentially, the operation is two parallel operations which occur at the same time. In that day, the donor, under a surgery, donates a part of their liver. In this case, if it's an adult-to-adult, typically it's a right side of the liver, And in a room right across the hall, in the operating room, the recipient will be prepared to receive that right side of liver, and thereby getting a good segment of liver which is sufficient for the overall function that the recipient needs. Even more importantly, the donor will have enough excellent liver for them to survive without any problems.

Interviewer: And I understand that that liver actually . . . it's the only organ that grows back in the human body.

Dr. Kim: Yeah, absolutely. The amazing thing about the adult liver is that within three months about 80 to 90% of the mass that was meant to be for that recipient will grow into place.

Interviewer: How long does it usually take for the donor to recover after the procedure?

Dr. Kim: A standard right liver operation to donate that part of the liver will require the donor to be in the hospital perhaps one week. They can likely return to work within three to four weeks, but we ask them to wait a little longer. We just want to make sure that they're fully comfortable after the surgery to embark on any activities.

Interviewer: It's pretty amazing. Really, that's not a lot of time considering that you just gave somebody else the gift of a few more years.
Dr. Kim: Yeah, and that's the incredible thing about the human body is it can heal so well.

Interviewer: How safe is this procedure for the donor?

Dr. Kim: This procedure is extremely safe. The risks of having complications, and usually they're minor, is 10%, very similar to other surgeries of equal magnitude, and in terms of mortality it's exceedingly low, far under 1%. The programs that do it throughout the country have been highly scrutinized by UNOS, that governing body which determines who can and cannot do these procedures, and they've been prescreened and only given certification once it's been determined that they are the right program with the right quality results.

Interviewer: Is there going to be a time where it's going to be more commonly practiced at other institutions?

Dr. Kim: I think that an institution has to be able to deliver and document excellent results. Then you have to have a scenario where the institution as well as the physicians and the healthcare providers all align together with a common mission to perform this fairly complex task. Once that's aligned, then we can move forward. But I have to say not a lot of programs throughout the country have that alignment.

Interviewer: Yeah, it's kind of like the perfect storm, if you will, of people that can do it, that have the expertise, the facility, they can handle it, and there's just not a lot of places like that.

Dr. Kim: Absolutely. The University of Utah, we enjoy such a luxury of having that alignment that doesn't necessarily exist in other institutions.

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