Partial liver donation for a live donor transplant: What you need to know By Dr. Arvinder Singh Soin

The liver is the body’s largest internal organ. It is a vital organ that performs over 500 functions including immunity against infection, manufacturing proteins, clearing toxic substances, production of bile which is essential for the digestion of fats, blood clotting and production of most hormones that run the various body systems. Therefore, at every stage of life, it is essential to have a healthy liver. 

When the liver fails or develops primary cancer, a liver transplant is usually necessary and lifesaving. A transplant can be done in two ways – via a donation from someone who is deceased (cadaveric liver transplant) or by donation of a part of the liver by a close relative (live donor liver transplant). If it is done in time, the chances of success in the best centers are 95% among adults and 97% in children. However, to ensure that the liver transplant is done successfully and ethically, there are a few essential criteria. Free will is extremely important – live donors must not be coerced into donating. They should be between the ages of 18-55 and not more than 10% overweight. They should be a close relative, and ideally have a matching blood group. However, now with the availability of successful swap transplant (exchange of donor livers between two families so both patients can have blood group matched livers) and blood group mismatched transplant protocols at big centers, this criterion is flexible. It is very important that the donor’s liver structure, functioning, as well as other systems are normal. During pre-transplant evaluation over 2-3 days, the transplant team checks the safety and fitness for donation and size match with the patient in all prospective donors. All the checks are done with a view to ensuring complete donor safety and recovery and ensuring that the transplant is a success.

Since the liver is the only organ in the human body which can regenerate itself, a relative can donate half of his/her liver safely without any consequences on the quality or expectancy of life after donation. Even immediately after donation, the donor’s liver will continue to function normally due to the immense reserve in the liver (up to 70% of liver can be safely removed). The entire process of donation is very safe and modern liver cutting techniques using CUSA have made it nearly bloodless. Robotic donor surgery is a new advance that is carried out by specially trained surgeons in selected centers. This is a precise method of 3D key-hole surgery where the surgery is performed via 4 small 1cm cuts on the abdomen, and the partial liver to be donated is removed via a small 10 cm cut just above the pubic bone (below the belt). While both Robotic and open surgeries are equally safe and successful, the donor comfort is higher with Robotic surgery as there is less pain, the scar is much smaller and hidden, and the recovery is faster. Over a period of two months, the liver regenerates to its normal size in both, the donor, and the recipient.

After the operation, donors have to stay in the hospital for 5-7 days. They are discharged on normal diet and after 2-3 weeks of recuperation at home, they can resume normal activity, barring strenuous physical exercise. Within 4-6 weeks he/she can resume sexual activity, walking, light stretching, driving and work. Sports, heavy physical activity, lifting weights can be resumed after 3 months of surgery. Women can conceive once their abdominal muscles have fully healed, which usually takes 6 months. It is important for everyone to be aware of the safety of donation for live donor liver transplants and to understand that partial liver donation saves a life without adversely impact the donor’s quality of life, or it is longevity. 

The author is the Chairman at Institute of Liver Transplantation and Regenerative Medicine, Medanta Hospital Gurugram.

Article Source: https://timesofindia.indiatimes.com/blogs/voices/partial-liver-donation-for-a-live-donor-transplant-what-you-need-to-know/