Frequently Asked Questions (FAQs)
Who is a good donor?
What is the process for evaluation the donor?
Where does the transplant occur?
When does the transplant occur?
How is the operation performed?
What is the postoperative period like for the donor?
Who is a good donor?
A good donor is someone who is in good physical and mental health, older than age 18, and free from the following:
- HIV infection
- Chronic viral hepatitis
- Active alcoholism or heavy alcohol use
- Psychiatric illness under treatment
- History of malignancy
- Heart and lung disease requiring medications
- Diabetes mellitus of greater than 7 years duration
- Free from any other serious chronic medical illness
- BMI (body mass index) of 30 or less
What is the process for evaluating the donor?
The potential donor will be asked to complete a questionnaire that includes attaching a copy of his or her blood type (to confirm whether the blood type is compatible with the recipient).
If the ABO blood type is appropriate, the donor's size (height/weight compared to that of the recipient) is acceptable, and the details on the questionnaire indicate donor suitability, the potential donor will have additional laboratory studies (complete blood count, liver panel, bloodtests for hepatitis B and C, and tests to incure normal clotting including proteins S, protein C and anti-thrombin III). Other tests include EKG and chest X-ray.
If the laboratory tests confirm that the donor is suitable, a volumetric CT scan will be arranged at Stanford to calculate the volume of the donor's liver that will permit a successful outcome.
If the CT scan indicates that LDLT is feasible, the donor will return to Stanford for consultations with a hepatologist (primary contact physician and advocate for the potential donor), liver transplant surgeon, and a social worker.
Under some circumstances, a psychiatric evaluation may also be appropriate.
Additional laboratory tests, chest x-ray and electrocardiogram will also be performed during the visit to Stanford.
The potential donor will be asked to sign an informed consent document, which will document understanding of the surgical procedure and recuperative period, knowledge of the approximate risk of potential complications (10%) or death (0.2%), unknown long-term risks of undergoing this procedure, expected outcome of the recipient, alternative available for the potential recipient, and SUMC statistics with LDLT. There will be a "cooling off period" between the initial consent process and scheduled donor operation.
After the tests and consultations are completed, the medical and social details of the evaluation will be discussed at a committee of the transplant team members. The decision regarding the suitability of the donor will be made at that time. This decision will be communicated to the donor by one of the team members, usually the transplant coordinator.
If not selected, the physician team members can be contacted for an explanation. Note that all information concerning the donor will be kept in strictest confidence.
Where does the transplant occur?
All pediatric and adult liver transplants, both cadaveric and LDLT, are performed at Stanford Hospital & Clinics.
When does the transplant occur?
The transplant is scheduled at a mutually convenient time for the donor and recipient. In the case of the latter, the team members will decide the optimal time based on the condition of the recipient and control of complications.
For example, if the recipient develops a sudden fever, the procedure will be delayed until the cause is found and potential infection controlled.
The advantage of LDLT is that the procedure can be timed when both recipient and donor are both in the best possible condition, and the donor can undergo a thorough medical evaluation.
How is the operation performed?
After all of the medical issues have been settled, the donor-recipient match-up is completed and the Patient Selection Committee has approved the transplant pair, a date is selected for the operation.
After the surgery date is scheduled, the donor will donate 2 units of autologous blood. Two teams perform the donor and recipient operations simultaneously.
As the diseased liver is removed from the recipient by one team, approximately half of the donor's liver (either right lobe or left lobe) is removed by the other team.
Once the donor operation is complete, both surgical teams complete the transplant by attaching the right or left lobe into the recipient.
The donor operation usually takes 5 - 7 hours and the recipient operation about 10 - 12 hours.
Both half-livers (the remaining half in the donor, and the transplant half in the recipient) grow to almost full size within 6 - 8 weeks.
What is the postoperative period like for the donor?
Prior to the transplant procedure, the donor will receive a detailed description of the procedure and will have an opportunity to discuss the potential risks and side effects of the operation with members of the transplant team.
The donor is usually in the hospital for 5 - 7 days. Most patients are up and out of bed (with assistance) by the second or third postoperative day. It is usually necessary to stay off work and usual home activities for a month full time and 2 - 4 weeks part time, depending upon the rapidity of the recovery.