Living Donor Liver Transplantation (LDLT)
What is a living donor liver transplantation?
Living donor liver transplantation (LDLT) is a procedure in which a healthy, living person donates a portion of his or her liver to another person. The feasibility of LDLT was first demonstrated in the United States in 1989. The recipient was a child, who received a segment of his mother's liver. Since this initial operation, LDLT for children has been very successful, including at Stanford Medicine. Many pediatric programs across the country now use the technique of LDLT, in which a portion (typically the left lateral segment, i.e., segments II and III) of the adult donor's liver is removed. In the pediatric experience, survival of the recipient child and function of the transplanted liver (graft) at 1 year is about 90 percent. Donors have had very few complications. An increase in the percentage of adult patients awaiting liver transplantation, many of whom cannot survive the waiting time for a cadaver liver, has led to the application of LDLT for adult patients, and the preliminary results have been very encouraging in the United States and worldwide. In adult-to-adult LDLT, the entire right liver lobe (segments V, VI, VII and VIII) or, less often, the full left lobe (segments II, III and IV) is removed from the donor and transplanted into the recipient.
LDLT at Stanford
The transplant team at SUMC has been performing LDLT in children at the Lucile Packard Children's Hospital for the past 7 years with excellent results (93% survival). In the latter part of 2000, the same team performed the first four adult-to-adult LDLT procedures at SUMC without complications in the donors and good success in the recipients, which has led to the expansion of this program.
Basic Facts for the Recipient
Patients being considered for adult-to-adult LDLT are candidates who are listed to receive a cadaver liver (liver from a brain-dead, unrelated individual) based on the severity of their liver disease and its complications. These patients are placed on the UNOS liver transplant waiting list, and will not be denied a cadaver donor liver if it becomes available prior to LDLT. Thus, failure to find a suitable donor for LDLT will not jeopardize a recipient's chances of receiving a cadaver liver, based on priority on the UNOS list. Patients considered for LDLT will be followed by the same SUMC liver transplant team, and it will manage all complications of liver disease with the view to optimizing the patient's condition prior to liver transplantation.
Basic Facts Regarding the Donor
- The donor should be a relative (close or distant) or emotionally related to the recipient.
- The donor must be competent and freely willing to donate.
- The donor should be in good physical and mental health.
- The decision to be a donor should be made after careful consideration and understanding the procedure, and accepting its risks and complications. There should be no evidence of financial gain arising out of the donation. Potential donors who are believed or known to be coerced must be excluded.
- The blood type of the donor must be the same, or compatible, with therecipient.
- The donor must be relatively close in size (or larger) than the recipient.
- Donors need to have the ability and willingness to comply with follow-up.
- All donors must have a primary care physician.
- All donors must have insurance coverage.