How Does Living Liver Donation Work? 6 Things to Know

The body’s ability to regrow its liver facilitates an uncommon but growing form of transplantation. A Michigan Medicine surgeon talks about the procedure.

7:00 AM

Author | Kevin Joy

drawing of kidney in red and the other just outlined with blue background in two different shades of blue

This article was updated on March 22, 2021.

In most cases, patients who need a new liver receive one from a deceased donor.

But some sick people find salvation from another source: living individuals.

MORE FROM MICHIGAN: Sign up for our weekly newsletter

A living liver donation surgery involves removing part of a person's healthy liver — as much as 60 percent — and using this partial liver to replace the recipient's diseased liver. In the weeks to come, both the donor and recipient sections will grow to the size of normal livers.

The exchange, performed on adults since the late 1990s, seems like something out of science fiction.

"There aren't many other organs in the body that truly have the capacity to regrow," says Christopher Sonnenday, M.D., surgical director of the Adult Liver Transplant Program at Michigan Medicine. "It is a totally transformative operation."

It's also a crucial one.

While dialysis, for instance, can bridge kidney failure patients until a transplant becomes available, there are no alternative therapies for liver failure. That's why liver transplants are prioritized by a recipient's level of sickness using an assessment known as a MELD score (Model for End-Stage Liver Disease).

This priority system has helped reduce deaths on the waiting list, but also requires patients to become critically ill before having the opportunity for a lifesaving transplant, Sonnenday says.

Still, demand far exceeds supply: More than 14,000 people in the United States are waiting for a new liver, according to the United Network for Organ Sharing. Livers are the second most-needed organ after kidneys.

Without a timely and suitable match, "the critically ill people are essentially dying of their disease without having a chance," says Sonnenday.

This is why a small but growing number of individuals are opting to give a part of their liver to help someone else — demand that is driving a need for more living donor liver transplant programs.

To help, a Michigan Medicine partnership with NewYork-Presbyterian/Columbia University Medical Center, one of the nation's busiest center for living donor liver transplants, was established in 2016 to promote knowledge and resource sharing between the programs

Sonnenday talked about the procedure, and what all involved parties should know:

Facts about living liver donation

Most donors know their recipient: Because of the size and scope of the operation — plus the speed a decision to donate might require — a living liver donor typically has close ties to the recipient. Still, both sides must undergo a range of compatibility tests. One problematic issue: if a donor's body is much smaller than the recipient. In these cases, "the portion of their liver might not be adequate" for the sick patient's needs, Sonnenday says.

Living donations save time: Living donation is intended to help a sick patient avoid the wait time for a deceased donor. That can mean an individual receives lifesaving intervention before his or her condition (typically end-stage liver failure, liver cancer or other rare and metabolic diseases) worsens. Notes Sonnenday: "Seeing someone they love waste away is often the motivating factor. It allows them to 'jump the line' and turn things around."

SEE ALSO: Strength in Numbers: Why Organ Donation Matters [Infographic]

Live liver donations remain rare: Living liver donation was first attempted in children in the late 1980s. Adult transplants initially took place a decade later, Sonnenday says. Today, they account for only about 5 percent of total liver transplants. That's partially because the surgery can frighten or disqualify some donors — and there are limited surgeons and centers with robust expertise. The latter is changing, as shown by the Michigan Medicine/Columbia partnership.

Risks affect both parties: Studies have shown that "long-term outcomes are as good or better" for living-donor recipients, Sonnenday says. But unique challenges remain. Because it's only part of a liver, the implantation process for the recipient is more complicated. There also are risks to the donor, such as bleeding and the need for blood transfusion. The mortality rate for the donor, Sonnenday says, is approximately 1 in 500 — a rare outcome, but an important piece of information for donors to consider.

Recovery time is significant: A living donor who gives a kidney might be hospitalized for a few days and spend four to six weeks healing. Those who offer part of their liver, however, can expect to double that length of time. "It's a bigger operation," says Sonnenday, noting that long-term data show no signs that the surgery affects a donor's life span or risk of developing liver disease. Meanwhile, it takes about six weeks for both parties' livers to grow to full size.

Patients bounce back: Whether a living or deceased donor, transplant surgery results speak volumes. "I see (recipients) eight or 12 weeks after their surgery and you can't even recognize them. They look like new people — muscle mass, color in their face, vigorous and energetic," says Sonnenday. "To see that happen through the miracle and generosity of living donation is unbelievable."


More Articles About: Wellness & Prevention Liver Transplant Transplant Surgery Health Care Quality Transplant
Health Lab word mark overlaying blue cells
Health Lab

This article is from the Health Lab digital publication.

Media Contact Public Relations

Department of Communication at Michigan Medicine

MichMedmedia@med.umich.edu

734-764-2220

Newsletter

Get a weekly digest of medical research and innovation, straight to your inbox.

Subscribe
Featured News & Stories scientist examining a kidney
Health Lab
An AI model predicting acute kidney injury works, but not without some tweaking
The model identified AKI 48 hours in advance, allowing ample time for clinicians to intervene and provide treatment.
woman doctor scrubs sad ashamed lab note
Health Lab
Study in residents shows high prevalence of sexual harassment, yet low reporting rates
Research reveals that one in four women among internal medicine residents experiences sexual harassment, but far fewer go on to report it.
older man holding hands up over head celebrating in hospital bed
Health Lab
Rebounding at 87 after CNS lymphoma
William Moldwin published a book, won awards and is making more plans for his future.
VAD heart device cooler red and teal
Health Lab
Medicare policy change could increase inequity in heart transplant access, study finds
Patients seen at transplant centers had almost 80% higher odds to receive “bridge-to-transplant” designation
pregnant stomach with yellow dots and blue undertone lab note
Health Lab
Few pregnant people who died of overdose, suicide in Michigan received proper treatment before death
A review of maternal deaths suggests most individuals had documented behavioral health conditions but only one-third received appropriate pharmacologic treatment before death
Three hands with two medical bands having the words penicillin allergy disappearing.
Health Lab
Are you still allergic to penicillin?
A new program is finding many diagnosed in childhood with antibiotic allergies are no longer allergic after retesting