Questions, Answers and Information for Donors Living Donor Liver Transplants Transplant Services, A unique partnership of University of Minnesota Physicians Transplant Program and Fairview Health Services If you are deaf or hard of hearing, please let us know. We provide many free services including sign language interpreters, oral interpreters, TTYs, telephone amplifiers, note takers and written materials.
2 Living Donor Liver Transplants What is a living donor liver transplant? A living donor liver transplant is a type of surgery in which part of the healthy liver of a living person, or living donor, is taken out and used to replace the unhealthy liver of another person. Why not use a liver from someone who has died? In years past, all donated livers came from people who had died. Today, there are not enough livers from people who have died, so living donations are also an option. How common are living donor liver transplants? The first living donor liver transplant in the United States was done in 1989 when a child received part of his mother s liver. Since then, more than 1,600 living donor liver transplants have been done for children across the nation. Transplant surgeons at the University of Minnesota have been transplanting livers from living donors since 1996. The first adult-tochild living donor liver transplant and the first adult-to-adult living donor liver transplant in Minnesota were both done by University of Minnesota surgeons. University of Minnesota Medical Center, Fairview, now offers living donor liver transplantation as an option to most of the children and adults who come to us for a liver transplant.
Living Donor Liver Transplants 3 Are there advantages to using a living donor for a liver transplant? Yes. The greatest advantage to using a living donor for a liver transplant is that the person with the unhealthy liver does not have to wait for someone to die to get a healthy liver. More than 18,000 people are now waiting for liver transplants in the United States, but only 5,500 transplants are done every year. About one out of five patients will die waiting for a healthy liver. From the day they are first placed on the waiting list, patients may wait up to 1½ to 2 years to get a liver from someone who has died. During this time, their health is likely to get worse. With a living donor transplant, there is no waiting. This allows the transplant to be done while the person with the unhealthy liver is better able to stand the surgery and get well more quickly. A piece of liver from a live donor can be placed into the recipient as soon as it is removed from the donor. This improves the chances that the transplanted liver will work the way it should. A liver from someone who has died may need to be stored for several hours before it is transplanted. Finally, living donor liver transplants increase the number of livers available for transplantation. Someone who receives a liver from a live donor will drop off the waiting list, allowing someone who does not have a suitable living donor to move up on the waiting list.
4 Living Donor Liver Transplants What are the results for living donor liver transplants? Because the procedure is fairly new, we can t yet be sure what the long-term results will be, especially for adult-to-adult living donor liver transplants. However, the short-term results are promising. In the United States, 85 percent of those who receive a liver transplant from a living donor are alive one year after their transplant. At University of Minnesota Medical Center, more than 95 percent of patients who receive a living donor liver are alive one year after transplant. Both adults and children who have had a living donor liver transplant have a good chance of leading a long and healthy life. Who can become a living donor? The transplant team will consider many different people as potential living donors. A donor can be a family member, friend or spouse. The donor must be in good physical and mental health. The donor cannot have a history of major medical problems, liver disease or heavy alcohol use. The transplant team will only consider healthy donors between the ages of 18 and 55. How can I become a living donor? To become a living donor, you must first be tested. Only about half of the people tested are suitable to become a living donor. You will not be suitable if you have the wrong type of blood or your liver is unusual (although you may otherwise be in excellent health).
Living Donor Liver Transplants 5 What sorts of tests would I need to have? First we would make sure that you have the right blood type. Then we would look at your medical history and do a complete physical exam. You must not have any medical problems that would increase your risk from having a major operation or having part of your liver taken out. Such medical problems would include certain liver, heart and lung problems; hepatitis or HIV infection; obesity; diabetes; and a history of cancer or heavy alcohol use. We would also do several blood tests to make sure that your blood and liver are normal. Next we would X-ray your liver. Everyone s liver is a little bit different. For a successful transplant, a donated liver must be the right size and have good blood vessels. Each part of the liver has its own blood supply and bile duct, a tube that carries away a fluid called bile, which is made in the liver. (Bile is used by the body to digest the fat that you eat.) Because each part of the liver has its own blood vessels and bile duct, it is possible to take one part of your liver and hook it up inside the body of another person. After your tests, a social worker from the transplant team will talk to you to make sure that you fully understand the risks of being a living donor and have made your decision entirely on your own, without any pressure from anyone else. Something to remember: If the liver of someone who has died becomes available, even while you are being tested to be a living donor, the doctors will go ahead and transplant the liver from the person who has died.
6 Living Donor Liver Transplants What happens after the tests are done? All of the information is carefully reviewed by the transplant team to make sure that you are a suitable living donor. If the decision is made to accept you as a donor, a date for the transplant is chosen. You will need to come back the week before surgery to get more tests and instructions for the day of surgery. If the person with the unhealthy liver becomes too ill, the living donor transplant may need to be canceled. What happens the day before surgery? 8 hours before surgery, stop all food, milk and chewing tobacco. Keep drinking clear liquids until 2 hours before your procedure. Clear liquids include water, clear juice, black coffee or clear tea without milk, gatorade, clear soda. Do not drink alcohol for 24 hours before your surgery. You will be given a bottle of antibacterial soap. You should scrub the front of your body from your chest to your knees the evening before the surgery and twice in the morning on the day of surgery, before you come to the hospital. This makes it less likely that you will get an infection in the incision, or cut, from the surgery. If you are allergic to antibacterial soap, please let us know. You cannot smoke in the hospital after you are admitted. Smoking raises the risk of having heart and lung problems, such as pneumonia, after surgery.
Living Donor Liver Transplants 7 Where can my family members stay overnight? Some hotels are available at a reduced rate. For more information, call the Accommodations Department of University of Minnesota Medical Center at 612-273-3695 or 1-800-328-5576. What happens the day of surgery? You will be admitted to the Same-Day Admission Unit (3C) of University of Minnesota Medical Center at about 5:30 a.m. We will ask you to wear special stretch stockings on your legs. You may wear only a hospital gown to surgery. You must remove dentures and glasses, nail polish, lipstick, makeup, jewelry and hairpins. Leave your valuables with relatives for safekeeping. You will be taken to a special room called the Pre-Induction Room outside of the Operating Room. Your family may come with you into this room. In this room, we will place a needle with a tube (called an IV) in your hand or arm. We will give you medicine through this tube. This will help you relax and then put you to sleep. Once you are asleep, a breathing tube will be put down your throat. If the breathing tube is still in place when you wake up, you will not be able to talk. When you are fully awake, the tube will be taken out. Your family can wait in the Surgery Waiting Area on the third floor. After the surgery is done, a doctor will talk briefly with your family there.
8 Living Donor Liver Transplants What is the operation like? The operation is done through an incision, or cut, in the skin just below your ribs. If the person who will get your liver is a child, only a piece of the left part of your liver will be taken out about one quarter of your total liver (see figure 1). If the person who will get your liver is an adult, a larger piece of your liver will be taken out over half of your total liver (see figure 2). Fig. 1 75% 25% Portion of liver to be used for child transplant
Living Donor Liver Transplants 9 Fig. 2 60% 40% Portion of liver to be used for adult transplant A tube called a catheter will be inserted in your bladder to drain urine. Another tube will be inserted through your nose and throat down to your stomach. This drains your stomach so that you don t get sick and vomit. The stomach tube will stay in place for a couple of days after the surgery, or until your bowels begin to work again. A small plastic drain will be left in your belly near the cut. This removes blood and bile that may collect where the piece of liver was removed. This drain is usually taken out four to five days after surgery. The operation takes six to eight hours.
10 Living Donor Liver Transplants Where will I wake up after surgery? You will wake up in the Post-Anesthesia Care Unit (PACU). Nurses will check your pulse and blood pressure often. You will breathe air through an oxygen mask. This air will feel cool and moist. After a while, the mask will be taken off, and you will breathe air through small tubes that run to your nose. These oxygen tubes will be taken off a day or two after surgery. Once you are fully awake, you will be moved to the Transplant Unit (6B). What will my incision look like? The incision (the cut that the doctor makes) is fairly large. It is made just under the ribs (see figure 3). Fig. 3 Liver Bottom of rib cage Incision for donor surgery
Living Donor Liver Transplants 11 Will the operation hurt? Because the incision is large, it may be painful. And because the ribs are pulled back during the operation so that the doctors can get to the liver more easily, the ribs may also be painful. It may hurt to breathe or cough, since breathing and coughing use some of the muscles that have been cut. However, the pain can usually be controlled by medicine. If you are having a lot of pain, you need to tell your nurse or doctor. To control your pain yourself, you will have a button you can push to pump pain medicine through an IV into your body. You can give yourself as much medicine as you need. The pump will be set so that you cannot give yourself too much medicine at one time. Most patients use the pump for two to three days. Once the IV is taken out and you are able to drink liquids again, pain medicine can be given by mouth instead. Besides pain, what should I expect the first days after surgery? Many people have a dry mouth and sore throat from the breathing tube that is put down their throat during the operation. You can rinse your mouth, but you cannot eat or drink until your bowels are working again and your stomach tube is taken out. Once you are fully awake, though, you may suck on ice chips. Many people also feel sick to their stomach the first few days. Medicine can help you feel better.
12 Living Donor Liver Transplants So that you can pass urine easily, a catheter is inserted into your bladder during surgery. The nurses measure the urine to see how much fluid must be given through the IV. The catheter will be taken out within one to two days after surgery. If you cannot urinate within six to eight hours after the catheter is taken out, another catheter will be put in to empty the bladder and then taken back out. Some people cannot urinate the first time the catheter is taken out. You may need to wear special stockings on your lower legs after surgery. Called pneumoboots, these stockings apply pressure every so often by filling with air and then emptying. The pressure from the pneumoboots helps your blood flow more freely and prevents blood clots. You can take off the pneumoboots once you are up and walking around several times a day. Why is it important to turn, cough and take deep breaths every couple of hours? You need to take deep breaths, cough and turn from side to side every two hours for the first few days after surgery. This helps prevent fluid from building up in your lungs. Fluid in the lungs can cause pneumonia. Getting out of bed to walk several times a day is the best way to prevent pneumonia. You will have a device to help you do breathing exercises. You should use this every one to two hours while you are awake.
Living Donor Liver Transplants 13 When can I sit up and walk? In the evening after surgery, you may be asked to sit up in bed and dangle your feet. Tell the nurse if you feel dizzy. You may feel well enough to stand, with some help, beside your bed. The morning after surgery, a nurse will help you get up and walk. This will be easier if you take some pain medicine first. Walking will help your lungs and bowels to work normally again, which helps you to get better more quickly. When can I start drinking and eating again? You can drink clear liquids once the stomach tube (the tube through your nose) is out and your bowels begin to work again. When you can drink enough by mouth, your IV will be removed. Over time, you will be able to drink and eat more things. You may have gas pain or constipation (hard stools). Walking and drinking plenty of fluids will help with these problems. How long will I need to stay in the hospital? Most donors are in the hospital about seven days.
14 Living Donor Liver Transplants How long will it take me to get better at home? When you leave the hospital, you should be able to shower, dress and do other simple daily activities. To heal, you need to eat a healthy, balanced diet. Fruits, vegetables, whole grains and water will help your bowels to work normally. Constipation (hard stools) can be painful, but it can usually be prevented with a good diet. You should check your temperature at least once a day for about a week. Check under the tongue. Your temperature should be about 98.6 F (37 C). A temperature above 100 F (37.8 C) may be a sign of an infection. You need to let us know if this happens. You should shower every day to keep the incision clean. Check the incision daily for any signs of swelling, redness or tenderness. If you have any of these, call your transplant coordinator. The skin along the incision may feel numb because nerves get cut during surgery. It may take you a while to get used to this numbness while the nerves grow back. As the nerves grow back, you may feel tiny shooting pains along the incision area for six to twelve months after surgery. Your incision may also feel uneven. This is normal. It will flatten over time.
Living Donor Liver Transplants 15 Are there things I won t be able to do, or shouldn t do, after the surgery? For a few weeks after major surgery, you may find that you tire more easily. Ask family members and friends for help with such things as household chores, meals, errands and child care. You can become more active, including sexually active, as you feel able. However, for at least six weeks after surgery, you must not lift more than 10 pounds. If you lift too much too soon, you could hurt yourself, which means you may need to have more surgery. You should be able to drive by three weeks after surgery. However, you should not drive while taking any kind of prescription pain medicine. When can I go back to work? You are the best judge of when you can go back to work. Generally, you should be able to return to work six to eight weeks after surgery if your job does not involve heavy physical labor or lifting. If it does, you should plan on waiting two to three months after surgery to allow your stomach muscles to heal. At first, you will tire easily at work.
16 Living Donor Liver Transplants Will I need any checkups after I leave the hospital? We ask donors to come back for a checkup a week after they have left the hospital. Sometimes, right after the surgery, the liver does not work as well as it should, but this quickly returns to normal. The incision should be checked every one to two weeks until it is totally healed. Three months after surgery, we will scan your liver to see how well it is growing back. We will also do some blood tests at this time. You will be asked to see your doctor again at six months, nine months and one year after the surgery. When will my liver return to its normal size? Your liver should return to its normal size in about two to three months. The part of the liver that was taken out does not grow back. What is left of your liver grows to fill the space of the part that was taken out. Are there any possible complications I should be aware of? The donor operation is a major procedure, so there are many possible complications. If you have donated part of your liver to an adult, the chances of having a complication may be higher because a larger piece of the liver had to be removed. Possible complications include:
Living Donor Liver Transplants 17 Bleeding The liver has a very rich blood supply, so there can be a lot of bleeding during the operation. If there is more bleeding than expected, we may need to give you blood from a blood bank. The chance that you will need this is very low. We rarely need to do a second operation to stop bleeding caused by the first surgery. Bile duct problems Bile may leak from the surface where the liver was cut or where the bile duct was cut. This may require a special X-ray or, more rarely, a second operation. Other Other possible complications include infection in the incision or body, a hernia (if the muscles don t heal together properly), and blood clots in the legs. So far, in the United States, more than 1,600 living donor liver transplants have been done for children, and 4,000 for adults. Complications happen in 15 to 30 percent of living donor liver transplants. There is also a small risk of dying (less than a half of one percent). While the risk of death is small, it is very real and must be considered.
18 Living Donor Liver Transplants What are the long-term effects of the surgery? When the incision is made, nerves are cut, so your scar may feel numb or tingle for several weeks or months after surgery. When you have fully recovered, there should be no difference in how much energy you have, your ability to do your job, how long you will live, how often you get sick, your ability to have sex or bear children, or your general feeling of health. You will not need to change how you live or eat, and you will not need any special medicine. Studies have shown that self-esteem remains high for years after donation and that donors have a positive attitude because of the surgery. Should I receive any bills after the surgery? You should not receive any bills. But if you do, send the bills to: The Transplant Center, MMC 482 516 Delaware St. SE. Minneapolis, MN 55455 Where can I get more information? The Transplant Center website offers more information on living liver donation, as well as links to other helpful sites. Go to fairviewtransplant.org.
The Transplant Center 516 Delaware St. SE, MMC 482 Minneapolis, Minnesota 55455 Tel: 612-625-5115 or 800-328-5465 fairviewtransplant.org For informational purposes only. Not to replace the advice of your health care provider. Copyright 2004 Fairview Health Services. All rights reserved. SMARTworks 520160 REV 09/14.