Principal Consultant & Unit Head, Liver Transplant, Fortis Hospital, Shalimar Bagh, New Delhi, India
Part 7 of 12 in Liver Transplant
Who Can Donate a Liver: Eligibility, Compatibility and the Ten-Year Myth
August 11, 2024
A relayed question asked directly who is eligible to donate a liver. Dr. George's answer covers both the legal and medical requirements.
Legal and blood-group requirements
Legally, a donor must be a relative of the patient. Medically, the ideal donor is blood-group compatible: A or O can donate to an A recipient, B or O to a B recipient, any group can donate to an AB recipient (a universal recipient), and only an O donor is compatible with an O recipient; Rh positive or negative does not matter for liver donation. If no compatible donor exists in the family, an incompatible donor can still be evaluated, though this requires a longer preparation period, higher cost, and slightly increased risk.
Medical fitness to donate
Beyond blood-group compatibility, a donor should be 18 to 55 years old and otherwise healthy: no diabetes, no advanced or uncontrolled pulmonary problems. Mild hypertension, previous abdominal surgery, benign gynaecological conditions, mild asthma, and a controlled seizure disorder are generally not disqualifying.
The donor's own long-term outlook
Dr. George was direct in correcting a common myth: there is no truth to the idea that donating a liver limits a donor's life expectancy to ten years. Once a donor has recovered, typically discharged within a month with no long-term follow-up needed after that, their food habits, work, family life, sexual life, and life expectancy are unaffected. The only lasting consideration is the surgical scar, whose strength takes about three months to normalise, during which heavy lifting is avoided. A person can only donate a liver once.
This article is based on a Jivo Masterclass session conducted by Dr. Ashish George, Principal Consultant & Unit Head, Liver Transplant, Fortis Hospital, Shalimar Bagh, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
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This guide is based on a live Jivo Masterclass: Dr. Ashish George taught doctors across Africa on August 11, 2024.
FROM THE LIVE Q&A
Jivo Doctor Partner (name unclear from transcript)
How long does it take for a donor's liver to regrow after donation, is it true that a donor only has ten years of survival left, and what is the age limit to donate?
Dr. Ashish George
About 70-80% of eventual growth happens in the first two to four weeks, and 95-97% of original size is reached by six months. The '10 years survival' claim is an absolute myth: once recovered, a donor's life expectancy, work, family and sexual life are completely unaffected. The donation age range is generally 18 to 55, and a person can only donate a liver once.
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Frequently Asked Questions
For someone who already had a liver transplant and requires another one, what are the possibilities, and how many times is it possible to have a repeat transplant?▼
Re-transplant is needed in about 5-7% of patients, due to disease recurrence, chronic rejection, or other causes. It is technically more challenging than a first transplant but achieves equal long-term results when performed by a skilled team; some patients have undergone two, three, or even four transplants over the years.
Is it possible for a healthy person without liver disease to have a partial hepatectomy stored, so that if they develop liver disease later it can be transplanted back to them?▼
No, this has not been thought of or done. Only a very small subset of the general population ever needs a liver transplant, so removing a healthy liver segment as a major surgery isn't advisable, and there is no method to preserve a graft for years, only for hours to a few days using specialised machines.
What is the time limit for liver cells to survive outside the body before transplant, and what is the recommended alcohol limit for a patient after liver transplant given a history of alcohol use?▼
A deceased-donor liver can be preserved up to 16 hours in solution, though shorter is always better. Living donor transplant avoids this almost entirely since donor and recipient surgeries happen side by side, keeping the liver outside the body for only half an hour to two hours. The prescribed alcohol limit after transplant for alcoholic liver disease is zero, and at least six months of abstinence is recommended before transplant, and none at all afterward.
On immune monitoring and tolerance after liver transplant, there is evidence of adverse effects including cardiovascular disease, osteoporosis, infection and renal failure. How can these risks be minimised to improve outcomes for patients?▼
Post-transplant medications do carry a risk of cardiac problems, hypertension, diabetes and renal dysfunction, and a modestly elevated cancer risk versus the general population. But comparing 100 transplanted patients against 100 similar patients who are not transplanted, more of the transplanted group are alive at one, three and five years. Doses are actively managed and medications changed where complications arise to minimise risk over time.
What is the survival rate of liver transplantation?▼
More than 90% of patients are alive at 1 year, 80-85% at 3 years, more than 75% at 5 years, and 65-70% at 10 years. Liver transplant does not have an expiry date because the liver can regenerate.
Who is legally and medically eligible to donate a liver?▼
Legally, a relative of the patient. Medically, blood-group compatible, aged 18-55, and free of diabetes or advanced uncontrolled pulmonary disease.
Does donating a liver shorten a donor's life expectancy?▼
No. This is a myth. Once recovered (typically within a month), a donor's life expectancy, work, family and sexual life are unaffected. Only heavy lifting is restricted for about three months while the surgical scar strengthens.
In This Series: Liver Transplant
- 1.Liver Transplant
- 2.Indications for Liver Transplant: Acute and Chronic Liver Disease
- 3.Liver Transplant for Liver Cancer: HCC, the UCSF Criteria and Downstaging
- 4.Contraindications and the MELD-Sodium Score for Timing Transplant
- 5.Survival Rates After Liver Transplant, and Why It's a Cure, Not Just a Therapy
- 6.Living Donor Evaluation: Compatibility, Safety and Liver Regeneration
- 7.Who Can Donate a Liver: Eligibility, Compatibility and the Ten-Year Myth
- 8.Hepatitis B and C in Liver Transplant Candidates
- 9.Re-Transplantation: When and How Often It's Possible
- 10.Nutrition Before and After Liver Transplant
- 11.Immunosuppression After Transplant: COVID-19, Cardiovascular and Renal Risk
- 12.Cold Ischemia Time and Post-Transplant Alcohol Limits