Sr. Consultant, Liver Transplant, HPB & GI Surgery, Metro Heart Institute with Multispeciality, Faridabad
Part 7 of 10 in Diagnosis and Management of Liver Cirrhosis
Living Liver Donor Safety and Evaluation
June 16, 2024
In a living donor transplant, protecting the donor, a healthy person undergoing major surgery to help someone else, is treated as being just as important as treating the recipient.
How donors are evaluated
Donors undergo extensive evaluation before being cleared: two CT scans, an MRI, and a large panel of blood tests, all aimed at confirming the donor can safely give up part of their liver.
Being honest about the risk
This is major surgery, not minor surgery, and donors need to understand that clearly during counselling. The overall global success rate for donors is 99.5%, meaning roughly 1 in 200 donors could lose their life during the donation process. This is a rare occurrence, and outcomes have improved as surgical experience has grown, but it is a real risk that must be disclosed rather than understated.
This article is based on a Jivo Masterclass session conducted by Dr. Sandeep Jha, Consultant Liver Transplant, Manipal Hospital, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
Looking for a liver transplant or hepatology consultation? Get in touch with the Jivo team
This guide is based on a live Jivo Masterclass: Dr. Sandeep Jha taught doctors across Africa on June 16, 2024.
FROM THE LIVE Q&A
Jivo Doctor Partner (name unclear from transcript)
What are the effective drugs for hepatitis B and C?
Dr. Sandeep Jha
For hepatitis B, tenofovir and entecavir are very effective drugs with low resistance levels that can practically control the virus. For hepatitis C, directly-acting agents such as sofosbuvir and velpatasvir are very effective and can practically eliminate the virus from the body.
Frequently Asked Questions
What is the donor's recovery timeline after living donor liver transplant?▼
The donor is admitted for about seven days. By the third or fourth day, the donor is walking around, eating, and relatively pain-free, and is discharged by day six or seven. A follow-up OPD visit happens on day 10; if doing fine, the donor can return to their home country and resume office and light household work, with the only restriction being on lifting heavy weights.
What is the recipient's recovery timeline after living donor liver transplant?▼
This depends on how sick the recipient was before surgery: a weaker, sicker patient takes longer to recover. The recipient typically stays in hospital for around 18 days, with discharges starting around day 12-13 and about 95% discharged by day 18. Complete recovery, meaning a return to normal muscle mass and full function, takes about two to three months. After 2-3 weeks of local follow-up near the hospital in India, the patient can return to their home country and continue follow-up from there.
What is the risk to the donor's life during liver donation?▼
The overall global success rate is 99.5%, meaning about 1 in 200 donors could lose their life during the liver donation process. This is a rare occurrence that donors must understand during counselling as part of a major surgery, though outcomes have become safer with growing surgical experience.
What is the success rate for the recipient of a liver transplant?▼
The success rate for recipients is 90-95%, meaning even a very well-performed transplant carries a 5-10% chance the recipient will not survive, accounting for both surgical risk and post-transplant complications. The first 10 days of recovery are considered just as important as the surgery itself, since the body's adjustment to the new liver isn't always predictable.
Can hepatitis B spread through blood exposure or within a family, and what precautions should be taken?▼
Yes, theoretically, exposure to blood (such as from a cut, or sharing blades) can transmit hepatitis B. The protocol is that if one family member is infected, the whole family should be vaccinated to build protective antibodies against accidental exposure. Married couples are protected against transmission even in a sexual relationship if the unaffected partner is adequately vaccinated.
How is a living liver donor evaluated for safety?▼
Through two CT scans, an MRI, and an extensive panel of blood tests, all aimed at confirming the donor can safely donate part of their liver.
What is the risk to a living donor's life?▼
The global success rate is 99.5%, meaning roughly 1 in 200 donors could lose their life during the process - a real but rare risk that has decreased with growing surgical experience.
In This Series: Diagnosis and Management of Liver Cirrhosis
- 1.Liver Cirrhosis
- 2.What Causes Liver Cirrhosis: Hepatitis, Alcohol and NAFLD
- 3.Diagnosing Cirrhosis Early: Fibroscan Before Symptoms Appear
- 4.MELD and Child-Pugh Scores: Grading Cirrhosis and Timing a Transplant
- 5.Decompensated Cirrhosis: Ascites, Encephalopathy and Liver Failure
- 6.Living Donor vs Deceased Donor Liver Transplant
- 7.Living Liver Donor Safety and Evaluation
- 8.Liver Transplant Recovery: Donor and Recipient Timelines
- 9.Hepatitis B and C: Treatment and Family Precautions
- 10.NAFLD and Metabolic Risk Factors: Diet and Lifestyle Management