Sr. Consultant, Liver Transplant, HPB & GI Surgery, Metro Heart Institute with Multispeciality, Faridabad
Part 6 of 10 in Diagnosis and Management of Liver Cirrhosis
Living Donor vs Deceased Donor Liver Transplant
June 16, 2024
There are two broad types of liver transplant, and which one is realistic depends heavily on where in the world the patient is being treated.
Deceased donor versus living donor
In deceased donor liver transplant (DDLT), organs are retrieved from a brain-dead donor and distributed to patients with organ failure. In living donor liver transplant (LDLT), roughly 60% of a living donor's liver is removed and transplanted into the recipient, replacing their failing liver entirely; the remarkable property of the liver is that it grows back to size in both the donor and the recipient. Deceased donor transplant requires major national infrastructure to run at scale and is common in the US and other developed countries, but is not widely available in India or the rest of Southeast Asia, which is why living donor transplant is the primary option used in this region.
Success rates are comparable
The success rate for the patient is the same in both DDLT and LDLT; the two techniques differ in approach, each with its own advantages and disadvantages, but not in patient outcomes.
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
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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 exam findings of cirrhosis, and when do they appear?
Dr. Sandeep Jha
On examination, jaundice, ascites, leg oedema, spider angiomas, palmar erythema and gynaecomastia are the telltale signs of cirrhosis. Unfortunately, these are only seen in advanced cirrhosis. Since the goal is to catch cirrhosis before complications develop, an ultrasound or fibroscan done proactively is the better approach for early diagnosis.
Frequently Asked Questions
What are the effective drugs for hepatitis B and C?▼
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.
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.
What is the difference between living and deceased donor liver transplant?▼
Deceased donor transplant uses organs from a brain-dead donor; living donor transplant removes about 60% of a living donor's liver, which regrows to full size in both donor and recipient.
Why is living donor transplant more common in India?▼
Deceased donor transplant requires major national infrastructure that isn't as developed in India and Southeast Asia, so living donor transplant is the primary option in this region.
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