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 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 August 22, 2023.

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% — 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," said Christopher Sonnenday, M.D., transplant center director and surgical director of the Adult Living Donor 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," said 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.

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

Facts about living liver donation

Many, but not all, 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 said. 

Individuals that come forward to donate to anyone on the list, known as “non-directed” donors, are evaluated as donors to children and other individuals who may face particular challenges finding an appropriate deceased donor.

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.

Noted Sonnenday: "Seeing someone they love waste away is often the motivating factor. It allows them to 'jump the line' and have the opportunity to become well."

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 7% 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, with national and international collaborative efforts among centers to share expertise and experience.

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. T

here 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 600 — 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," said 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 four to six weeks for both parties' livers to grow to full size.

Recipients bounce back: Whether due to the generosity of a living or deceased donor, transplant surgery is transformative.

"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," said Sonnenday.

"To see that happen through the generosity of living donation is truly a miracle we are honored to witness."


More Articles About: Preventative health and wellness Liver Transplant Transplant Surgery Health Care Quality Transplant
Health Lab word mark overlaying blue cells
Health Lab

Explore a variety of healthcare news & stories by visiting the Health Lab home page for more articles.

Media Contact Public Relations

Department of Communication at Michigan Medicine

[email protected]

734-764-2220

Stay Informed

Want top health & research news weekly? Sign up for Health Lab’s newsletters today!

Subscribe
Featured News & Stories Spilled pills next to a stethoscope and pile of cash
Health Lab
Drug pricing program improved prostate cancer treatment adherence
Socially vulnerable patients were more likely to stick with oral medications when treated at a hospital participating in 340B program, suggesting these hospitals may have more resources to help patients.
computer
Health Lab
Same patient. Different visit. Different race and ethnicity?
Data on the race and ethnicity of patients underpins efforts to reduce health care disparities, but a study shows inconsistent recording in emergency departments
Microscopic image of bone marrow with pink and white hues
Health Lab
Novel risk score for cardiovascular complications after bone marrow transplant
More bone marrow transplants, also known as hematopoietic stem cell transplantation, are being offered to older patients, a population at greater risk of cardiovascular disease.
Drawing of parent trying to get child's attention who is listening to music on headphones
Health Lab
Are headphones and earbuds exposing your children to noise health risks?
2 in 3 parents in national poll say their child ages 5-12 use personal audio devices; pediatrician offers 4 tips to reduce noise exposure risks
Closeup of medical ventilator breathing tube
Health Lab
Patients on respiratory support in rural intermediate care units have higher death rates
Patients receiving ventilator life support in intermediate care units of rural hospitals had significantly higher death rates than patients in the same type of unit at urban hospitals, according to new study.
Illustration of Plan B contraceptive in the palm of a hand
Health Lab
Emergency contraception related ER visits dropped significantly over 14 year period
After federal approval for over the counter emergency contraception in 2006, emergency departments across the U.S. saw dramatic decreases in related visits.