Your new liver can come from either of the two sources: a living donor or a brain-dead deceased donor.
A) Living donor:
It is technically feasible to remove part of the liver from a living person and transplant it to a patient who needs a new liver. The operation has now been done since 1989. Depending on the size matching of the donor and recipient, either the left side (about 35%) or the right side (50-65%) of the liver will have to be removed. The liver remnant in the donor will grow to its original size in 6-8 weeks time.The donor complications-donor death 0.2 to 0.4%.
- Benefits for the recipients:
- Earlier transplant before the recipient s conditions deteriorates.
- Good quality liver graft from a living donor.
- Risk for the donor:
- Pain, discomfort and complications of the investigations and surgical procedures.
- Average hospital stay of 7-10 days.
- Average loss of work of 6-8 weeks.
- Complication rate of about 10-15% ( wound infection, hernia, bleeding, bile leakage, bile duct problems, infection, pneumonia, liver failure which may require liver transplant, etc).
B) Brain-dead deceased donor:
You will be put on waiting list for a brain dead deceased donor liver and receive a liver graft according to the following criteria:
- Your blood group matching.
- The urgency of your operation.
- Severity of your liver disease according to the Model for end-stage liver disease score(MELD) or Pediatric end stage liver disease (PELD).
Unfortunately, the availability of deceased donor liver is not very often. Depending on your blood group, you may have to wait for 12-36 months before you get a new liver. During this waiting period, you may develop complications like spontaneous bacterial peritonitis which, if repetitive may produce severe adhesions in your abdomen rendering liver transplant difficult if not impossible. Overall the complications of liver disease would adversely affect the success rate of the liver transplant.
When potential deceased donor liver graft is allocated to you, you will be admitted to the hospital by our liver transplant coordinator. A series of tests and investigations (blood tests, cultures, chest x-ray, ECG) and assessments by the anesthetist will be performed on you promptly after admission. You will be explained on the nature, purpose, and risk of the operation by our transplant surgeons in the ward. You are also required to sign a consent form referring to the success rate or diseases from the cadaveric organ. For a minor patient(age under 18yrs) the patient s parents, guardian or next of kin should sign the form. It is important for you and your family to understand that assessments and investigations on the potential deceased donor are on going and unexpected changes may happen to the donors medical condition. There are uncertain circumstances that may render the donor unsuitable for donation even when you have been admitted to the hospital.
- Unstable hemodynamics of the donor.
- Unhealthy, abnormal or doubtful appearance or pathology of the liver graft on examination by the harvesting surgeons during the donor operation.
- Suspected malignant tumor(s) found during donor operation.