For patients in need of a liver transplant, a shortage of livers available for a transplant has long been an issue.
One solution for helping address the shortage is living donor liver transplants.
How do they work?
Learn more from a UVA specialist in liver transplantation.
Selected Podcast
How Does a Living Donor Liver Transplant Work?
Featured Speaker:
Organization: UVA Transplant Center
Dr. Shawn Pelletier
Dr. Shawn Pelletier is a board-certified surgeon and surgical director of liver transplantation at UVA.Organization: UVA Transplant Center
Transcription:
How Does a Living Donor Liver Transplant Work?
Melanie Cole (Host): For patients in need of a liver transplant, a shortage of livers available for transplant has long been an issue. One solution for helping address this issue and this shortage is living donor liver transplants. My guest is Dr. Shawn Pelletier, he is a board certified surgeon and surgical director of liver transplantation at UVA. Welcome to the show Dr. Pelletier. How does a living liver donation work?
Dr. Pelletier (Guest): Well Melanie, we start first by identifying a candidate who needs a liver transplant. So, for the most part, people will come forward who have liver disease, if their symptoms are severe enough, we will work towards getting them on the waiting list for a liver transplant, and at that point, we will talk to the candidate about how the waiting list works and their options and whether or not finding a friend or relative to donate part of their liver would be the right step for them. Once we get to that step, then we would bring in the living donor and meet them and talk to them, it sounds like that is going to lead into your next question.
Melanie: So, what are the benefits for the patient first to a living donor versus, you know, another type of donor.
Dr. Pelletier: Right, there are several benefits to the transplant candidate. First of all, the waiting list works pretty well. We are able to get a liver for about 80% of people on the list, what that means is that there’s somewhere close to one in five people who we see who needs a liver transplant never gets one in time and either gets too sick to the point where they are not a candidate anymore or they might die waiting. So, if you have a living donor, you can avoid that risk in a sense you are bringing your own liver, so you are almost, you know, you increase your chances of getting a liver transplant in time. The other is that the way the system works right now is that the sickest person who’s on the list that’s most likely to get the next liver available. So, you have to wait not only until you are sick enough to need a liver transplant but then to the point where you are sicker than everyone else who is on the list before liver comes to you. So, if you have a living donor, we can wait, we can evaluate the candidate, wait till there, at their best that they are healthiest and do it rather than waiting until they are so sick that it’s kind of at the last minute and saving their life at the last minute.
Melanie: And what is this like for the donor and what eligibility requirements do they have to fulfil.
Dr. Pelletier: For the donor, it really starts out with us asking the candidates to talk to the potential donors. If they are interested, they can either call or they can go to a website and give some basic information. For the most part, people who can be potential donors have to be pretty healthy, they have to be an adult less than 55 years old and if they fit and then also be blood type compatible, so as far as matching the organs, matching a liver is one of the easier organs that do as long as their blood types are similar or compatible then we are able to do it. At that point, we would have the donor coming to meet our team, we talk to them about the different risks and the benefits, what’s involved, there is a number of different tests we have to do to make sure that if we could do the surgery safely for the donor and it includes getting a CT scan and an MRI looking at the blood vessels going to the liver, essentially looking to see if we can put the liver into two pieces and that both pieces will work okay.
Melanie: So, what should a potential donor know before making this decision. What is the recovery and the surgery like for the donor?
Dr. Pelletier: For the most part, the donors do relatively well. There is some information that they have to know and part of what we want them to know is the risk to the recipient and why anyone would consider doing this and you know really it’s a pretty big benefit that the recipient is getting that we talked about little bit earlier as far as not having beyond the waiting list and die waiting. The other part though is the risks for them. We can do the donor surgery safely and we can get donors through it somewhere around 99.5 to 99.7% of the time. So, some people come and say, you know, the odds are way in my favour, it won’t happen to me. Obviously, we take even that small risk whenever we operate on someone who’s healthy and doesn’t need that surgery very seriously. So, we let them know that we would only do the surgery if we thought that we could do it safely and that they agree that the benefit to helping their friend or relative is enough for them to get through it. Usually, the recovery is that would come in on the same day of surgery. The surgery itself takes somewhere around five hours for the donor. We watch them in the ICU for one night assuming that everything is going okay, they are usually in the hospital for five or seven days and then somewhere around four weeks, six weeks after the surgery, they come in and say, wow that was kind of a big surgery, but I’m starting to feel better and then somewhere around six to eight weeks after the surgery, they can get back into their normal life. So, in a sense what we are asking a living donor to do is to take two months out of their life to potentially save the life of their friend or loved one.
Melanie: And what happens to the liver of the donor. Does this grow back, people always want to know if now that donor is liver deficient, the liver itself grows back.
Dr. Pelletier: Yeah, it’s an amazing process. So, if you are removing part of a liver for a different reason for cancer or something like that, you can remove up to 80% of a healthy person’s liver and they can survive that and the liver will regenerate and come back. When we do the process for the living donor, we remove up to about 65% of the liver, so really we might take even a little bit more than half of the donor’s liver and give to the recipient. As fast as four or six weeks down the road, both sides of those liver, one in the donor and the one in the recipient will both be somewhere around 90 to 100% normal size again. So, the donor and the recipient don’t grow, if you get the right side of the liver, you don’t grow a left side, it’s just that the right side grows bigger, so you make up the difference, but it’s a pretty amazing thing and then for the most part, donors have normal liver function for the rest of their life.
Melanie: And what are you seeing for the patient when they get a living liver donation, is the recovery process for them a little bit quicker.
Dr. Pelletier: It’s varied a little bit, so that is a part of this. For liver transplant, when you get a whole liver from the waiting list, the liver is little bit bigger, the blood vessels are bigger, so in a sense, the surgery for the surgeon is a little bit easier to do. So, if we had a whole liver that is our preference, when we get a living donor liver, we only get a part of the liver, so the piece is smaller, the blood vessels are smaller, so the chance of having a complication is little bit higher, but on the other hand, we can do it when the patient is not at their sickest and when, you know, they are relatively at their strongest. So, it kind of forms a little bit of a mixture where the surgery is a little bit more difficult to do, but the patient is in better condition. So, for the most part, we do the same as someone who got a liver from the waiting list and what that means is the average person in the hospital somewhere around 10 days, their recovery is, you know, little bit slow for the first two or three months, somewhere around three months, they come in and they say they feel better and then somewhere between six months to a year down the road, they come in and they come in and they booed and even realize how sick I was, I have not felt this good in 10 years, and most of those people who receive a liver are able to go back to living and enjoying their life.
Melanie: In just the last minute Dr. Pelletier, tell us why patients should come to UVA for their transplant care.
Dr. Pelletier: I can tell you the strongest reason is the team approach that we take, that if someone comes in with liver disease or kidney disease, the first approach is to help them to maintain their own organs and to keep those functioning and we really take an approach from the entire patient including, you know, from a social perspective and all those different reasons along with medical and surgical approaches. If it’s needed, we help people get on the list, maintain them on the list until an organ becomes available and then as a team, we really get them through the whole process and back to, you know, normal life.
Melanie: Thank you so much Dr. Shawn Pelletier. You are listening to UVA Health System Radio. For more information, you can go to UVAhealth.com. This is Melanie Cole, thanks for listening.
How Does a Living Donor Liver Transplant Work?
Melanie Cole (Host): For patients in need of a liver transplant, a shortage of livers available for transplant has long been an issue. One solution for helping address this issue and this shortage is living donor liver transplants. My guest is Dr. Shawn Pelletier, he is a board certified surgeon and surgical director of liver transplantation at UVA. Welcome to the show Dr. Pelletier. How does a living liver donation work?
Dr. Pelletier (Guest): Well Melanie, we start first by identifying a candidate who needs a liver transplant. So, for the most part, people will come forward who have liver disease, if their symptoms are severe enough, we will work towards getting them on the waiting list for a liver transplant, and at that point, we will talk to the candidate about how the waiting list works and their options and whether or not finding a friend or relative to donate part of their liver would be the right step for them. Once we get to that step, then we would bring in the living donor and meet them and talk to them, it sounds like that is going to lead into your next question.
Melanie: So, what are the benefits for the patient first to a living donor versus, you know, another type of donor.
Dr. Pelletier: Right, there are several benefits to the transplant candidate. First of all, the waiting list works pretty well. We are able to get a liver for about 80% of people on the list, what that means is that there’s somewhere close to one in five people who we see who needs a liver transplant never gets one in time and either gets too sick to the point where they are not a candidate anymore or they might die waiting. So, if you have a living donor, you can avoid that risk in a sense you are bringing your own liver, so you are almost, you know, you increase your chances of getting a liver transplant in time. The other is that the way the system works right now is that the sickest person who’s on the list that’s most likely to get the next liver available. So, you have to wait not only until you are sick enough to need a liver transplant but then to the point where you are sicker than everyone else who is on the list before liver comes to you. So, if you have a living donor, we can wait, we can evaluate the candidate, wait till there, at their best that they are healthiest and do it rather than waiting until they are so sick that it’s kind of at the last minute and saving their life at the last minute.
Melanie: And what is this like for the donor and what eligibility requirements do they have to fulfil.
Dr. Pelletier: For the donor, it really starts out with us asking the candidates to talk to the potential donors. If they are interested, they can either call or they can go to a website and give some basic information. For the most part, people who can be potential donors have to be pretty healthy, they have to be an adult less than 55 years old and if they fit and then also be blood type compatible, so as far as matching the organs, matching a liver is one of the easier organs that do as long as their blood types are similar or compatible then we are able to do it. At that point, we would have the donor coming to meet our team, we talk to them about the different risks and the benefits, what’s involved, there is a number of different tests we have to do to make sure that if we could do the surgery safely for the donor and it includes getting a CT scan and an MRI looking at the blood vessels going to the liver, essentially looking to see if we can put the liver into two pieces and that both pieces will work okay.
Melanie: So, what should a potential donor know before making this decision. What is the recovery and the surgery like for the donor?
Dr. Pelletier: For the most part, the donors do relatively well. There is some information that they have to know and part of what we want them to know is the risk to the recipient and why anyone would consider doing this and you know really it’s a pretty big benefit that the recipient is getting that we talked about little bit earlier as far as not having beyond the waiting list and die waiting. The other part though is the risks for them. We can do the donor surgery safely and we can get donors through it somewhere around 99.5 to 99.7% of the time. So, some people come and say, you know, the odds are way in my favour, it won’t happen to me. Obviously, we take even that small risk whenever we operate on someone who’s healthy and doesn’t need that surgery very seriously. So, we let them know that we would only do the surgery if we thought that we could do it safely and that they agree that the benefit to helping their friend or relative is enough for them to get through it. Usually, the recovery is that would come in on the same day of surgery. The surgery itself takes somewhere around five hours for the donor. We watch them in the ICU for one night assuming that everything is going okay, they are usually in the hospital for five or seven days and then somewhere around four weeks, six weeks after the surgery, they come in and say, wow that was kind of a big surgery, but I’m starting to feel better and then somewhere around six to eight weeks after the surgery, they can get back into their normal life. So, in a sense what we are asking a living donor to do is to take two months out of their life to potentially save the life of their friend or loved one.
Melanie: And what happens to the liver of the donor. Does this grow back, people always want to know if now that donor is liver deficient, the liver itself grows back.
Dr. Pelletier: Yeah, it’s an amazing process. So, if you are removing part of a liver for a different reason for cancer or something like that, you can remove up to 80% of a healthy person’s liver and they can survive that and the liver will regenerate and come back. When we do the process for the living donor, we remove up to about 65% of the liver, so really we might take even a little bit more than half of the donor’s liver and give to the recipient. As fast as four or six weeks down the road, both sides of those liver, one in the donor and the one in the recipient will both be somewhere around 90 to 100% normal size again. So, the donor and the recipient don’t grow, if you get the right side of the liver, you don’t grow a left side, it’s just that the right side grows bigger, so you make up the difference, but it’s a pretty amazing thing and then for the most part, donors have normal liver function for the rest of their life.
Melanie: And what are you seeing for the patient when they get a living liver donation, is the recovery process for them a little bit quicker.
Dr. Pelletier: It’s varied a little bit, so that is a part of this. For liver transplant, when you get a whole liver from the waiting list, the liver is little bit bigger, the blood vessels are bigger, so in a sense, the surgery for the surgeon is a little bit easier to do. So, if we had a whole liver that is our preference, when we get a living donor liver, we only get a part of the liver, so the piece is smaller, the blood vessels are smaller, so the chance of having a complication is little bit higher, but on the other hand, we can do it when the patient is not at their sickest and when, you know, they are relatively at their strongest. So, it kind of forms a little bit of a mixture where the surgery is a little bit more difficult to do, but the patient is in better condition. So, for the most part, we do the same as someone who got a liver from the waiting list and what that means is the average person in the hospital somewhere around 10 days, their recovery is, you know, little bit slow for the first two or three months, somewhere around three months, they come in and they say they feel better and then somewhere between six months to a year down the road, they come in and they come in and they booed and even realize how sick I was, I have not felt this good in 10 years, and most of those people who receive a liver are able to go back to living and enjoying their life.
Melanie: In just the last minute Dr. Pelletier, tell us why patients should come to UVA for their transplant care.
Dr. Pelletier: I can tell you the strongest reason is the team approach that we take, that if someone comes in with liver disease or kidney disease, the first approach is to help them to maintain their own organs and to keep those functioning and we really take an approach from the entire patient including, you know, from a social perspective and all those different reasons along with medical and surgical approaches. If it’s needed, we help people get on the list, maintain them on the list until an organ becomes available and then as a team, we really get them through the whole process and back to, you know, normal life.
Melanie: Thank you so much Dr. Shawn Pelletier. You are listening to UVA Health System Radio. For more information, you can go to UVAhealth.com. This is Melanie Cole, thanks for listening.