Liver Donor

The new liver is not your own. The body’s immune system treats it like a foreign body and attacks it. If this immune attack is significant we call it ‘ Rejection .’To prevent this happening, you will need anti-rejection medicines or ‘Immunosuppresants’. These will be started immediately after your transplant ,and at least one of them will continue lifelong.

What Is Living Liver Donation?

When a healthy person donates a portion of their liver to a transplant recipient who is suffering from end-stage liver disease it is living liver donation. At the time of transplant procedure, the patient’s diseased liver has to be removed and replaced with a small portion of the healthy donor’s liver. Because a healthy person’s liver is able to grow back, living liver donation is one of the most generous decisions some people decide to make.

Why Living Liver Donation??

Patients who have been suffering from end-stage liver disease have two options for treatment

  • A liver transplant from a dead donor
  • A liver from a living donor.

The demand for liver for transplantation isexceeded the number available absolutely, and demand is steadily increasing. Indian Medical Council, has taken up the responsibility to allocate dead donor livers for transplant, reports that there are more than 16,000 candidates who had waiting for a liver transplant. In 2017, only 9,368 livers were donated from dead donors. For the patients who need a liver transplant, for them receiving a part of a liver from a living donor is the only option.

Then waitingtime for a liver from a dead donor can be ranging from many months to years, this depends on the patient’s ranking on the wait list. 70 patients in India transplant program have been awaiting for a liver transplant. Whereas for patients who are able to receive a living donor liver transplant get their reduced their wait time for transplantation and therefore it so, that they have more control over when the operation occurs.

Because in case of requirements for living liver donors at India, only selected patients are able to go ahead with a living liver donor transplant. A lot of times individuals interested in donating are family members, but a growing number are friends or co-workers. The main reason of liver failure are viral infections like Hepatitis C, cirrhosis of the liver, early-stage liver cancer, hemochromatosis, primary biliary cirrhosis, primary sclerosing cholangitis, Wilson’s disease, alcoholic liver disease, nonalcoholic fatty liver disease, biliary duct atresia, and cystic fibrosis. A living donor’s liver is able to fully regrow within 4 months and it is ultimately able to regainit’s full function.

The donated portion has the same effect for the recipient. A liver from a dead donor might also be split and transplanted into two different recipients. Indian transplant doctors and surgeons have had extensive experience with living-donor liver transplant ranging from adults to children. An adult to adult living-donor liver transplant program offers an alternative over dead-donor organ transplantation. Patients would have a shorter waiting period and equal or improved life expectancy with a living-donor transplant.

Who Can be a Donor of Liver

  • The donor must be a relative. He must be willing and happy to donate a part of his liver purely for altruistic reasons.
  • He or she must preferably be between 18 and 45 years of age, healthy, fit and of a compatible / matching blood group.
  • Patient blood group Matching donor groups
    A+ or A- A+ / A- /O+ / O-
    B+ or B- B+ / B- / O+ / O-
    AB+ or AB – Any blood group acceptable
    O+ or O- O+ / O-
  • The donors need to be related to the patient , either of the same family or related through marriage :
    • First degree relatives :Son, daughter, brother, sister, father , mother, husband , wife , grandfather, grandmother, grandson, granddaughter.
    • Second degree relatives: Maternal or paternal uncle or aunt, nephew or niece, first cousins, son in law , daughter in law, brother-in-law, sister-in-law, father-in-law, mother-in-law.
  • A potential donor must:
    • Be in good overall health and physical condition.
    • Be older than 18 years of age and younger than 60 years of age
    • Have a liver that is the right size for the recipient
    • Have a blood type compatible with the recipient
    • Have a near normal body weight (body mass index less than 35).
  • A potential donor must be free from:
    • HIV infection
    • Known viral hepatitis
    • Active alcoholism with frequent and heavy alcohol intake
    • Psychiatric illness
    • A history of cancer.
    • Heart and lung disease requiring medication
    • Diabetes
    • A history of previous liver surgery.
Donor Evaluation
  • The donor must be a relative. He must be willing and happy to donate a part of his liver purely for altruistic reasons.
  • He or she must preferably be between 18 and 45 years of age, healthy, fit and of a compatible / matching blood group.

See the table Below
Patient blood group Matching donor groups
A+ or A- A+ / A- /O+ / O-
B+ or B- B+ / B- / O+ / O-
AB+ or AB – Any blood group acceptable
O+ or O- O+ / O-

Occasionally a donor / patient combination of non compatible blood groups may be considered for ABO incompatible liver transplant – this involves additional cost, additional procedures pre-transplant and additional risks for the recipient ( not for the donor ).

  • The liver looks one organ but is actually 8 separate lobes packaged in one. Hence it can be divided into these lobes ! Usually for an adult – to – adult liver transplant , the right half of the liver is donated. Modern equipments and techniques allow almost bloodless division of the liver into the right and left halves. Liver donation from a living donor is feasible and safe because the remnant left lobe grows back to 80% of the original size in weeks and no near original size within months. Such is the remarkable ability of the liver to regenerate. The risks of liver donation is perhaps less than 1 in 200.
  • The donor must be an adult and must be psychologically sound to be able to decide that he can be donor.
  • Unrelated liver donation with any financial transaction between donor and recipient is illegal and punishable under Indian laws. We are unable to entertain any queries in this regard.
  • If you wish to begin the donor evaluation immediately you could do the Level I & Level II tests in your country and mail us the reports :

Level 1

  • Blood group
  • HBsAg, Anti HCV, HIV I & II.
  • CBC / Hemogram , LFT, Urea, Creatinine, P time/ INR, HbA1c.
  • After 14 hr Fasting, Lipid profile and Serum T3, T4, TSH.
  • If these are okay, proceed to Level II.
Level 2
  • A good quality Triple phase CT Liver Angio ( donor protocol ) including a plain scan to look at Liver Attenuation.
  • Please mail us report and either courier or bring with you a CD which contains all sequences of all images ( all volume data ) of the CT in DICOM format. This scan is a crucial part of the donor work up
Level 3
  • MRCP
Level 4
  • Chest X-ray, ECG, Stress Echo, Lung Function Tests USG breast & pelvis, Mammography ( > 40 yrs ), PAP smear ( married ladies ) , CA 125, HLA tissue typing, Blood group antibody screen
  • Level III & IV tests for donor and all tests for patient / recipient can be completed within 48 hrs of arrival at our centre. If all tests are okay , we can get on with the transplant quickly after seeking approval from Government of India Transplant Authorisation committee. This may cause a 1 week delay.

Making The decision

Making the decision to donate an organ is a non-public one that merits cautious idea and attention of each the critical dangers and benefits. Speak via your decision with your pals, family and different trusted advisers. Making the selection to donate is personal one. You ought to no longer sense compelled to donate, and you could exchange your thoughts at any factor.

Some Beneficial Questions to consider:

  • How do I feel approximately organ donation?
  • What are the clinical dangers?
  • What is going to my insurance cowl?
  • How will donating affect me financially or my potential to paintings?
  • Is someone pressuring me psychologically to be a living donor?
  • How will donating or no longer donating have an effect on my courting with the recipient?
  • If there may be more than one feasible donor, how will the residing donor be chosen?
  • Are there components of my health or clinical history that I recognize ought to keep me from donating?
  • I’vea assist network in location to help me via this process?
  • How will I experience if i am rejected at some stage in the assessment manner?
  • How will I experience if my recipient does no longer do properly after the transplant?

Your medical information is saved exclusive by way of the transplant center. If you are rejected as a donor during the evaluation system, the donor is instructed simplest that your organ become declined. it is up to you whether or not you tell the recipient (if regarded) the motive in case you selected to accomplish that.

The living-donor transplant facilities offer an independent dwelling-donor suggest to guard the knowledgeable consent manner. This endorse is mostly a social employee or counselor who will let you talk your feelings, answer any questions you have and help in defensive your nice hobbies all through the donation process.

Life After Donation

Barring any post-operative complications, the living liver donor can expect to :

  • Be discharged from hospital in within 7 – 8 days after surgery
  • Perform all activities of daily living independently after discharge from hospital
  • Be off all medicines 3 – 10 days after discharge
  • Travel back to home country a week after discharge
  • Perform light exercises, get back to driving a car or riding a bike and to usual sexual activities from 2 – 3 months after the operation
  • Perform strenuous exercise or rigorous sports or contact sports from 6 months after the operation.
  • Perform completely normal life within 2-3 months of surgery and to remain healthy for the rest of his or her natural life. Since the procedure of living donor Liver transplantation is fairly new, statistics on the long-term follow-up of donors who have undergone this surgery are not yet available.

Some centres recommend an annual physical examination for all living liver donors by any doctor in the home country itself : no routine tests are recommended. Post donation , a donor should be able to lead a normal life. The scar will remain , although will become less prominent usually with time, and there may be an occasional mild discomfort at the scar site which may rarely require oral painkillers.

Deceased Donor

It isn’t necessary to match the donor and recipient for age, sex or race. All donors are screened for hepatitis viruses and the HIV virus. What’s more, all deceased donor organs are tested extensively to help ensure that they don’t pose a health threat to the recipient. Also, many studies – such as ABO blood type and HLA matching – are performed to ensure that the organs are functioning properly.

As soon as a deceased donor is declared brain-dead, the liver is removed and transplanted in the body of the recipient who is registered in the waiting list of Deceased donor Liver transplantation. The waiting list is maintained by NATIONAL ORGAN & TISSUE TRANSPLANTATION ORGANISATION (NOTTO) and by Artemis Hospitals. The national organization is responsible for fairly prioritizing recipients as organs become available for transplant. Priority is based on several factors, including:

  • MELD score
  • ABO blood type

Pledge your organs

Pledging organs is a very simple procedure. Just fill out Form No. 7 which is attached below and send it to the following address.

Director (NOTTO) 4th Floor, National Institute of Pathology, NIOP Building, Safdarjung Hospital Campus New Delhi-110029

Once the forms are filled and registry is completed NOTTO shall send you your donor card within two weeks. You must remember that at the moment, registering as a donor does not mean that your donor card is a legal entity. It is merely an expression of your wish to be a donor. The card that we will send you does not carry any legal weight. But do keep it with you at all times and make sure you let all your friends and family know about your choice.