Guidelines For Live Donor Liver Transplantation ( LDLT )

Evaluation Of The Recipient

  • You should have a letter / prescription from a gastroenterologist / hepatologist / physician which will recommend a Liver Transplant as the treatment of your liver disease. This is important, as we would like you to remain in the care of your treating physician after going back to your hometown after your transplant.
  • The need for liver transplant will be re-assessed and confirmed once the patient reaches our centre.

If you wish to have an opinion over e-mail about the possible need for a Liver Transplant, please mail the following reports to us at the earliest

  • HbsAg, Anti HCV, HIV I & II, CBC / Hemogram, Liver Function Tests (LFT), Urea , Creatinine, Sodium , Potassium, P time / INR , AFP.
  • Urine routine/microscopy, urine protein creatinine ratio.
  • A good quality triple phase CT angiography of the liver ( It is safe to do this tests in those who have normal urea, creatinine levels and no contrast allergy ).
  • A recent Upper GI endoscopy report.
  • A Medical Summary prepared by any doctor detailing the patient’s history / symptoms is very useful.

These will help us guide you about the need for a Liver Transplant. However, once you are here we will examine the patient and perform a few more tests ( Stress Echo, PA pressure measurements, PFT, ABG ) which will determine the patient’s fitness to undergo such a major operation.

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.