The human liver has the unique capability to regenerate parts of itself that have been damaged, which makes living donor transplants possible. Surgeons can cut a lobe off from a healthy individual’s liver and implant it into the recipient where it will grow into a fully functioning organ. Meanwhile, the donor’s liver can regrow to its original state within a month or two after the procedure. While live organ donations can be performed safely, there are some potential long-term effects that potential donors should know about.
Most surgeons would prefer not to operate on living donors due to the health risks involved; however, the number of patients needing organs far outweighs the number of healthy livers available from deceased donors. The U.S. Organ Procurement and Transplantation Network documented more than 16,000 people waiting for a liver transplant in 2011. Over 900 patients died during that year due to lack of livers. Fortunately, livers from living donors tend to be healthier than those taken from cadavers and living donor transplants can be scheduled for a time that is best for the patient.
New Evidence of Long-Term Effects for Liver Donors
A 2011 German study investigating the long-term effects of liver donation found that some physical and psychological complications do not manifest until several years after the procedure. Researchers surveyed 83 participants who had donated their liver at least three years prior to the study, half of which complained about complications such as recurring pain, digestive issues and depression. Nonetheless, it is important to note that all of those surveyed claimed that they had no regrets about their decision, and they would gladly donate again if given the chance.
Diarrhea and intolerance to fatty foods were reported by 31 percent of participants, and 10 percent reported gastro esophageal reflux. A few of the donors still had pain near their incision site. Three had experienced depressive episodes, two of which resulted in hospitalization. One donor who had preexisting psoriasis saw their condition worsen in the years after liver donation.
About half of the donors in the German study, 39 out of the 83, reported no current health complications stemming from their procedure. Nonetheless, three of those individuals were denied life insurance policies due to the lack of research about the long-term risks of living donation.
Due to the small sample size and lack of a control group for the study, more research is needed to make generalizations about liver donation risks; however, the results were consistent with previous findings, and the data gives healthcare providers direction for issues to look out for. The authors called for more advanced surgical techniques and improved follow-up with donors to help manage complications. They also recommended a central registry of living organ donors to better document the potential long-term risks of donation.
Unfortunately, many donors do not attend follow-up visits because they feel fine immediately after the procedure, yet symptoms of an underlying complication may not manifest until weeks or months later. If an organ recipient dies, the donor may be less likely to attend follow-up visits because it can bring up painful memories. For these reasons, donors should receive psychological counseling before and after surgery.
The History of Liver Transplants
The first liver transplant with a living donor was performed in 1989, and the National Transplant Database has documented about 5,000 successful procedures in the U.S. since then. The earliest of such transplants were performed on children who needed livers since they require a smaller portion of the organ than adult recipients. Adult transplants have become more common over the past few decades. Strict procedural regulations were instituted in 2002 after a liver donor died of an infection at Mount Sinai Medical Center in New York. Despite advancements in the field, two liver donors in the U.S. died shortly after surgery in the year 2010, which is alarming considering that the risk of dying following liver donation is estimated to be one in 1,000. While some degree of risks is unavoidable, many doctors and patients agree that sometimes the risk to the donor doesn’t outweigh the potential benefits to the recipient. Ultimately, the potential donor should make their own decision with a full understanding of the possible long-term consequences.
Who Can Be A Liver Donor?
To be a suitable candidate for live liver donation, a person should be healthy and between the ages of 18-55. They must have the same blood type as the recipient, but they do not have to be related. Due to the complex nature of the procedure, many transplant surgeons will only perform transplants between donors and recipients who share an emotional bond. Unfortunately, some patients are unable to accept a live liver donation for a number of medical reasons.
How Does the Liver Donation Process Work?
After the patient has been examined and deemed an acceptable donor by the team performing the operation, the process can begin. Although removing a piece of the liver takes only about five hours, the donor must remain in the hospital for a week following surgery to recover. Doctors generally target the right lobe and may remove anywhere between 40 to 60 percent of the patient’s liver. The organ starts to repair itself right away with most regrowth occurring in the two weeks following the procedure. Regeneration then slows down, but the donor’s liver returns to its original size within a year.
Short Term Side Effects of Liver Donation
Recovering from live liver donation can be very painful even while taking high doses of painkillers. The pain should lessen in intensity with each passing day, but it will likely persist from two weeks to a month after the procedure. Medications used to manage pain can typically cause drowsiness, nausea and other mild adverse effects.
The Costs of Liver Donation
The costs of the operation itself are usually paid for by the recipient’s insurance; however, insurance usually doesn’t cover all of the donor’s expenses such as lost time from work and medication for pain management following surgery. Sometimes donors must travel long distances for their appointments, so transportation and lodging are additional expenses that should be considered. Some states actually allow residents to deduct their liver donation on their income taxes. In Wisconsin, liver donors can deduct $10,000 from their adjusted gross income during the year of their donation. Some employers also offer paid leave for organ donation.
Donors should return to their surgeon for a follow-up appointment between two and three weeks after their operation. Patients should also schedule follow-up visits with the same surgeon for one year and two years after donation. After that, patients should receive a yearly medical exam from their regular doctor looking specifically for complications related to organ donation. No dietary restrictions or special medications other than painkillers are necessary after surgery.
Some people can return to work within eight weeks after donation, but patients should plan to be out for longer just in case recovery goes slowly. Workers who perform physical labor may have to be out for longer than those who work in an office environment.
Additional Risks for Liver Donors
Most of the risks associated with liver donation are the same that come with any major surgery. Some patients report anxiety, depression and mood swings after organ donation. Other possible complications include:
– Adverse reaction to anesthesia
– Blood clots
– Bile leakage
– Excessive bleeding
Potential donors should also consider the non-medical risks, such as the financial impact of taking significant time off from work. Although health insurance companies can no longer discriminate against organ donors in the U.S., life insurance companies can still deny policies to people who have donated, so potential liver donors should purchase a life insurance plan before their operation.