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TRANSPLANT SERVICES

Procedure

Living Donor Liver Transplants

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Overview

The liver transplant program at NewYork-Presbyterian, Columbia, and Weill Cornell Medicine is among the longest-established and most experienced programs in North America. Our focus has been on innovation in surgical techniques for living donor transplant surgery. Our organ transplant surgeons are pioneers in minimally invasive donor surgeries. We were the first and largest laparoscopic donor program in the nation. As of 2023, all of our donor operations are performed robotically—making us the largest robotic living donor liver program in the nation. This advanced minimally invasive technique allows us to perform some of the most complex transplants while improving patient outcomes and safety.

What is Living Donor Liver Transplant?

What is Living Donor Liver Transplant?

A living donor liver transplant occurs when a living donor donates a part of their liver to an individual whose liver is not properly functioning. Patients requiring a liver transplant may have acute or chronic end-stage liver failure caused by common liver diseases such as:

There are many benefits to patients undergoing living donor liver transplantation. Recipients of livers from living donors generally fare better than those who receive livers from deceased donors because their health is more preserved at the time of transplant, and the tissue they receive is from a young, healthy donor.

Since time is critical, receiving a liver transplant from a living donor is also ideal as it eliminates the need to wait on the waiting list and for a deceased donor liver. The longer the patient has to wait, the sicker they become and the more health complications they experience. Both adults and children that receive a liver from a living donor have an improved survival rate and faster recovery time.

Requirements to Become a Living Donor

Requirements to Become a Living Donor

Since the liver is the only organ that regenerates itself, a healthy adult can donate a portion of a healthy liver, and their liver will grow back to most of its original size in just weeks. Adults between the age of 18 and 59 that are committed to the process and in good mental and physical health can become a living donor.

Donors can be biologically related family members such as parents, siblings, aunts, uncles, cousins, or spouses and non-biologically related individuals such as a spouse, friend, significant other, or even a stranger.

Requirements to be a living donor include:

  • At least 18 years of age
  • Have a healthy liver
  • Maintain a healthy weight and normal blood pressure
  • Cancer-free
  • Non-diabetic
  • No drug or alcohol abuse
  • No viruses such as hepatitis C or HIV

How is a Living Donor Liver Transplant Performed?

How is a Living Donor Liver Transplant Performed?

Once an individual has decided to be a living donor, the process begins to provide a donated liver to a specific recipient (directed) or to a recipient in need based on a compatible blood type (non-directed). The process includes:

  1. A donor evaluation to ensure all requirements are met which is conducted over 2-3 days and includes medical tests and consultations.
  2. The donor and recipient are matched for blood type (either directed or non-directed). In some cases, if a directed donor does not match with the recipients’ blood type, a “swap” can be performed to allow for paired exchanges between two pairs of donors and recipients.
  3. The surgical plan is determined through a series of comprehensive tests. Using specialized imaging software, the donor team will determine the optimal lobe of the liver for donation (left or right) to ensure the adequate size of the liver for the recipient and adequate remnant for regeneration in the donor. This process also ensures that the bile ducts and blood vessels are ideal for live donation. Robotic surgery (minimally invasive) uses cutting-edge technology to enhance surgical precision and patient outcomes. Patients undergoing robotic donor surgery have faster recovery times with fewer postoperative complications, including less pain, shorter hospital stays, less blood loss, and improved quality of life compared with traditional transplantation methods.
  4. The surgery is scheduled between the donor and recipient. The donor surgery typically takes four to six hours, and the recipient surgery which can take up to ten hours, occur on the same day.
  5. Donors recover in the ICU for one day then transition to the medical floor where they usually stay for 5 days prior to being discharged.
  6. Donors follow up at our center the week following discharge, at 6 weeks, 4 months, and one year. We contact donors annually after donation to check in and ensure they’re in optimal health.
  7. The majority of our donors return to work by 6 weeks after the surgery.

More to explore

Risks to Consider

Risks

The risks and complications to consider associated with a living donor liver transplant include short and long-term risks. The chances of a successful liver transplant depend on the individual patient circumstances. People who receive a liver from a living donor often have a longer survival rate, faster recovery time, and fewer complications after surgery.

Although very rare, some possible complications could be significant and include the following which are all thoroughly reviewed as part of the informed consent process during the donor evaluation process:

  • Bleeding
  • Blood clots
  • Hernia
  • Infection
  • Pain
  • Primary non-function of the liver in the recipient including loss of liver and kidney function
  • Psychological issues including anxiety and depression
  • Rejection of the liver in the recipient
  • Wound complications

Preparing for a Living Donor Liver Transplant

Preparing for a Living Donor Liver Transplant

Once the living donor has been approved to donate, the process of preparing for the transplantation surgery begins. Even though everyone is unique, and their situation is different, in most cases, the preparations for a living liver donation include the following steps:

  • The transplant team will discuss your schedule and what to expect before, during and after surgery
  • A series of comprehensive tests will be completed to map your liver to determine the size of the liver, blood vessel locations, and how much of the liver is needed by the recipient
  • The donor surgery is scheduled, which will take approximately four to six hours

What to Expect After Living Donor Liver Transplant

What to Expect

After living donor liver transplantation, most patients should expect to:

  • Stay in the intensive care unit for one day
  • Stay in the hospital for five days
  • A follow-up appointment with your transplant team and doctor the week following discharge. After that, you’ll return at 6 weeks, 4 months, and one year to monitor your progress. Blood tests will be required based on your overall condition and requested by your doctor.
  • Recovery times vary by individual donor based on overall health and age. The typical recovery time for laparoscopic surgery is four to six weeks. If the surgery is more extensive, full recovery could take an average of three to six months.

Dedicated Donor Support Services

  • A dedicated liver donor coordinator
  • 24/7 online donor registration
  • Separate donor care team to protect donor privacy
  • Pre- and post-surgery nutritional support, smoking cessation, weight loss guidance, and pain management
  • A series of post-surgery follow-up appointments to monitor and assess donor wellbeing and track outcomes for years after donation

Our Donor Mentoring Program also enables donors to seek emotional support and advice from other donors that may have experienced some of the same issues.

FAQs

FAQs

Since the liver is unique and regenerates itself unlike other organs, you can safely donate up to two-thirds of a healthy liver. Adult donations typically require one-third of the left or two-thirds of the right lobe. Pediatric donations require much less and are typically selected from the lobe.

Even though the liver regenerates itself after liver donation, you cannot donate your liver more than once.

After donation surgery, a healthy liver will typically grow back to most of the original size in six to eight weeks. The liver will continue to grow back to its full size over a period of a year.

 

This content has been reviewed by the following medical editors.

Alyson Fox, MD

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Receive a Living Donor Liver Transplant at NewYork-Presbyterian

As pioneers in the field, our transplant doctors offer expert care, close to home. As one of North America's largest innovative transplant programs, our living donor liver transplant program offers excellent outcomes for donors and recipients. Read more here.

If you or a family member are in need of a liver transplant, call to schedule an appointment with one of our NewYork-Presbyterian transplant doctors to learn more about what specific living donor treatment options are available to you.