Living Liver Donation: Eligibility, Procedure & Recovery

Living donor liver transplantation (LDLT) is a life-saving option for end-stage liver disease, leveraging the liver's unique regenerative capacity.

Donor Eligibility

• Age: Typically 18–55 (varies by center).
• Relationship: Often relative/spouse/close friend; non-directed (altruistic) donation possible.
• Health: No significant medical/psychiatric illness. BMI <30–35. No active substance use.
• Liver Health: Normal LFTs, no steatosis >10–30% (on biopsy), normal vascular/biliary anatomy on imaging.
• Blood Type: Compatible (not necessarily identical) with recipient.
• Voluntary & Informed: No coercion; independent donor advocate team.

Donor Surgery

• Right Lobe (Adult-to-Adult): ~60–70% of liver volume (segments V–VIII). Includes IVC, hepatic veins, right hepatic artery, right portal vein, right bile duct.
• Left Lobe (Adult-to-Child): ~30–40% (segments II–III ± IV).
• Approach: Open (midline + subcostal) or hybrid/laparoscopic-assisted (center-dependent). Duration: 4–8 hours.
• Principles: Preserve middle hepatic vein drainage (segment IV/V) to prevent donor congestion; meticulous hemostasis.

Recipient Surgery

Native hepatectomy → implantation of graft → vascular anastomoses (IVC, portal vein, hepatic artery) → biliary reconstruction (duct-to-duct or Roux-en-Y). Duration: 6–12 hours.

Regeneration

• Donor: Liver regenerates to ~90% original volume in 6–8 weeks (hypertrophy + hyperplasia). Function normalizes sooner.
• Recipient: Graft regenerates to meet metabolic demand.

Recovery & Outcomes

• Donor Hospital Stay: 5–7 days. Full recovery: 8–12 weeks. Mortality: 0.1–0.3% (center-dependent).
• Recipient: ICU stay, immunosuppression (tacrolimus/MMF/steroid), rejection monitoring, infection prophylaxis.
• Long-Term: Donor QOL generally excellent; small risk of incisional hernia, biliary stricture, psychological impact.

Ethical Imperative

Donor safety is paramount. The "Rule of 30%": donor remnant liver volume ≥30% of standard liver volume (or ≥0.8% body weight) to ensure safe regeneration.