Liver transplantation is a surgical procedure to replace a diseased liver with a new, healthy one. This is a treatment option for patients with end-stage liver disease that cannot be treated with any other method. A liver transplantation restores adequate function to the liver to meet the body’s needs. Liver transplantation also improves quality of life and extends lifespan.

The procedure is performed to remove a portion of the living donor’s liver to place it in the patient with end-stage liver disease.
 

The living donor must acknowledge certain information as well as undergo a detailed assessment to become a liver donor, as follows:

1. Acknowledge the eligibility criteria to be a living liver donor, such as blood group and liver size.
2. The donor must be aware of that they will be assessed and cared for by a different hepatologist as to protect the rights of the donor.
3. Acknowledge the short- and long‐term risks and potential adverse effects for the donor after surgical hepatectomy.
4. Acknowledge the short- and long‐term risks and potential adverse effects for the recipient, including the fact that the recipient may not survive even after receiving a portion of the liver.
5. Evidence to confirm the donor’s relationship to the recipient according to the regulations of the Organ Donation Center of Thai Red Cross Society, such as house registration, citizenship identification card or passport, marriage certificate, birth certificate, etc.
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6. Medical history and health screening carried out by a physician or designated person.
7. Additional blood tests will be carried out to rule out viral and bacterial infections, such as hepatitis B, hepatitis C, syphilis, cytomegalovirus (CMV), and human immunodeficiency virus (HIV), as well as x-rays, ultrasounds, computed tomography (CT) liver volumetry, and other diagnostic tests as recommended by the doctor.
8. Psychological and sociological assessments will be carried out by a psychiatrist to check for the donor’s readiness and willingness to be a donor.
9. Approval must then be received from the hospital’s Organ Transplantation Committee for the donation.
10. All involved parties must acknowledge the expenses involved with the procedures and how much coverage will be provide by insurance for the living donor. The insurance company may not cover the expenses associated with a living donor liver transplantation.
11. All relevant documentation must be signed to acknowledge the date and time of surgery as well as length of hospital stay and post-procedure considerations.

When the living liver donor has a procedure date, please do the following:

1. Fast for at least eight hours before the procedure and carefully follow the pre-operative instructions given to you by the Organ Transplant Clinical Nurse Coordinator.
2. A surgeon will remove a portion of the donor’s liver that they have previously designed is adequtred for the recipient and place the donated liver portion in the recipient's body.
3. After the surgery, the donor will be cared for in an Intensive Care Unit (ICU) until recovering from the surgery. The donor's liver will soon grow back to normal size after surgery.
4. The donor and the recipient will receive care information from the organ transplant team.

1. Monitor your incision daily. If you notice any swelling, redness, warmth, tightness, or leaking of fluid from the site, please come to the hospital immediately.
2. Please don’t remove the waterproof bandage until you see your doctor. If the bandage comes off on its own, please don’t reapply a new bandage. Avoid letting the incision get wet until it is fully healed.
3. Reduce foods high in cholesterol and focus on eating plenty of vegetables, fruit, and low-fat products.
4. Maintain a healthy weight (body mass index or BMI under 25).
5. Do not drinking alcohol for at least six weeks after the surgery.
6. Avoid smoking as nicotine causes blood vessels to constrict, increasing blood pressure.
7. Drink at least two liters of clean water each day.
8. Do not lifting heavy objects and strenuous exercise for at least six months after the procedure to ensure proper healing and for the muscles to regain their strength.
9. Get enough rest and get at least eight hours of sleep each night.
10. You can resume normal activities and sexual activity as soon as you feel ready.
11. You can return to work as soon as you feel ready, depending on the kind of work you do.
12. Do not drive at least four weeks after surgery.
13. Keep all follow-up appointments and have a comprehensive health check-up every six months to one year to monitor liver function.
14. Please inform your transplant team immediately if:

• You notice blood or pus from the surgery incision.
• Your body temperature is higher than 37.5 degrees Celsius.
• You have vomiting or diarrhea.
• You have uncontrolled pain.
• You are jaundiced (your skin and the white of your eyes are yellow.)

 

General Physical Risks

• Complications caused by anesthesia.
• Excessive bleeding that may require blood transfusions and the risks involved with the use of blood or blood products.
• Cardiovascular complications, such as heart attack, arrhythmia, cardiovascular collapse, and hypertension.
• Injury to other organs in the abdomen, fluid collection, and intra-abdominal adhesions.
• Blood clots in the legs that can break free and move to the lungs (pulmonary embolism).
• Digestive tract problems, such as constipation, bloating, nausea, ileus (slow or absent bowel activity), bowel obstruction or perforation.
• Painful surgical wound or discomfort at the incision site that can develop into chronic pain.
• Infection (such as urinary tract infection) or other complications caused by catheterization, fever, pneumonia, or wound infection.
• Living donor could develop liver failure after the donation surgery. This could require an emergency liver transplant for the donor or lead to death. This is a very rare complication and occurs in approximately 2 out of every 1000 (0.2%) living liver donor surgeries.

Specific Physical Risks
Specific risks associated with liver surgery and particularly a partial hepatectomy include:

• Bile leaks are the most common complication and occur 5-15% of the time. Most bile leaks get better without requiring additional surgery and can be treated with an endoscopic procedure. that places a plastic drain (stent) to decompress the area or a soft tube that diverts the leaking bile and allows the area to heal. Sometimes the bile is drained outside the body via a tube into a bag that is removed once the leak stops.
• Bile duct strictures (narrowing) can also occur after surgery, but are much less common. This can usually be treated by endoscopic placement of a stent that dilates the narrow area in the bile duct.
• The donor’s liver may not be suitable for transplantation and this may even be decided in the operating room if the doctor assesses the donor liver and determines that it cannot be transplanted. The donor’s liver may also have abnormalities that could not be detected through diagnostic tests before the procedure. The transplantation will then be aborted.

Based on national statistics, the risk of having some type of complication, either major or minor, is approximately 15‐40%. Most of these problems are minor and will get better on their own and rarely require a procedure or corrective surgery.
Psychosocial Risks
There are potential temporary or permanent psychosocial risks associated with liver donation. The donor’s quality of life may be affected by donation due to insomnia, anxiety, depression, preoccupation with overall health or liver health, suicidal thoughts, body image issues, post-traumatic stress disorder (PTSD), or feelings of guilt or emotional distress if the recipient experiences complications, recurrence of their disease, or even death.

If the donor is feeling anxious, overwhelmed, or emotionally distressed in any way, please reach out to the organ transplant team for support and assistance. Psychologists and other experts will be available for support should the donor or family members require it.

• Travelers to Thailand should stay in the country for at least four to six weeks after the procedure.
• If you plan to travel after the procedure, please talk to your doctor before making reservations or buying tickets.
• At your follow-up appointment your medical team will assess your health and wound and you will receive documents that include your medical and treatment history as well as a “fit to fly” certificate (if needed).

After receiving a portion of the liver from living donor, the transplantation is considered successful when the patient no longer requires liver dialysis. However, there are potential unexpected complications that may make the transplantation unsuccessful despite appropriate medical care. The success rate of the procedure depends on the expertise and experience of the medical team as well as a number of other factors.
Factors that affect success include:

• The age, current health, and existing medical conditions of the recipient.
• The age and current health of the donor.
• The condition of the donated liver.
• Graft rejection.
• Possible post-procedure complications.
• Possible side effects of the medications used.
• The recipient’s lifestyle and behavior after the procedure.

 
What if the procedure is not performed?
When the disease reaches the end-stage, if the patient does not receive liver transplantation he/she will have a shorter life span. Other treatments can only stop the damage from progressing or slow it down.
 

Liver transplantation is the best treatment option, with the objective of extending the patient’s life and improving quality of life. The healthy liver will come from an organ donor who’s alive or who’s died. The living liver donor will be carefully assessed before the donation and will only be allowed to donate the liver if they meet the strict criteria set. However, the liver donor may feel free to make a decision whether to donate or to cancel the donation at any time.