Living Donor Liver Transplant

The human body has only one liver. But that remarkable liver — the body’s largest solid organ — is the only organ capable of regenerating itself. Learn more about what the liver does in our Health Blog post, "What Does the Liver Do, and How Do I Keep Mine Healthy?"

That means that if a portion of a liver is removed, the body can replace the missing section, actually growing new, functioning liver in its place.

Liver regeneration makes living donor liver transplantation possible. A person can donate a portion of his or her liver – up to 60 percent of it – to be transplanted into another person. In only about six weeks, the transplanted liver section grows into a normal sized, fully functioning liver in the recipient, and the donor’s remaining liver regenerates to replace the transplanted section.

How does regeneration happen?

How do the transplanted liver and the residual liver in the donor “know” how much to grow, and when to stop? In a pediatric patient, how does the liver’s regrowth coordinate with normal childhood growth? Medical science is still trying to answer these questions.

Living Donor Liver Transplantation at Michigan Medicine

Michigan Medicine performed our first living donor liver transplant in a pediatric patient — the first of its kind in the state — more than 20 years ago. Our center was part of a landmark study establishing the safety of the procedure. The expertise and dedicated team we have built make us one of only about 70 U.S. centers offering living donor liver transplantation. Living donor transplants currently make up about seven percent of liver transplants nationwide, and about 10 percent of the liver transplants we perform. That percentage is increasing yearly, and we have the capacity to do many more.

Information for Patients

A liver from a living donor is an alternative to the organ waiting list, and a faster path to transplant.

Most liver transplants are performed with livers from deceased donors. But the demand for donated livers far exceeds their supply.

With about 15,000 Americans on the waiting list for a new liver, a scoring system based on a recipient’s level of sickness is used to prioritize patients, with donor organs going to only the most critically ill. One result is that patients must wait a long time – and grow progressively sicker – to reach the top of the list. By that time, many are no longer good transplant candidates.

Living donor patients can receive transplants sooner, when their disease is advanced but not yet life-threatening. This puts the patient in a better position for long term survival.

Living donors tend to donate healthier livers.

Extensive prescreening and preparation precede a living donor transplant, ensuring the best possible liver from the healthiest possible donor.

While not without risks, the long-term outcomes of living donor liver transplantation are as good as or better than those of traditional liver transplantation. 

Every organ transplant involves risk. (Read more about liver transplant surgery). Because a living donor transplant involves only part of a liver, the procedure to implant it is more intricate, and may take more time. Fortunately, organ rejection is less common and less serious in liver transplantation than in other transplants. The extent of the patient’s illness at time of surgery is a more worrisome risk factor, so the ability to operate sooner is a clear advantage of living donor transplantation.

View our expert videos if you are considering becoming a living donor, or are a patient who wants to know more about living donation.

Questions and Answers About Living Donor Liver Transplantation

Here are the questions most often asked by people considering donating a portion of their liver for transplant.

Individuals who wish to be considered for liver donation can begin the donor process by submitting our Liver Transplant Donor Interest Form (for donors).

What does the operation involve?

During the procedure, a portion of the donor’s liver (as much as 60 percent) is removed, leaving the “plumbing” like bile ducts and blood vessels, intact. Over a period of about 6 weeks, both the donor’s and recipient’s livers will regenerate, growing to their normal size.

  • Because the procedure to remove the liver section is delicate and technically precise, it usually takes 4 to 6 hours.
  • Most donors will spend 3 to 5 days in the hospital.
  • Within 3-4 weeks, donors can return to normal activities and work (not strenuous physical work).
  • In order to allow the incision to heal properly, donors are discouraged from heavy lifting or strenuous activities for 6-8 weeks.

What are the potential risks?

While it is major surgery, afterward the donor can expect a return to normal metabolism, liver function and life expectancy.

  • The risk of a life-threatening complication is 1 in 500. While very rare, the risk of death is still considered significant for a procedure not essential for the donor.
  • The risk of bleeding is minimal; only 1-2 percent of donors require a blood transfusion.
  • Our screening/preparation process ensures that an adequate volume of liver is left behind to regenerate, minimizing any chance of long term liver dysfunction.

What are the criteria for selecting a liver donor?

While we strive to guarantee the best possible organ match for the patient, every step in the evaluation process prioritizes the safety of the donor.
Both the patient and the potential donor undergo a range of compatibility tests:

  • Detailed screening explores the donor’s current health and health history to confirm that he or she has no medical conditions that might compromise the safety of the operation or a successful recovery.
  • Imaging is performed to confirm that the size and anatomy of the portion of liver to be removed is optimal, and that a sufficient amount of the organ is left behind to retain liver function as it regrows.
  • In general terms, donors must meet the following requirements:
    • Adults age 21-55: As the body ages, liver regeneration is less efficient
    • Body Mass Index of 30 or less: This minimizes both surgical and liver function risks
    • No major medical problems, with any chronic conditions well-managed

Do donors always know the people who receive their livers?

Because this is a major procedure, and a need for a donor may arise quickly, most donors have a close tie with their recipient. However, anyone who wishes to be considered as a potential donor can be evaluated.