29.NOV.2016 10 MIN READ | 10 MIN READ

With improved surgical techniques and better understanding of the liver regenerative process, there has been an exponential rise in the number of patients undergoing living donor liver transplant.

Dr Stephen Chang, general surgeon at Mount Elizabeth Hospital specialising in liver transplant, answers various questions from liver donors and recipients.

What is a living donor liver transplant?

Liver transplant is increasingly being recognised as the best treatment for many diseases arising in the liver, as well as for some diseases that affect the whole body. In recent years, as more people have become aware that liver transplant can prolong life significantly, even in the case of liver cancer, there has been an increasing demand for liver transplant.

A living donor liver transplant involves the removal of part of the liver from a healthy donor with a good liver and transplanting it to a recipient. The recipient’s diseased liver will have to be removed from them before the donor’s liver graft can be implanted. Both the donor and recipient operations will be conducted simultaneously. In expert centres, the risk of this procedure is minimal both to the donor and the recipient.

The liver has great regenerative ability. Both the donor and recipient’s liver portion will grow to its full functionality within just a few months given adequate nutrition.

General questions

What is the age limit to be a donor or recipient of a liver transplant?

There is no specific age limit to be a donor as long as the donor is a healthy adult. The selection process to qualify as a donor is very stringent. In general, the younger the candidate, the lower the chance that they may have an underlying medical condition that will exclude them from being a donor.

As for the recipient, the general guide is 70 years old. However, if the patient is otherwise healthy apart from their liver condition, they may still be suitable.

Must the donor be a relative of the recipient?

A related donor is preferable.  Every potential liver transplant donor will need to be interviewed by a panel of ethics committee members to assess the appropriateness of the donation. The aim is exclude any form of coercion and to prevent the practice of organ selling.

There were cases where the donor was only emotionally related or when the ethics committee determined that the donor was truly altruistic. However, these are not common.

Donors’ frequently asked questions

Will I have enough liver left for myself after I donate part of my liver?

In Singapore, the outcome of every living donor liver transplant is reportable to the Ministry of Health and the results are strictly monitored. The safety of the donor is of foremost importance. If there is any doubt that the remnant liver may not be sufficient for the donor, the candidate will automatically be excluded from being a donor.

The candidate’s liver will be assessed for its function through blood tests. The quality of the liver will then be assessed by specialised imaging. The estimated volume of remaining liver will then be computed to ensure that it is enough for the donor’s own health. Finally, the anatomy of the liver or the structural pattern of the blood vessels and bile ducts in the liver will be analysed by the transplant team to ensure that the surgery will benefit the patient as well as be safe for the donor.

As long as the quality and function of your liver is normal, your remaining liver will be able to regenerate to its full volume and functionality within a few months after the donation.

Are there any consequences to my health after I donate part of my liver?

As your liver has the ability to regenerate itself, there should not be any consequences to your liver function or health after the donation. 

There may be some mild and uncommon complications that could occur such as hernia at the incision site, wound infection or prolonged numbness. Other complications are rare and the surgeon will discuss them with you in detail.

Must I be on long term medication after I donate?

No, you need not be on any long term medication.

Must I be on long term follow up after I donate?

After the surgery, you will be followed up with to ensure that you as a donor is well.  The frequency of follow up will subsequently decrease to only once a year.

What tests must I do before I donate?

A panel of blood tests and liver scans will be done to assess your overall fitness for the surgery as well as the suitability of your liver for donation. A psychiatric assessment will also be required to determine if you are a suitable donor. There are strict criteria for donor selection, and these tests will be screened by a panel of specialists in liver transplant.

Who pays for all the tests, treatment and hospitalisation for the donor? What about the treatment in the case of complications?

There is provision for all donor medical expenses to be covered by the recipient’s insurance.

How long is the operation for the donor? How long must I stay in hospital after I donate?

It is usually between 6 – 8 hours. In the usual uncomplicated scenario, the donor’s hospital stay is usually between 5 days to 1 week.

When can I go back to my normal activities or work?

As with most major surgery, the surgical wound will take about a week to heal.  Therefore, you should go back to normal activities in a gradual way. Normal functional activities are encouraged but strenuous activities and exercises should be avoided until the wound is healed completely and strong, which would be around 6 – 8 weeks after the surgery.

Can I donate again if someone else in my family needs it?

No, you have already donated your liver once and you should not be subjected to another donation. Your example of sacrificial kindness as a previous donor will be an encouragement to future potential donors.

Are there any benefits for me if I were a liver donor?

Practically, there may be no tangible benefits as a donor. However, as a donor who is willing to undergo a surgery and give part of your liver to save another person’s life, the emotional satisfaction will be priceless.

Recipients’ frequently asked questions

When do I need a liver transplant? Is there any benefit for early transplant? Are there any bad consequences if I delay it?

Transplant is recommended when the risk of demise from the liver condition outweighs the risk of the immediate and long term risk of liver transplant.

If transplant is performed prematurely, the patient will be subjected to unnecessary surgical risk as well as the risks of long term immunosuppressants. If the transplant is unnecessarily delayed, it may jeopardise the effectiveness of the transplant, as well as make the transplant surgery more complicated.

How long with I live if I did not have a transplant?  How long more can I prolong my life with a transplant?

This is dependent on the stage of the liver condition. In some conditions, it may be too advanced for a transplant to be of any benefit.

Can my insurance pay for my recipient?

Most of the insurance companies in Singapore make provisions for transplant costs for the donor to be covered.

Must I take long term medication after my liver transplant?

Yes, you will need lifelong immunosuppressants to prevent your body from rejecting the transplanted liver.

Can I have a normal life after my transplant?

You are expected to have a normal life after the transplant.  Most transplant recipients return to productive and fruitful lives after their transplant.

Chang Kin Yong Stephen
General Surgeon
Mount Elizabeth Hospital

Dr Stephen Chang is a general surgeon practising at Mount Elizabeth Hospital, Singapore. He is also the medical director of the liver programme at Mount Elizabeth Hospital. He subspecialises in laparoscopic surgery, management of gall bladder, liver and pancreatic diseases, and liver transplantation.