Liver Transplant - Frequently Asked Questions

What are the Advantages of a Living Donor Liver Transplant?

The main advantage of living donor liver transplantation is that the transplant process can take place without having to wait the order of the cadaver transplant waiting list when the transplant is needed. Since organ donation is extremely low in our country, the patients waiting on the list, while waiting for the queue to come to her/him, their condition get worse, the risk of complications in the early period after organ transplantation increases and the chance of success after transplantation reduces. If a sufficient number of liver transplant could be made from cadavers, a living donor organ transplant would not be considered much.

How Much Is The Donor’s Liver Removed?

Generally, 60-70 % of the liver is removed. The liver is divided into right lobe and left lobe. In this manner the fact that the liver is divided anatomically into two enables to have two separate pieces of liver which function freely from each other. The left lobe forms an average of 30-40 % of the liver and the right lobe is 60-70 %. The gallbladder of the donor is also removed during the transplant surgery.

How Long Does It Take To Transplant The Liver To The Recipient After Receiving The Liver From The Donor?

Donor and recipient surgeries are performed simultaneously.

Can Anyone Be A Living Donor?

In general, the donor must be between the ages of 18 and 60. It is preferred that the donor and recepient are of the same size, but in some cases it is seen that the donor is smaller in size than the recepient. If the donor is a woman, she should not be pregnant. The donor should not be overweight, but even if he has a weight, he can lose weight and become a potential donor. The donor should be able to understand all the risks of this surgery, and should also comply with all the instructions given by doctors in the short and long term postoperative period.

In our country, relatives up to 4th degree can be liver donors. The status of donors who do not have a kinship degree is evaluated and decided by the Ethics Committee of the Ministry of Health.

If I Am a Relative to the Recipient, Does This Reduce the Risk of Rejection That May Occur?

It has been reported in studies that the blood relation between the donor and the recipient does not reduce the risk of rejection. In addition, the relationship between the recipient and the donor does not affect the level of immunosuppressive treatment that the recipient needs after surgery. However, identical twins are likely to differ in such cases.

What To Look For In The Evaluation Process?

The blood groups of the recipient and the donor must be compatible. The evaluation of the donor’s liver is considered to be normal and sufficient in size. It is also important that the donor does not have any psychiatric disorders that would make this procedure in trouble. The donor must not have any infectious disease that can pass to the recipient. Finally, the donor must have made a decision with his/her own free will without any pressure.

Can I Have My Own Doctor Do The Evaluation?

Since Organ transplantation is a detailed process, it would be better to have all the tests and evaluations done by our team. If you live in a remote place from our center, you may be able to do some of the evaluation where you live, but in any case you need to be examined into by our doctors.

What Are The Steps Of Evaluation?

The first step in evaluation is to determine your blood group. This is a very simple test. If you want, you can have your doctor or at any blood center do it. The donor’s blood group must either be the same as the recipient or must be “0”. The donor’s Rh factor to be either (+) or (-) does not have any effect.

The next step in the evaluation is to look at your abdomen and liver in detail with ultrasound and computed tomography. The size and flushing of your liver is measured. CT gives us detailed information about your liver, plays a major role role in the decision-making process. The donor candidate who is found eligible in CT have an MRCP scan for biliary tract. In addition to this, a hepatologist and a surgeon from our team evaluate you. Other tests may be important depending on your situation.

Shoul I Be Fasting Before Coming To My Appointments?

For CT scan, you should come with 3-4 hours of fasting. For MRCP, you must be 8 hours of fasting. But in general, you do not have to be fasting for appointments unless you are specifically told.

Should My Family Also Be With Me On Appointments?

It is important to have a relative or kin with you when coming to appointments. Thus, they also have a knowledge of the procedure. At all appointments, the donor and his family can ask all the questions they have in mind and learn more. It is important that your relative accompanying you be with you until the last appointment.

When Can I Find Out Whether I Can Be A Donor?

In general, the donor is informed immediately after completing the assessment. Sometimes, it may be needed further medical tests that are thought to affect your surgery. It is highly important that you understand the information given to you. The decision to donate your liver is a serious decision.

Who Last Decides I Can Be A Donor?

After completing all necessary tests, the results will be reviewed. The team includes doctors, surgeons, nurse coordinators, radiologists, anesthesiologists, psychiatrists, and, if any, consultative physicians who have evaluated you at appointments. The decision to be made is never individual. The decision is always made as a team and by taking into account the donor’s health.

If My Being A Donor Is Certain Who Decides On The Date Of Transplant?

For the date of transplantation, the surgical team, the recipient and the donor take a joint decision together. Depending on the severity of the recipient’s condition, doctors prefer this surgery to be done as quickly as possible. In this case, the preparations for the surgery begin with talking to the donor. The coordination of operating room is also important. For transplantation, it is required to have surgeons, nurses and anesthesiologists consisting of 2 operating rooms and 2 teams.

The Reason Of The Recipient’s Disease Should Affect My Decision?

The donor makes a great sacrifice and volunteers to give a part of his liver. This sacrifice will save the recipient’s life. Some diseases (such as hepatitis C and liver cancer) may recur after transplantation. Before the operation, you will be told what is expected from this transplant, its possible complications and the medical condition of the recipient at the time. Confidentiality is essential in these conversations and the same sensitivity is expected from the donor. Talking about these issues with the donor will not be hidden from the recipient.

What Are The Possible Complications Of Donor Surgery?

The mortality risk in donor surgeries is 0.2 - 0.5 %, which is a very low risk. During the donor surgery, excessive fat in the liver, unexpected anatomical and structural variation in the liver, or masses that may be seen in the abdomen, and so forth complications, which may be encountered when the abdomen is opened, may cause this surgery to be terminated. There may be a risk of bleeding and bile leakage after surgery. This may rarely require blood transfusion and reoperation. Although the incidence of these complications is very low, there is always a risk. These risks will be explained to you in detail during the evaluations. Small bile leakages, minor wound infections and some gastrointestinal disorders (constipation, dyspepsia, nausea) are the most common complications. These complications resolve within a few week

Will Blood Transfusion Be Applied To The Donor During The Operation?

Although blood transfusion is very rare for the donor, it is sometimes needed

Should I Stop Taking Medication Before Evaluation Or Surgery?

Do not stop taking the medications until our doctors tell you. You should stop taking aspirin and similar drugs 7 days before liver biopsy or surgery. Since Such drugs prevent clotting, bleeding increases the risk of complications considerably. Women taking birth control or hormone replacement therapy are also advised to stop taking these drugs. Such drugs increase the risk of complications in the postoperative period, as they provide the blood to clot more quickly.

How Long Will I Stay From Work?

The minimum rest period after surgery is 4-6 weeks. Since the healing process can vary from person to person, it may take 8-12 weeks for pain and fatigue to stop.

Will There Be A Scar On My Body After The Incision Wound Heals?

In most cases, the incision heals quickly and dwindles away. But, it always remains visible. If your wound is infected, then you may have a larger and more visible wound

Will I Have A Lot Of Pain After The Surgery

After the surgery, your pain is controlled by intravenous drugs for the
first 3 days and then by drugs taken orally.

Will I Get Back To Normal Life After Surgery?

If there are no complications, you are expected to get back to your previous life in about 3 months. The risk of having complications in the long term is very low

When The Liver Transplant Is Scheduled, Will The Transplant Definitely Take Place?

Unfortunately, as far as the liver transplantation is concerned, a lot of situations can change our plans. The recipient’s situation may deteriorate and become unable to receive a transplant, or an infection and a condition like this that must be treated preoperatively may occur.

Can I Donate Another Part Of My Liver To Someone Else In The Future?

When you donate a specific part of your liver for once, you cannot donate it a second time.

When Can I Drive After The Surgery?

It is recommended not to drive for 4 weeks after surgery. Before deciding to drive, you need to be physically and mentally sound, you should not have any problems related with your reflexes and, most importantly, with your abdomen.

When Can I Get Better After Surgery?

As soon as you come out of anesthesia, you will start doing “exercise.” You will be asked to do breathing and coughing exercises. You will also be asked to periodically contract and relax your legs muscles. You will get out of bed 24-48 hours after the surgery and be walked with help. Walking is of great importance in the healing process. Being able to get better as quickly as possible reduces the risk of many complications (such as blood clots, pneumonia, muscle atrophy) that may develop after surgery. A walking program will be prepared to apply at your home. Please note that the goal is to restore your previous health in 2-3 months.

When Can I Travel or Take A Plane?

Do not make any plans to go abroad for at least 4 weeks, or preferably 8-12 weeks. If you want to return back to your home and you have a doctor in your city who has information about a living donor liver transplant, and if you’ll feel better after 2-4 weeks, you can return back home. Please be reminded that that you will be recalled to our center for evaluation and treatment in case of the slightest doubt of complication. At the end of the 12th week, you can travel wherever you want and as you please

How Long Should The Donor Stay In The Hospital For A Liver Transplant?

The duration of the hospital stay for donors is 7 to 10 days.

No. The recipient is kept in the surgical intensive care unit for 1-2 days before transferring the ward.

Is The Donor Kept In The Intensive Care Unit After The Surgery?

After surgery, the donor is kept in the surgical intensive care unit for a night. Here, close donor follow-up is performed. The next day, after completely eliminating anesthesia and everything is stable, he/she is transferred to the ward if he/she does not bleed or have any complications.

What Can I Eat and Drink After Surgery?

After surgery, you can eat and drink as soon as your intestines start working. If your flatulation are expelled, there is no harm in sipping water. If you are not accompanied by nausea or vomiting while sipping water, you can consume liquids and soft foods. You can start normal food intake within 2 days. Sometimes donors may not be able to return to eating habits that quickly, and some donors may have severe nausea complaints between the 3rd and 7th days of the surgery and last for 3-4 days. The less painkillers are used, the faster the intestines recover.

Are Stuff Like Tube Or Drain Attach To The Donor During Surgery?

You may have 1 or 2 vascular access to deliver drugs or liquid from outside. One of these vascular accesses is used to give you painkiller. In addition, a probe is placed in your bladder to monitor kidney function. 1 or 2 small drainage tubes are placed on your abdomen. The vascular access and urinary catheter are removed within 3-4 days. The drainage tube in your abdomen is removed within 6-7 days.

Do Donors Have To Come Back To The Hospital for Examination?

Since this is a major surgery, you need to be under the control of a physician until you are sure all went well. After discharge, you must come to our hospital for examination 1 week later. Donors will be asked to have a blood test done at 3 months and 6 months. If everything is normal, no further control will be required for the donor.

Should I Be Located Near The Hospital After Surgery?

You should be in a place close to our Center for 2-3 weeks after surgery. You should also be able to return to our center in case of any problems. If you are coming from outside the city, it would be good for a relative to stay with you as a companion.

Does The Donor Need Any Treatment After Donating His/Her Liver?

You do not need any treatment other than painkillers. If the wound infection develops, you may need to take antibiotics.

Will I Need A Nurse For Home Care When I’m Discharged From The Hospital?

Although this surgery is a major surgery, even if you feel very weak and tired, you will not need such professional help. It will be enough to have a relative or friend to take care of you at home. You will also need someone to bring you to the hospital for checks and blood tests.

Do I Need To Make A Special Preparation For This Surgery?

Medical preparations are made fully for this surgery in our center. After you decide to be a donor, not many additional tests are done. The donor, the recipient and his/her family are invited to our center 1-2 days before surgery. All the details are reviewed and clarified to every subject that the patient or his/her relatives are curious about.