Living donor liver transplantation is a surgical procedure in which a healthy individual, usually a consanguineous or unrelated family member donates part of his or her liver to a loved one with chronic liver disease.
Why it is proposed
Unfortunately, the number of organs is largely insufficient to transplant all the patients who need it. This results in the impossibility for many patients to be transplanted in time. To remedy this problem, a living donor liver transplant operation has been developed that allows the extraction of a part of the liver from a healthy donor and its transplantation into the patient who needs it. This is not impossible, all thanks to the ability of the liver to regenerate once a portion is removed (in the case of the donor) and to regrow until reaching normal size once transplanted (in the recipient).
The use of living donor liver transplantation allows the patient to be transplanted when he needs the new organ, without having to wait on the waiting list and therefore without the risk that his condition will worsen, making the transplantation more risky and with a higher chance of complications. Moreover, since the intervention on the recipient and on the donor take place at the same time, the organ ischemia times are reduced to a minimum, differently from what happens in the case of a transplant performed with an organ taken from a deceased donor.
How the procedure is carried out
From a surgical point of view, living donor liver transplantation among adult individuals consists in taking the right side of the donor's liver (about 60% of the whole organ) and transplanting it into the recipient, after having removed the diseased organ. In the case in which the patient is a child, the part of the donated liver is the left, smaller. It is easy to divide the liver into two parts because each of the two lobes has its own arterial and venous vascularization and drains the bile through two main ducts, right and left, which unite only in their last stretch outside the liver.
The donor evaluation process
To safeguard the health of the donor of a portion of the liver, strict selection criteria for the donor have been developed by liver transplant hospitals in India. It must always be remembered that those who donate undergo major surgery only for purely altruistic purposes, so it is necessary to pay as much attention as possible. The evaluation phase includes: blood tests, instrumental tests and specialist examinations aimed at excluding any contraindications to the procedure (anatomical abnormalities of the liver, changes in liver function and other pathologies), psychological evaluation, divided into several sessions and interviews; evaluation of a multidisciplinary team composed of all the specialists involved in the care.
Surgery on the donor
The intervention to which the donor is subjected is called a right hepatectomy. Surgeons make an incision in abdomen large enough (see figure) to allow the location and safe removal of a portion of the liver that is equal to 65% of the entire organ. During the surgery, specific compression systems are used by liver transplant hospitals in Delhi to maintain blood flow in the legs and prevent the formation of clots.