For children who need a liver transplant, there are a number of advantages to having a live liver donation; one that comes from a living person rather than a deceased donor. One advantage is that the wait for the transplant could be shorter and that the date can be scheduled in advance. Having a scheduled date allows the whole family to prepare for the surgery for example bringing in out of town family members to assist the donor and or care for other children and provide support to parents.

The liver can be split into two different lobes. If a live donation is done, the smaller (left) lobe is removed leaving the right lobe in place in the donor.

A child awaiting liver transplant remains on the deceased donor list right up until a live donor liver transplant is completed; having a potential or confirmed live donor does not change a child’s status on the deceased donor waiting list. 

Living liver donor requirements

If you are considering living liver donation for a young friend or family member who needs a liver transplant, you must meet certain qualifications. You do not need to be a blood relative of the recipient. You must:

• Be between 21 and 50 years of age
• Have a compatible blood type with the recipient
• Be the right size and in good health

Living liver donor evaluation

A potential donor undergoes a head-to-toe evaluation by the living donor team at Penn to ensure the donation is safe for the donor and that the liver is an appropriate match for the recipient.

This evaluation takes place at the Penn Transplant Institute at the Hospital of the University of Pennsylvania (HUP). Since all living organ donors are adults, CHOP’s partnership with HUP ensures the best care for both living donor and recipient. The evaluation includes, but is not limited to:

• Submission of a health questionnaire to start the process (Please note: Submitting the online questionnaire will not result in automatic living donor enrollment and potential living donors can withdraw from the process at any time)
• An education session at Penn Transplant Institute Blood work to confirm blood type 
• Physical examination and visit with Penn team that includes height, weight, pulse and blood pressure measurement 
• An appointment with a HUP social worker and a HUP living donor advocate
• CT abdomen
• PSA for males over 45 years of age
• Electrocardiogram (EKG)
• Cardiac testing (echocardiogram or exercise stress depending on donor age)
• Chest X-ray
• Review of medical records including general health information such as mammogram, Pap smear, colonoscopy, as indicated by age/history

The potential donor will also have appointments with a liver specialist (hepatologist) at HUP for a physical exam and discussion of their eligibility; a living donor transplant surgeon to discuss surgical options; a cardiologist; and other specialists based on prior history and/or testing results. The donor will also meet with an independent living donor advocate and the donor nurse coordinator.

The above criteria are all part of the initial evaluation, but keep in mind that each case is unique. Additional testing and/or consults may be needed. If you are considering living donation, we encourage you complete an application. (Please note: Submitting the online questionnaire will not result in automatic living donor enrollment and potential living donors can withdraw from the process at any time).

Living donor liver transplant surgery

The donor surgery is done at HUP’s new hospital, the Pavilion at Penn. The operating room team consists of anesthesiologists, surgeons, nurses, and technicians. The surgery usually takes 5 to 7 hours. The portion of liver removed from the donor is hand-carried by members of the surgical team through a secure tunnel to the recipient's operating room location at CHOP while other members remain behind to care for the donor. When the donor surgery is complete, the living donor will be brought to the recovery room for brief observation and then to the surgical intensive care unit overnight. By the day after surgery, most donors will be well enough to transition to the specialized transplant floor for the remainder of their hospital stay.  They can anticipate being in the hospital for 4 to 7 days.

Health risks to living liver donors

At the Penn Transplant Center, a specialized team of surgeons is dedicated to the living donor operation and returning the living donor to a fully functional and healthy life. Most of the time, the operation goes very smoothly for a healthy living donor. But every time anesthesia is given, or someone has surgery, there is a possibility of a complication. Risks of the donor surgery are discussed in detail in the education session. Learn more here.

After recovery from surgery, the donor is able to return to normal routine — work, drive a car and play sports as before. Living liver donation does not change life expectancy.

Other considerations

• Many donors can return to work in six to eight weeks depending on the physical demands required for their job. Donors with physically taxing jobs may require three months to return to work.
• The living donor’s insurance is not billed for the living donor evaluation, hospitalization, surgery or follow-up care. Symptoms or conditions not associated with donation may be identified by the donor team, but would be billed to the donor’s insurance for treatment or follow-up.
• There are grant opportunities to assist living donors with incidental costs: travel, lodging, food while traveling, and a portion of lost wages may be eligible for reimbursement. The donor’s social worker will discuss various funding opportunities with the donor during the evaluation process.
• There are no direct health benefits to the living liver donor, but there may be psychological benefits. Many living donors feel rewarded and very happy from helping a loved one or person in need. Many times, they can see the life of that person improved greatly after the transplant.

How to ask someone to be a living donor

Asking someone to donate an organ is a major decision, but it can be a life-saving effort, as well. Potential living donors can include family, friends, co-workers and acquaintances. Therefore, it's important to inform those people of your child’s need for an organ transplant. Often, just discussing your child’s situation with these individuals will lead to volunteer donors.

If no volunteers arise, here are some suggestions for initiating a conversation about your need for a living donor:

• Discuss the benefits of living donor liver transplantation.
• Ask in a way that’s heartfelt but doesn’t pressure the person.
• If a person declines, do not push the issue.
• If a person seems interested or says yes, provide them with more information about the details of donating, including requirements for eligibility, and inform them they will not incur any medical costs. Use Penn's website as an additional resource. 
• Give the donor time to consider whether this is the right decision. Organ donation is a life-altering decision that may or may not be appropriate for a person’s particular situation. Offer additional information and support when needed.
• Provide the potential donor with the website to apply for living liver donation. (Please note: Submitting the online questionnaire will not result in automatic living donor enrollment and potential living donors can withdraw from the process at any time)