the handbook what is a living donor liver transplantation? during

8/14/2019 The Handbook What is a Living Donor Liver Transplantation? During

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The Handbook

WHAT IS A LIVING DONOR LIVER TRANSPLANTATION?

During living donor liver transplantation procedures, a piece of healthy liver is surgically

removed from a living person and transplanted into a recipient immediately after the

recipients diseased liver has been entirely removed.

The liver, unlike other organs in the body, has the features of self-renewal and growing

back. Owing to these features, it enables living donor liver transplantation. The liverimmediately starts renewing itself and grows back almost in a year. Therefore, when

surgeons remove a piece of a donors liver, the piece remaining in the donor and the

piece transplanted into the recipient regenerate to their original sizes immediately.

As recently as fifteen years ago, this procedure was performed in the world only in cases

where adult donors provided livers to children needing a liver transplantation, but by now

surgeons have gained experience even in cutting the whole liver from cadavers into two

parts for different recipients.

MOST FREQUENTLY ASKED QUESTIONS

Q. What are the advantages of living donor liver transplantation?

A. The main advantage of living donor liver transplantation is when the recipient needs

the transplant, he/she is able to have it without having to wait on the list for the transplantfrom a cadaver. As organ donation is very limited in our country, patients on the list are

likely to get worse, even die, while waiting for their turn to come. Besides, patients

whose health conditions may be worsening while waiting for their organ turn on the list,are more subject to post-surgery complication risks at the initial stage and this situation

decreases the chance of success after the transplant surgery. However, if enough cadaverlivers were available, we would certainly consider living donor liver transplantation less.

Q. How much of the donor liver is removed?

A. Usually, about 40 percent to 70 percent of a donor's liver is removed. The liver isdivided into a right lobe and a left lobe. The anatomical division between the lobes

permits surgeons to divide the liver into two distinct parts that can function independently

of each other. The right lobe comprises about 60 percent of the total liver volume and the

left lobe comprises approximately 40 percent. During the transplant surgeries, thegallbladder of the donor is also removed.

Q. How much time must you wait to transplant the liver to the recipient after the removalof donors liver?

A. Recipients and donors surgeries are performed simultaneously.

Q. Can everyone be a living donor?

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will inform you about living donor liver transplantation surgery, its risks, and statistical

data both in the organ transplant center and the world. In this appointment, you will

undergo a very detailed blood test. They will evaluate your results, and if everything is asit should be, then they will plan the second step with you.

Q. What is the second step in the evaluation process?A. The following step in the evaluation process is checking in detail your abdomen and

liver through ultrasonography and computerized tomography. Your liver size and the

blood building up your liver are measured. CT gives us detailed information about yourliver, and it has a crucial role in our decision-making process. In addition to these, a

hepatologist and surgeon from the team of organ transplant center evaluate you. Other

tests may also be important depending on your health condition.

Q. Shall I not eat before my appointment?

A. For CT screening, you should not eat for 3-4 hours before the exam, and you should

not eat for 8 hours before MRCP. However you do not generally have to come to the

appointment hungry, unless particularly indicated to do so.

Q. Should my family be with me in the appointment?A. It is important that you bring one of your friends or relatives with you to the

appointment. In this way, they also have an understanding of the procedures. During all

appointments the donor and his/her family can ask any questions that come to their mind

and acquire more information. It is recommended that your companion be with you in allappointments until the last one.

Q. When can I learn whether I can be a donor or not?A. Generally, right after the examination is done, you are informed. Sometimes you may

be asked for further medical tests that may likely affect your surgery. It is crucial that you

understand everything you are told. Donating your liver is a serious decision.

Q. Who decides finally whether I can be a donor or not?

A. After completing all the required tests, the organ transplant team will meet and reviewthe results. Within the team, there are doctors, surgeons, nurse coordinators, radiologists,

anesthetists, psychiatrists, and, if available, consultant doctors who have evaluated you

during the appointments. The decision is never taken individually; it is always decided as

a team. The donors health condition is always considered in the decision.

Q. If my being a donor is finalized, who decides on the date of the transplant?

A. The surgery team decides on the transplant date together with the donor and recipient.Doctors may prefer an early date as possible depending on the severity of health

condition of the recipient. In cases where it is urgent, after discussing it with the donor,

surgery preparations start. Coordination in surgical operating rooms is also important. Forthe transplant, 2 surgery operating rooms and 2 teams formed by surgeons, nurses and

anesthetists are required.

Q. Should the cause for the recipients illness affect my decision?

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A. It is a very big sacrifice for the donor to volunteer giving a piece of his/her liver. This

sacrifice will save the recipients life. Some illnesses (like hepatitis C and liver cancer)

may recur after the transplantation surgery. Before the surgery, what is expected of thistransplantation surgery, its possible complications and recipients current health condition

will be discussed with you. During all these discussions, confidentiality will be

maintained and it is also expected of the donor to maintain confidentiality. Thesediscussions with the donor will not be kept secret from the recipient.

Q. What are the possible complications of donor surgeries?A. After the surgery, there may be risk of bleeding and bile leaks. These complications

may rarely require blood transfusion and additional surgery. Even though the frequency

of these complications is quite low, there is always a risk. These risks will be discussed

with you in more detail during the evaluation. The most frequent complications can belisted as small bile leaks, small infections and some gastrointestinal disorders

(constipation, indigestion, nausea). These complications will improve within a few weeks

after the surgery.

Q. Will the donor require a blood transfusion during the surgery?

A. Although a blood transfusion for a donor during this surgery is uncommon, it maysometimes be necessary.

Q.Should I stop drinking alcohol?

A. If you are going to be a liver donor, it is better if you stop drinking. If you have ahistory of heavy alcohol use, it is very important to tell our doctors. Alcohol use may not

preclude you from being a donor, but you may need a liver biopsy to be sure your liver

has not sustained any damage.

Q. Should I stop taking my medications before the evaluation or the surgery?

A. You should not stop any prescription medication unless advised to do so by a doctor.You should avoid aspirin or non-steroidal medications for seven days before a liver

biopsy or surgery. These medications can affect the blood's ability to clot and put you at

higher risk of bleeding complications. It is also recommended that women who take birthcontrol pills stop taking them. These kinds of medications increase the complication risk

after the surgery as they accelerate the bloods ability to clot.

Q. How long will I be away from work?A. The minimum rest time after the surgery is 4 to 6 weeks. As the recovery period will

vary from one person to another, relief from fatigue and pain may take 8 to 12 weeks.

Q. How large is the incision?

A. The incision is a large J-shaped incision and it is called the Mercedes incision.

Q. Will there be marks on my body after the incision heals?

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Q. When can I start doing some tiring exercises such as running, swimming, or

weightlifting?A. For the first 6 weeks, you should be particularly careful about not carrying heavy

objects until your abdominal wall heals. Do not lift more than 5 kilos during this period.

After 6 to 8 weeks, if you are feeling all right and you do not have any complications,you may go back to your regular daily activities. These activities include sports like

running, swimming, aerobics, cycling. However, you should still pay particular attention

in exercises related to your abdomen. You should start slowly and by repeating someexercises a few times and you should gradually increase your strength and endurance.

Q. When can I go for a trip or travel by plane?

A. Do not plan on going abroad for at least 4 weeks and preferably for 8 to 12 weeks afterthe surgery. If you live outside Istanbul and wish to return home, and provided it is

certain there is a doctor knowledgeable about living donor liver transplantation whom

you can see where you live, you may return home within 2 to 4 weeks after the surgery if

you feel okay. However, we must remind you that you will be asked to come to the centerwhere you had your surgery upon any doubts about a complication in order to re-evaluate

and treat it. At the end of 12 weeks, you can travel wherever you wish by any means oftransportation.

Q. When the liver transplantation is scheduled, does it mean that it is certainly going to

be performed?A. Unfortunately, when it comes to liver transplantation, many factors may change our

plans. The recipients health condition may worsen and thus not allow the transplantation

surgery or the recipient may become infected or there may be other incidents like thesethat must be treated before the surgery.

Q. How long will I stay in the hospital?A. The donors stay in the hospital 7 to10 days on average.

Q. Will I share the same room with the recipient?A. No. Before the recipient is transferred to the service, he/she is kept in the surgical

intensive care unit for 1 or 2 days.

Q. Will the donor be kept in the intensive care unit after the surgery?A. After the surgery, the donor will be kept in the intensive care unit overnight. In this

unit, the donor is closely monitored. The following day, if he/she does not have any

bleeding or complication, after he/she recovers fully from anesthesia and his/her healthcondition is stabilized, he/she can be transferred to the service.

Q. When can I start eating after the surgery?A. As soon as your intestines start working properly again after the surgery, you can start

eating. If your release of gas is proper, there is no harm in taking sips of water. You can

consume liquids and soft foods provided that there is no nausea or vomiting while taking

sips of water. Within two days, you may begin eating regular foods. Sometimes it may

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take more time for the donors to return to their regular eating habits. The faster the

intestines improve, the less analgesics are required.

Q. Will tubes or similar tools such as a drainage tube be inserted in the donor after the

surgery?

A. 1 or 2 intravenous catheters may be inserted so that you receive medication or liquid.One of these catheters is also used for giving you analgesics. Another catheter will be

placed into your bladder in order to follow your kidney functions, and a small drainage

tube will be inserted into your abdomen. Intravenous and urinary catheters are removedwithin 3 to 4 days. The drainage tube in your abdomen is also removed within 6 to 7

days.

Q. Do I need to come back to the hospital for check-ups?A. As this is a serious surgery, you will be monitored closely to make sure that

everything goes well. You should come back to the hospital a week after you are

discharged. You will also be called for a check-up the first month after the surgery. After

that, you will be asked to come for check-ups on the third month and at the end of thefirst year.

Q. Shall I stay at a place close to the hospital after the surgery?

A. It is required that you stay somewhere close to the organ transplant center up to 2 or 3

weeks after the surgery. Also, if any kind of problem occurs, you should be able to return

to the center. If you live somewhere outside Istanbul, it will be better if one of yourrelatives stays with you for this period of 2 or 3 weeks.

Q. After donating his/her liver, will the donor need any kind of treatment?A. You will not need any kind of treatment except getting analgesics. If your wound gets

infected, you may need to use antibiotics.

Q. Will I need nurse care at home after being discharged from the hospital?

A. Although this surgery is a serious one and you will feel weak and tired, you will not

necessarily need professional care at home. It will be enough to have a relative or friendat home to take care of you. Moreover, you will need someone to accompany or drive

you to the hospital for check-ups and some blood tests.

Q. Will I need special preparation for this surgery?A. All medical preparation for this surgery is done in the organ transplant center. Once

we decide that you can be a donor, there is not much additional testing. We may need to

repeat some blood tests, if they were done more than 30 days before your surgery date.We will ask you, your recipient and your immediate family to come in to our center two

or three days before the surgery for a final detailed pre-transplant review and to answer

any questions you or your relatives may have.

Q. Will I stay in the hospital the night before the surgery?

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