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Liver failure occurs when the liver is not functioning properly. When the liver is not functioning properly, patients may experience jaundice (a yellow discoloration of the skin and eyes), uncontrolled bleeding, decreased level of consciousness (patients may be very drowsy, irritable, and occasionally go into a coma), malnutrition, and ascites (a collection of fluid in the belly).
There are many causes of adult end-stage liver disease but the most common include:
Although the liver can regenerate to a certain degree, the disease process may become too extensive. In adults who have advanced liver disease, if all of the usual medical and surgical treatments are no longer effective, liver transplantation becomes the only treatment option. There are two types of liver transplants - a living donor transplant or a deceased donor transplant, which uses a liver from a person who has died suddenly. Sometimes, a donated liver can be split into two pieces so two recipients can benefit from one deceased donor. The liver may be split while it is still within the donor ("in situ") or after it has been removed ("ex vivo"). The smaller piece of the liver (about 25 per cent) is used for a child and the remaining 75 per cent is used for an adult.
Liver transplant surgery usually takes four to six hours. The operation consists of complete removal of the diseased liver through an incision in the upper abdomen. The patient's gall bladder will also be removed. The donor liver is then placed inside the abdomen and attached. The blood vessels and bile ducts from the body will then be attached to those of the new liver.
Since our program started, 2,000 liver transplants have been performed. Some of our first patients are the longest-surviving liver recipients in Canada – still well almost 30 years after their transplants. Some of our female recipients have delivered healthy babies, including twins, after their liver transplant.
You may want to read this handbook about liver transplantation.