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The number of people waiting for a liver transplant has always been greater than the number of organs available from deceased donors. For that reason, many transplant centres now use living donors. In Canada, our centre performed the first parent-to-child and the first adult-to-adult liver transplant using living donors. Livers from living donors have become an increasingly important resource in treating end-stage liver disease.
In 1993, London Health Sciences Centre performed its first parent-to-child liver transplant using a living donor. In parent-to-child transplantation, a parent gives a piece of liver (the left lateral segment) to their child. The donor is able to function without all of their liver, which regenerates to its normal previous size within a few months. The piece of liver that is transplanted grows along with the recipient and is able to meet all of the child's requirements.
In 2000, London Health Sciences Centre performed its first adult-to-adult liver transplant using a living donor. In adult-to-adult transplantation, a person may be able to donate the right lobe (approximately 60 per cent) of the liver. The amount of liver transplanted must be appropriately size-matched. This is determined by doing CAT scans of the donor and estimating the weight of the right lobe graft, then comparing it to the weight of the recipient. The remaining segment in the donor will regenerate to its normal previous size within a few months. The transplanted liver segment grows in the recipient to the full size of a whole liver.
A healthy family member or friend may be able to donate a portion of their liver to save the life of someone with terminal liver failure. In most programs, donation is restricted to family members and close friends who are between 18 and 55 years of age. The potential donor must be in good health and must undergo several tests to ensure that the liver is working well. Donors are thoroughly informed about the risks and the fact that they can choose to decline at any time prior to surgery.
Historically, the number of children and adults who died waiting for a liver transplant was significant. The most obvious benefit of living donation is that the transplant can be performed without a long waiting time. Surgery can be scheduled before the child and adult becomes critically ill, which increases the success of the transplant. Overall, the survival rate following this procedure is 93 per cent. There may also be financial benefits to the health-care system because the recipient often spends less time in hospital before and after the transplant.
Removing a portion of the donor's liver is major surgery, and the possible complications include bleeding, bile duct injury, infection, and death. Having said this, most donors do very well and are out of hospital within 6-10 days with no complications. With kidney and bone marrow transplantation, a living-related transplant decreases the likelihood of rejection, but this is not the case with liver transplantation. The chances of rejection are the same as with a deceased donor.
PRELOD is a last-resort program to help assist potential and actual living organ donors with some of the out-of-hospital expenses associated with their donation; for example, travel, parking, accommodation, meals, loss of income. PRELOD aims to reduce the financial burden incurred by living liver donors. This is a new government program, only applicable to donors whose recipient lives in Ontario and only effective if the donation occurred after August 3, 2007. There is eligibility criteria that donors must meet to obtain reimbursement. For further information about PRELOD, you can call 1.888.9PRELOD or 416.619.2342, or contact the PRELOD Administrator at PRELOD@giftoflife.on.ca.
Click here to read a more detailed handbook about the living liver donation program.
For additional information, please contact our transplant program:
phone: 519.685.8500 ext. 33552