Organ donation: The gift of life.
A liver transplant is a life-preserving operation that replaces a diseased and poorly functioning liver with a healthy donated liver. A liver transplant recipient can receive either an entire liver or a portion of a healthy liver. Liver transplantation has become a well-recognized treatment option for people with liver failure. In Canada, over 400 such operations are performed every year. Livers are donated either from individuals who have been declared brain dead and with the consent of their next of kin, or from a living donor such as a relative or friend. Liver transplant centres match donors with recipients based on compatible liver size and blood type.
A liver transplant is a major surgery with an operation lasting between six and eight hours. As with any major medical procedure, liver transplantation has risks. These risks along with the benefits are carefully considered before a patient is placed on a waiting list for a new organ. A successful outcome depends upon many factors. Patients who enter surgery very ill carry a higher risk of dying. Similarly, older patients with cardiac or respiratory illnesses will find the transplant a greater challenge.
When medical therapy is effective in stopping the progression of liver disease, transplantation may be avoided or delayed. If a patient develops advanced disease, with impaired liver function, which is non-reversible, liver transplantation should be considered. Liver transplantation is not suitable for everyone, so all potential transplant patients must be carefully assessed. The assessment starts when the specialist or family doctor makes a referral to the transplant team. Patients receive a comprehensive medical evaluation which includes various tests and interviews by various team members to determine whether transplantation is the best treatment option. The patient and/or family members are extensively involved in the transplant assessment and decision-making process.
The waiting time for a new liver may be uncertain and stressful. The sickest patients receive priority for a transplant. Prioritization is based on severity of the liver disease measured by a Model for End-stage Liver Disease score (MELD). In children, a modified scoring system, called Pediatric End-stage Liver disease score (PELD), is used to prioritize children in need of a liver transplant. If patients and families are having difficulty in coping during this time, it is recommended that they seek the assistance of a qualified health professional.
For more information please contact the Canadian Liver Foundation’s National Help Line at 1 (800) 563-5483.
In Canada, the long-term success rate of transplantation for both adults and children is over 80%. Immediately after surgery, patients are taken to the Intensive Care Unit (ICU) where they are placed on a machine known as a mechanical ventilator that supports their breathing. They are carefully monitored for signs of infection. Frequent tests are conducted to assess the functioning of the new liver. Most patients spend one to three days in the ICU before they are transferred to a step-down transplant unit. At this point, they are able to breathe on their own but will continue to have intravenous lines delivering medication. Following continued improvement and physiotherapy, patients usually leave the hospital after 10 to 14 days. They will be required to remain close to the transplant centre for several weeks and will attend an outpatient clinic for continued monitoring of their new liver. Most patients return to a good quality of life within three to six months after surgery.
At the age of 3, Alessandria was diagnosed with primary sclerosing cholangitis (PSC), a disease that affects the bile ducts and can lead to severe liver damage. Although PSC affects primarily middle-aged men, a growing number of women and children are being diagnosed. The exact cause of this liver disease is still unknown. Today, there is no cure and no specific treatment. Alessandria’s parents fear that one day she may need a liver transplant.
Donate now to support research that may one day lead to a cure for people like Alessandria, and keep reading to learn about living donor transplants.
All liver transplant patients must take anti-rejection medications for life. These medications must be monitored to ensure the right amount of medication is present in the patient’s blood. These medications suppress the immune system, which enables your body to accept the new liver without attacking it. However, these medications also make all liver transplant patients more susceptible to developing infections. Infection prevention techniques are very important after receiving a transplant. The side effects associated with anti-rejection medications are many and are specific to the medication regimen a patient receives. Many patients experience some form of side effect during their course of treatment; however, many of the side effects are temporary or manageable. The risk of side effects also depends on the amount of anti-rejection medications one requires to protect the transplanted organ. The transplant team will often use the least amount of anti-rejection medications needed in hopes of avoiding or minimizing the risk of unwanted side effects. Furthermore, the transplant team monitors patients closely so that side effects can be identified and dealt with quickly.
Most liver transplant recipients are able to return to a normal and healthy lifestyle. Most report that they feel re-energized, have an improved quality of life and enjoy everyday activities once more. Liver transplant recipients are able to participate in normal exercise after their recuperation and women are able to conceive and have normal post-transplant pregnancies and deliveries.
The long waiting time for a liver transplant and the progression of the liver disease that occurs during this period has motivated many families to consider living donation. It should be noted, however, that not all candidates are suitable for this option. Liver transplant centres match donors with recipients based on compatible liver size and blood type.
Living donor transplants in babies involve transplanting a small portion of the left lobe of the adult donor’s liver to an infant. Adult to adult living donor transplant is achieved by using the entire right lobe of the donor’s liver. Not all potential donors are suitable for living donation and extra precautions are taken by the transplant team to ensure that the decision to donate is without coercion and is unconditional. The living donation operation is a major surgery and requires a five to 10-day hospitalization and two to three-month period of recovery. The donor surgery has a very low risk of death and within a few months, the donor’s liver regenerates to within 90 per cent of its original size.