Liver Donation Surgery and Recovery
Living liver donor operations differ depending on whether you are donating to a child or an adult. Donation to a child involves removal of the smaller left lobe of the liver (about 20 percent of the liver), while donating to an adult requires removal of the full left lobe or a portion of the larger right lobe (40-60 percent). The larger the piece of liver removed, the more strenuous the surgery and the longer it takes you to recover. Additionally the risk of complications during the procedure and after is slightly higher as more liver is removed. Due to these factors, the care team makes the decision about how much and which part of the liver to use carefully to ensure that neither patient’s health is put at greater risk.
The surgery requires general anesthesia and a large abdominal incision. During the procedure the liver will be exposed so that the proper blood vessels and bile ducts can be safely disconnected. Then a segment of the liver will be dissected out, the cut surfaces will be cauterized, and the segment will be removed for transplantation. In donations to adults, the gallbladder will likely also be removed because it is connected to the right lobe of the liver; this does not typically cause any long-term complications.
The surgery lasts approximately four-six hours. At the end you will be closed with internal sutures and externally with steri strips, tape, or glue. In rare instances staples will be required.
Regarding the scar, the incision varies depending on the size of your abdomen and the lobe removed, but the surgical team will try to keep the size to a minimum. It is important to follow your team’s instructions post donation so that you can care for your incision to promote healing and minimize the appearance of the scar. This includes following activity and lifting restrictions to avoid a hernia.
Recovery from Living Liver Donation
Liver donors do not typically experience any serious long-term complications, in part because the liver is unique among the body’s organs in its ability to regenerate. After giving part of one’s liver, it will eventually return to close to its original size. The most rapid regeneration occurs in the first six weeks after surgery—during this time, the liver typically returns to about 80 percent of its original size. Growth will continue for up to a year, at which point the liver should return to about 90 percent of its original size.
After living liver donation surgery, the process of recovery usually follows these steps.
The week after surgery: A donor is typically hospitalized for five-seven days after the surgery and is out of work for four-six weeks. The first day after surgery, you may be sore and slightly groggy. But by day four you should start to feel yourself again. You will be allowed to have clear liquids, and bowel function will begin to return. After five-seven days, assuming no further complications, you will be released from the hospital. Following discharge, you will be given a prescription for oral pain medicine to take as needed. You may be moderately fatigued for several weeks.
The first twelve weeks after: After leaving the hospital, you are encouraged to slowly resume normal activity at your own pace, making sure that you walk daily and stay active. However, you must not lift greater than 15 lbs for four weeks or greater than 30 lbs for 12 weeks. Once you return home, if you develop a fever or have drainage from your incision you should call the transplant office and speak to your nurse or doctor.
The first year after: The Zweig Family Center will follow you closely as you recuperate. You will be seen one week after discharge to assess your condition and check your blood tests. You will then be seen regularly during the first year to make sure you are recovering as expected. Most donors will not feel 100 percent normal for up to four-six months. During the first six months, you are very strongly encouraged to avoid alcohol and any medications or herbal remedies that can be toxic to the liver. Additionally, for the first year, women should avoid becoming pregnant.
For five years after: At one year and annually for five years you will be asked to return for a checkup. You are strongly encouraged to comply with these follow-up recommendations. If you feel ill and need additional follow-up at any time, you should not hesitate to call the transplant center.
Throughout this process, it is also important to keep your family doctor abreast of your progress and see him or her annually for checkups. The donor team will ask for your primary care physician’s contact information so that we may keep him or her fully informed of your care.
A Long-Term Relationship with Mount Sinai
Living donation doesn’t end with the donation. Donors can expect a long-term relationship with the Zweig Family Center, the RMTI, and Mount Sinai. This will include post-surgery follow-ups for the first year after the donation, as well as easy access to the RMTI team thereafter should any other concerns arise.