Adult-to-Adult Living Donor Liver Transplantation
Liver transplantation is now an accepted and
proven therapy for patients dying from liver disease.
As a result, the number of patients awaiting transplantation
has grown dramatically, but the supply of livers
has not. This has led to longer waiting times,
poorer health of those on the waiting lists (making
the outcome less certain), and an increase in
the number of patients who die while waiting for
a liver transplant.
The Penn Transplant Institute is one of nine centers
sponsored by the National Institutes of Health
(NIH) in a multi-center study of adult-to-adult
living donor liver transplantation.
How does living liver donation work?
The anatomy of the liver is favorable for partial
donation in that there are specific segments with
their own blood supply that can be divided and
transplanted into another individual. The liver
also has the unique ability to regenerate within
weeks of removing a segment. These characteristics
of the liver encouraged transplant surgeons to
pursue living donation of the liver.
History of living liver donor
transplantation
Using living people as a source for donor
organs began with kidney transplantation, with
earliest kidney transplants performed between
identical twins. In the late 1980's, living donation
began to include living donor liver transplantation
for children. This involved removing a small portion
of an adult liver, usually from a parent, and
transplanting it into a small child.
The continued shortage of cadaveric livers for
adults has led to living donor liver transplantation
from adult-to-adult. In adult living donor liver
transplantation, either a full right side or full
left side of a liver from a healthy adult is transplanted
into another adult with end-stage liver disease.
Appropriate donor selection requires experience
on the part of the entire transplant team, including
transplant surgeons, hepatologists, psychiatrists,
social workers, nursing staff and transplant coordinators.
Successful partial liver transplantation requires
skill and technical expertise on the part of the
transplant surgeons. This, coupled with protecting
the donor's health and welfare, makes adult living
donor liver transplantation one of the most challenging
procedures in medicine and surgery.
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