People are often surprised when they first learn that a living person may donate his or her liver — "don't you need your liver?" is a common question.
In fact, living donor liver transplantation, or LDLT, is not only possible, but is the optimal choice for patients who need a liver transplant.
The advantages of LDLT are dramatic, as the family of Aidan Ward recently learned. The teenage boy from New Jersey, his liver failing due to primary sclerosing cholangitis, was placed on the organ waitlist in January 2010. But for someone in need of a new liver, he was relatively healthy, which meant that he was far down on the list and was unlikely to receive a liver from a deceased donor for several years. Alternatively, a living donor transplant would allow their son to receive a liver much sooner. With a living donor operation, Aidan would be in much better health during the transplant, enabling him to better withstand the surgery and recover more quickly. Second, his long-term outcomes, including his liver function and overall survival, would be significantly better with a living donor than with a deceased donor organ.
For the Ward family, the choice was clear: according to Aidan's father, Michael, "If Aidan had to wait several years to receive a deceased donor liver, his health would continue to deteriorate. Getting a new liver sooner would likely enable Aidan to catch up with his peers and return to a normal life much faster." The thought of Aidan going through high school with persistent health issues 'sealed the deal,' his father recalls, and Michael began the thorough process of medical and psychological evaluation to determine whether he was a suitable living donor. He was deemed eligible to donate in early April, and the operation was promptly scheduled for April 13 – less than four months after Aidan was initially placed on the transplant list.
LDLT is made possible by the unique capability of the human liver to regenerate. It is the only internal organ in the human body with this capability. This allows a living person to donate part of his or her liver according to the following procedure: first, the recipient's diseased liver is partially or entirely removed; at roughly the same time, a portion of the donor's liver is removed (up to 60% for an adult transplant, and up to 20-25% for transplant to a child); and that portion is implanted in the recipient where the original liver had been. Over time, that small portion will grow into a full-sized, fully functional liver. Similarly, the donor's remaining liver will regenerate over the following weeks, eventually regaining full functionality. In short, two livers are generated from one.
On the day of surgery, Benjamin Samstein, MD, Jean Emond, MD, and their team removed about 25-30% of Michael's liver — a little less than usual, partly because Michael's liver was especially large and partly because of Aidan's youth and size. The surgeons were able to do the procedure laparoscopically, which reduced the likelihood of complications, greatly reduced scarring, and prompted a smoother recovery. Meanwhile, Tomoaki Kato, MD and his team placed the liver segment in Aidan's abdomen in a nearby room. In a matter of about eight hours, it was all over, both operations completed successfully.
Only four days after the operation, Michael was feeling well enough to go home. An avid cyclist, he was soon back to riding his usual distances. The after-effects of the surgery were relatively minimal, he says, including a few weeks for normal GI function and sleep patterns to return, and a month to recover from a torn nerve in his shoulder (it was unclear whether this occurred from arm placement during surgery or stress on the shoulder during recovery). Mike's liver maintained acceptable function throughout the post-transplant period and by three months had grown to its original size.
Aidan's recovery took longer, not only because of the more demanding nature of his operation, but also because his subsequent medication regimen was complicated by his Crohn's disease. He had missed many months of school, but thanks to in-home tutoring provided by the school district over the summer, he was able to make up for lost time, and he enrolled in eighth grade, with his friends, in the fall. He was feeling well enough by then to attend school full-time.
According to Aidan's father, "My wife and I were both so impressed with the entire staff at NYPH/Columbia, I felt confident that the medical team was the best in the world and they would do everything in their power to make sure I came out okay. I put complete trust in them." He found it reassuring that the surgeons had expressed a willingness to halt the procedure for any reason: "They said they can stop at any point, and that if they ever felt I was at risk, they would stop. That was one thing that came across very clearly. They're extremely focused on ensuring the health and safety of the donor. The donor is a healthy person and they don't want to change that."
Aidan's mother, Frances Ward, said that her son's and husband's successful results were due not only to the surgeons who performed the transplant, but to the "extraordinary" nursing care at every step from pre-operative testing through post-surgical care, from physical care to psychological care. She also appreciated that the staff was meticulous about ensuring that family members were fully informed about each aspect of treatment before it was done.
By way of advice to other prospective organ donors, Mike shares that the emotional aspects were perhaps more challenging than the physical for him. He advises others against underestimating the mental aspect of the process: "I certainly underestimated the effect the entire experience has on one's mental state. I found I was more keenly aware of and responsive to emotional situations... It was as if my emotions were always 'on edge.' However, not once do I regret what I went through, especially as I watch Aidan – now in high school – continue to thrive. I'm still amazed that I was able to give a piece of my liver to my son to save his life."