The Operative Procedure

Both the donor and recipient will be admitted to Ward 6A or 6B in Mount Elizabeth Hospital before their surgery. Both will have final pre-operative lab work, ECG and a chest X-rays completed.

On the day of surgery both donor and recipient will be taken to the operating theatre at the third level of the Hospital block. Any family members and friends accompanying them to the hospital can wait in the waiting area outside the operating theatres, where the doctors will speak to them after surgery is complete.

The donor and recipient will be taken to separate operating rooms that are side by side. In each operating room, the respective anaesthesiologists will give the donor and the recipient a medication through the IV(intra-venous) line to put them to sleep. You will be under general anaesthesia throughout the entire operation and a member of the surgical team will be at your side at all times. Sometimes the two operations will occur simultaneously while at other times, either the recipient or the donor operation will start first.

In essence, a living donor liver transplant actually involves two overlapping surgeries between the healthy donor and the recipient.

For the donor:-

An inverted T shaped incision is made in the abdomen. The liver is mobilised and assessed for suitability for use. Sometimes a biopsy is done to check for the amount of fat. A final x-ray to identify the bile ducts to aid in surgery is done. A portion of the donor liver, either the right lobe or left lobe, is removed with its blood supply intact in one operating room while the recipient's diseased liver is removed in its entirety in another operating room. During the donor’s surgery, the gallbladder is also typically removed as part of this procedure. Once either the right or left lobe of the liver is removed, it is washed with a special preservation solution called HTK to remove the blood that is in it. It is then packed for use in the recipient. All blood vessels are repaired in the donor and a stent may be placed in the bile duct that will be removed in 3 weeks post-operatively. The skin incision is then closed.

The donor operation usually takes between 6 and 8 hours.

In the Recipient:-

The surgical team removes the failed liver. This can be the most difficult part of the operation and can take several hours because of the liver’s impaired clotting and multiple blood vessels. A clamp is then placed on remnant right hepatic vein entering the inferior vena cava. Clamps are also placed on the artery to the liver (hepatic artery) and on the portal vein. The liver is cut out and all bleeding is stopped. The donor liver is kept cold while it is sewn in place. This usually takes 1-1.5 hours. Five anastomoses must be made (tubes sewn together). The first is the vena cava above the liver, the second is the vena cava below the liver, and the third and fourth are the portal vein and hepatic artery, (not necessarily in the same order in each case). Once all four of these are done, the clamps are released and blood is allowed to flow through the liver. The fifth and final step involved is sewing the bile ducts together, sometimes placing drainage tubes and closing the incision.

The recipient operation can take between 6 to 16 hours

Both will wake up in the Recovery Room where blood pressure and other vital signs will be closely monitored by the nursing staff. They will feel very groggy and may have some discomfort. A catheter will be draining urine from their bladders and frequent urinary output measurements will be taken. The recipient will also have two tubes coming out of your abdomen to drain excess fluid for a few days. The donor will probably have one tube draining form the abdomen.

Once they are sufficiently awake and their vital signs are stable, the donor will be transferred to the High dependency unit while the recipient will be transferred to the Intensive care unit. Their family members may visit with them. The IV will remain in place until they are able to take in fluids and food by mouth. Medicine for pain will be available when you need it. Both will be given compression stockings for their legs. In addition you they will have sequential compression devices on your legs to prevent blood clots in your legs. Also upon awakening they will be asked to take deep breaths, and to cough and turn to help keep their lungs free from infections. Once able, they will be encouraged to get out of bed, usually on the following morning. During their hospital stay, they will be encouraged to move around as much as possible. They may have some discomfort the first couple of days, which is completely normal. They will remain in the hospital for approximately seven days and will be given an appointment to follow up in the Transplant clinic before they go home

Afterward...

The liver possesses amazing regenerative properties. Within two months of the surgery, the remaining portion of your liver grows back to full size. Note that the liver does not assume its former complete anatomy. Instead, the remaining portion (e.g., the right lobe) simply enlarges.

On the average most people return to work by the 3rd month.