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Living Donor

Hi, my husband is 50 and diagnosed with stage 4 cirrhosis.  He recently had varicies banded.  He is on Nadolol for his PHT and  is scheduled for his biopsy soon. His CT scan and Ultra Sound show some liver shrinkage. They say he will eventually need a transplant but all they can do for him is try to keep him stable and for him to go on living and stay as healthy as possible. His MELD is at 9 right now and when we asked if he could get a referral to Emory in Atlanta, the Gastro doctor said he has to be at a 20 MELD,  so there is no point in referring because he would just be turned down. He then asked about a living donor, his sister wants to to be his donor, if possible.  Doctor said living donors are only accepted for children? His sister wants to get his biopsy results as soon as available and head to Emory to talk with someone face to face. Have you or anyone heard that only children can have a living donor?   His ESLD has come to light in the last few months.  After his mom died suddenly last year, his GP said he thought he was just suffering depression.  He got a new doctor and she found all this.  We are all still in shock and feel we are running in circles with little guidance from doctors. Any advise would be appreciated.  Thanks so much!
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446474 tn?1446347682
COMMUNITY LEADER
Hello thanks for asking about the liver transplant process.

I don't know what the MELD score requirement at Emory is but it is usually at least a MELD score of 15 at most transplant centers to be listed and eligible for a liver transplant.

Liver transplantation is a process. A long and complex process that those of us who have had transplants have learned about through educating ourselves over many years of experience. First,a patient has to be referred to a liver transplantation center, assuming they are not already being cared for at the hospital. This usually happens when a patient's doctor suspects that the patient may need a liver transplant at some point in the future.

As the gastro explained transplant centers have certain criteria 'to list' a person so that they are eligible to receive a liver transplant at that center. Not everyone with cirrhosis needs a transplant anytime soon or is qualified to receive a liver transplant. Many people live for years with cirrhosis before becoming so ill that the the risk of keeping their own liver out-ways the risk of going through such a serious surgery and life changing experience. This is why a person must be ill to a certain medically demonstrated amount (using the MELD score) to even be eligible for a transplant. Data shows that for people with a MELD score under 15 they will live longer without and transplant than with one.

Whether or nor someone needs a liver transplant depends on many factors and has to be judged on an individual, case by case basis. To learn more talk to your husband's doctor.

After the patient is referred to the liver transplant center the patient must go through the liver transplantation evaluation process. This process includes a complete workup of their overall health status, not just their liver disease. I person must have reasonable health besides their liver disease to benefit from a transplant. They also will be evaluated to see if they will be able to manage the transplant surgery and the life-long care that it requires to live with a liver transplant. They need to have caregiver through and after the surgery, the ability to take daily meds and monthly lab tests for the rest of their lives. Health insurance coverage, etc. This is to name only a few of the requirements to be listed for a transpant.

Only when they have been approved by the doctors at the transplantation center after the evaluation is someone list and eligible for a liver transplant.

As far as a Living Donor Liver Transplant...
Not all liver transplant centers perform the same services. Not all centers provide living donor liver transplantation (LDLT) and different centers may have different criteria for who they give transplants to. Each Liver Transplant center decides what services they provide and to whom.

It is very generous of his sister to offer to be tested for being a donor but that is putting the horse before the cart - so to speak. The first steps are being ill enough to be in need of a new liver and then being approved for being listed for a liver transplant. A living donor only comes into the picture once one has accomplished the preliminary steps on the long road to transplant and a second chance at life.

So first he will have to be ill enough to need a transplant. Organs in the US are rationed. Typically only the sickest people get an organ do to the shortage of organs available. This is why many people may need to wait for years before getting a transplant. I waited 4 years myself on the waiting list before receiving my deceased donor liver. This is the advantage of LDLT. There is no waiting for a deceased organ to be available. The surgery can be scheduled once the donor is approved. Typically in a matter of months.

Please be aware that only one in three (1/3) of who offer to donate a piece of their liver are compatible with the recipient.. There are many requirements needed to be an organ donor. For now it is a mute point until he is listed. But becoming educated about the living donor process would be a good idea. If LDLT is an options he may want to be listed at a center that does adult Living Donor Liver Transplants so he has that option.

In the meantime the focus should be on staying as health as possible for as long as possible. Depending on the cause of his liver disease everything should be done to not cause further injury to his liver and maintain his health. When the time comes
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It sounds life his gastro is aware of the situation and the options that are available at this time. I would recommend discussing the practical steps to a transplant with his gastro as things progress.

Best of luck to you and your husband.
Hector
Helpful - 0
446474 tn?1446347682
COMMUNITY LEADER
Here is more detailed information about the Living Donor Liver Transplant process from my transplant center where my center has been doing adult to adult living donor liver transplants since the year 2000. I have met many liver transplant donors and recipients over the years and have seen good results from this transplant option. From my experience the process of evaluating someone as a liver living donor to when the transplant happens is about 6 months at my transplant center here in San Francisco.

- Please keep in mind... the living donor process may very from center to center, but the overall approach will be very similar.
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Living Liver Donor Transplant

Preparation

In living donor liver transplantation, a piece of liver is removed from a living donor and transplanted into a recipient. The procedure, performed after the diseased liver has been removed, is possible because the liver regenerates or grows. The liver's unique ability to regenerate itself — combined with technological advances — allows more people to be donors.

Regeneration happens over a short period, possibly days to weeks and certainly within eight weeks. When surgeons remove a piece of the donor's liver, the part that remains grows back quickly to its original size.

Waiting for a Liver

At our Medical Center, the vast majority of organs for transplantation are obtained from people who have died and whose families have given permission for their organs to be donated. But today, an increasing number of liver transplants are performed with portions of livers donated by a living relative or friend.

Nationally, there are more than 17,500 patients on the waiting list, with more added each day. Almost 5,000 patients receive transplanted livers every year, but more than 1,700 patients die each year while on the waiting list.

Living donors not only reduce the waiting time, but they improve the chance for transplant success. Patients who receive transplants from living donors can better prepare for their surgery, knowing well in advance when the transplant will take place. Also, the liver itself is "fresher" because donor and recipient are in nearby operating rooms and the donated liver portion is transported within minutes.

Becoming a Donor

Potential donors must meet certain basic requirements to be considered. First, the donor must want to make this gift. During the evaluation process, we want to make sure you are not being coerced to do this in any way. You do not have to be a relative of the recipient, as long as you are a good donor match in other respects such as blood type.

Donors, however, cannot be pregnant and cannot be overweight, although overweight candidates who lose weight may be considered.

Donors should be:

    18 to 60 years of age.
    In good health with no major medical or psychiatric illnesses.
    A non-smoker for at least six weeks prior to surgery.
    Able to understand and comply with instructions for surgery preparation and recovery.

A living donor doesn't have to be a blood relative of the liver recipient but you must have a compatible blood type. You must be in good health and be motivated to donate for altruistic reasons. If live donation is a feasible option for a patient, a donor evaluation will be performed after the recipient's testing is completed. If, after testing the donor, the transplant team determines the donation can be performed, a surgery date is scheduled for both the donor and recipient. This process usually takes up to four to six months.

Evaluation

Once your blood type is confirmed, you will receive a detailed confidential questionnaire about your family medical history, lifestyle and other information. The evaluation includes a series of tests to check your blood type and overall health. Tests include:

* Extensive blood tests - to determine if you have any:
- Transmittable diseases (such as viral hepatitis)
- Underlying liver diseases (such as fatty liver)
- Serious medical conditions (such as heart disease) that might make liver donation unsafe for you or the liver transplant recipient
* Chest X-ray
* Electrocardiogram (EKG or ECG) - to see how well the your heart and valves are functioning.
* Abdominal ultrasound - to determine the size of the portion of the liver that can be safely donated, and to check the adequacy of the liver's blood supply.

A doctor who is not a member of the transplant team will complete your medical evaluation and serve as the "donor advocate" doctor throughout your surgery and recovery.

I hope this helps you to understand the basic steps of the liver living donor process.
Hector
Helpful - 0
Avatar universal
Hector, thank you so much for taking the time to write and share all the knowledge and experience you have regarding this disease.  We have learned more from you in last 24 hours than we have in the two months since we got the first results from his doctor.  I wish you continued good health and happiness!
Helpful - 0
446474 tn?1446347682
COMMUNITY LEADER
Thank you for your kind words.
I am glad I could be of some help.
We all learn from each other.

Hector
Helpful - 0
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