The Liver and Its Functions
The liver, the largest and most important organ in the body, has many vital functions. Among its numerous roles, the four most critical functions are:
- Storing nutrients from the food we consume and producing proteins essential for maintaining normal life cycles.
- Producing bile acid necessary for digesting food and delivering it to the digestive system.
- Detoxifying harmful substances produced by other systems in the body.
- Producing factors necessary for fighting infections and for stopping bleeding in any part of the body.
Types of Liver Transplantation
There are two types of liver transplantation:
- Deceased donor (cadaveric)
- Living donor
Deceased Donor Liver Transplantation
Deceased donor liver transplantation refers to the transplantation of an organ taken from an individual who has passed away. Increasing the number of organ transplants should begin with increasing the number of deceased donor transplants. The identification of the cadaver, its care, communication with the family, and organ retrieval is a well-coordinated process that starts in the emergency department and ends in the operating room. In this context, organ transplant coordinators play a key role in public education about organ donation, family discussions, and the donation process.
Waiting List
Currently, in almost all countries, there are not enough deceased donor organs to meet the growing number of liver failure patients. Unfortunately, our country ranks low in obtaining organs from deceased donors. According to 2009 data, there are about 5,000 liver patients. In our country, approximately 200–250 deceased donor and 300–350 living donor liver transplants are performed annually. Considering that 8–10% of those waiting die each year, the gravity of the situation becomes even more evident.
Recipient Selection for Deceased Donor Liver Transplant
Each organ transplant center follows a fair point-based selection system for identifying deceased donor liver transplant recipients, which is regulated by the Ministry of Health.
Blood Supply
Another major issue in liver transplants is the provision of blood during surgery. Despite the major support and organizational efforts of the Turkish Red Crescent, special occasions such as Ramadan or holidays can lead to significant shortages. Each patient on the waiting list needs to compile a list of 30–40 blood donors of the same blood type. When an organ becomes available, while one person brings the patient to the hospital for final tests, others must quickly notify the donors to come to the hospital. Especially for liver transplants, preparing platelet samples takes 3–4 hours.
What is Living Donor Liver Transplantation?
Living donor liver transplantation involves transplanting a portion of the liver from a living donor (ensuring enough liver remains for the donor’s survival) into the recipient. This is a complex surgical procedure.
Why Are Living Donors Needed?
There are thousands of patients diagnosed with end-stage liver failure on the national waiting list. Sadly, there are not enough organs to meet this demand. Approximately 50% of patients on the waiting list die before receiving a transplant, and new patients are added to the list every day. Living donors can help reduce organ shortages and mortality rates.
Advantages of Living Donor Liver Transplantation
- Shorter waiting time.
- Reduced patient loss while on the waiting list, and allows for optimal conditions for the recipient to undergo surgery.
- Ensures the most suitable organ is transplanted.
- Allows for surgical procedures to be conducted under the best possible conditions, maximizing transplant success rates.
BASIC PRINCIPLES IN THE EVALUATION PROCESS FOR LIVING LIVER DONORS
According to the regulation enacted by the Republic of Turkey Ministry of Health on 28.06.2004, decision number 4690, organ and tissue transplantation from living donors can only be performed from blood relatives and in-laws up to the fourth degree (including the fourth degree). According to Article 17 of the Turkish Civil Code, the degree of kinship is determined by the number of births connecting the relatives.
Based on this:
- 1st-degree relatives: parents, children
- 2nd-degree relatives: siblings, grandparents, grandchildren
- 3rd-degree relatives: uncles, aunts, nephews, nieces (siblings’ children)
- 4th-degree relatives: children of third-degree relatives
The same classification applies to in-law relatives through one’s spouse.
In some cases, living liver donation may not be possible or appropriate. The transplant team has the final decision in performing the living donor liver transplant. The transplant team is not obligated to proceed with every living donor surgery.
To proceed with living donor liver transplantation, consensus must be established among the donor candidate, recipient, and the medical team. In unusual ethical situations, guidance from the Transplant Ethics Committee may be sought.
If you wish to speak with a previous liver transplant recipient or donor, we can help facilitate this. The recipient candidate must consent to a living donor liver transplant.
Every recipient for whom a living donor evaluation is initiated is also registered on the deceased donor waiting list. The preparation of a living donor does not affect the recipient’s position on the deceased donor list. Organs obtained from deceased donors are allocated based on the national transplant waiting list priority, regardless of whether the recipient has a potential living donor.
Donors must be between 18 and 60 years old, of sound mental health, and free of any medical conditions.
The donor’s primary motivation should be to help the recipient. Living donation should be a voluntary choice, free from coercion, pressure, threats, or significant financial gain.
The safety of the donor is the top priority for the entire transplant team during the evaluation process.
If any findings during clinical exams or lab tests suggest potential harm to the donor, the evaluation will be stopped at that stage.
The preparation period varies depending on the donor’s health and the recipient’s urgency — it can take days, weeks, or even months.
If there is more than one donor candidate, evaluations are conducted, and the most suitable donor is selected based on medical results.
It is essential that the donor trusts the team, feels free to ask any questions, and receives clear answers.
All information obtained during the evaluation is strictly confidential and will not be shared with third parties.
Donor candidates should be prepared for the possibility of discovering previously undiagnosed medical conditions, which may affect their daily life, employment, or mental well-being.
All expenses related to the living liver donation process are covered by the recipient’s healthcare provider, including pre-transplant evaluations, hospitalization, treatments, and surgery. After discharge, any follow-up tests or check-ups are covered by the donor’s own health insurance.
LIVING DONOR EVALUATION PROCESS
The donor candidate must be in excellent physical and emotional health. A history of cancer and/or active infections is a definitive contraindication.
The donor must have normal liver function, and the liver must have adequate blood flow and bile duct distribution.
The donor must have close relatives or friends to support them before, during, and after the surgery.
Before starting tests, the donor candidate must understand and accept that:
- The process can take 3 weeks to 3 months,
- It can be canceled at any stage if any incompatibility is found.
Smoking and birth control pills increase the risk of post-surgery embolism. Therefore:
- Donors should quit smoking at least 2 weeks before surgery,
- Women should stop birth control pills 4 weeks prior and use an alternative contraception method.
If a reversible contraindication is found (e.g., fatty liver), preparations may be resumed after improvement.
PREPARATION PROCESS
Blood tests are performed to confirm normal organ function and rule out viral infections such as hepatitis B, hepatitis C, HIV, and syphilis. Some test results must be reported to the Ministry of Health.
An electrocardiogram (ECG) and chest X-ray are done to assess heart and lung function. If normal, further imaging tests like CT scan, ultrasound, and MRI are performed.
The transplant team reviews these results in weekly meetings to assess liver health and suitability. In some cases, a liver biopsy or bile duct imaging may be required.
The donor candidate is also referred to various medical specialties for consultations to assess surgical risks. These consultations ensure donor safety and may reveal the need for additional tests.
Only about 20% of all candidates evaluated for liver donation eventually become eligible living donors. The most common reasons for disqualification include:
- Inappropriate vascular anatomy
- Abnormal lab results
- Previously undiagnosed medical conditions
Candidates have the right to withdraw at any time for any reason, without needing to justify their decision.
Donor decisions are always respected, and no information is shared with the recipient unless explicitly authorized. Donor safety and confidentiality are paramount.
Donor candidates should communicate openly with the transplant team regarding all questions and concerns. No donor information will ever be disclosed to third parties (family, friends, recipients, etc.).
There is a risk of infectious disease transmission through transplantation. Donors must report any fever, flu-like symptoms, or neurological issues during evaluation. If the donor has an active infection, the transplant will be postponed, as transmission to the recipient may result in fatal consequences.
To reduce infection risk, blood tests will be conducted both at the beginning of the evaluation and a few days before surgery.
Donors should also take precautions against sexually transmitted infections. Alcohol should be completely stopped 4 weeks before surgery and not resumed for at least 8 weeks after the operation.
What is Emergency Liver Transplantation and When is it Needed?
Emergency living donor liver transplantation is typically considered in cases of acute liver failure, which can lead to death within a few days if not treated.
In such cases, the donor evaluation process is expedited, but safety is never compromised.
✅ Basic Requirements to Be a Living Liver Donor
- Aged between 18 and 60
- Compatible blood type
- Physically and psychologically healthy
- Voluntary consent is essential
❌ Who Cannot Be a Donor?
- Individuals with Hepatitis B/C, HIV, active cancer, or substance abuse
- Those with severe psychiatric disorders
- Those with unsuitable vascular anatomy for surgery
🔍 STEP-BY-STEP DONOR EVALUATION
- Initial meeting and clinical examination
- Blood and organ function tests
- Specialist consultations (Psychiatry, Cardiology, etc.)
- CT imaging and liver volume calculation
- Liver biopsy, if necessary
⚠️ MAJOR SURGICAL RISKS
- Pulmonary embolism (1.8%)
- Fluid accumulation in the abdomen (3.6%)
- Bile leakage (1.8%)
- Risk of death: 0.5–1% overall (higher in right lobe donors)
🛌 POSTOPERATIVE RECOVERY
- 1–2 days in intensive care, followed by transfer to the ward
- Pain, loss of appetite, fatigue are common but temporary
- Hospital discharge typically in 7–10 days
- Full recovery in 3–6 months (longer for physically demanding jobs)
🤔 FREQUENTLY ASKED QUESTIONS
Will the remaining 50–60% of my liver be enough?
Yes. The remaining liver is sufficient for survival. It begins regenerating within 10 days and regains near-original size in about 3 months.
When can I return to work?
3–4 months for desk jobs; 5–6 months for physically intensive jobs.
Will I need lifelong medication?
No. Only short-term medications like vitamins and stomach protectors for about 3 months.