How is live liver donor matching done for a liver transplant? | Dr. Rahul Saxena |

When we talk about liver transplantation, a donor liver can be obtained in two ways:
First, from a cadaveric or brain-dead donor, and second, from a live donor, i.e., a living person.
In the case of a live donor, 50 to 60% of the liver is removed and transplanted into the patient.

Live liver transplantation is possible due to two important characteristics of the liver:
1. Reserve – A healthy person needs only 30 to 35% of their liver to carry out normal daily functions.
2. Regeneration – If 50 to 60% of the liver is removed and transplanted, both the donor’s remaining liver and the transplanted liver in the recipient will regenerate and grow to normal size within 6 to 8 weeks.
Because of the liver’s reserve and regeneration capacity, live liver donation and transplantation are possible.

In today’s video, we will discuss in detail how live liver donor and recipient matching is done.

For liver transplantation, only blood group matching is required—unlike other organs, there is no need for HLA typing or DNA matching. Anyone in the family between 18 to 55 years of age, with a matching blood group, can donate part of their liver. Additionally, people with blood group ‘O’, being universal donors, can also donate a portion of their liver to the patient. There is no role of Rh factor (positive or negative) in liver donation.
The evaluation (workup) of a potential live liver donor is done in four stages.
In the first two stages, liver compatibility is assessed.
In the next two stages, the overall physical and mental fitness of the donor is evaluated.
Let’s now discuss these stages in detail:
Stage 1 – Basic Blood Tests
Basic blood investigations are done for the donor, including: Complete Blood Count (CBC), Kidney Function Test (KFT), Liver Function Test (LFT), Blood sugar, Lipid profile, Thyroid function tests. These tests give an overview of the donor’s general health.
The Liver Function Test (LFT) specifically provides a basic idea about the liver’s quality.

Stage 2 – CT Scan (Most Important Stage)
In this stage, three major aspects of the liver are assessed:

1. Liver Quality –
A CT scan is done to evaluate how much fat is deposited in the donor’s liver, and to detect any signs of cirrhosis or infection.
The Liver Attenuation Index from the CT scan helps assess fat percentage.
Generally, up to 20–30% fat is acceptable for donation.
If fat content exceeds 30%, the liver is usually not accepted.
If the CT scan does not provide conclusive information, an MRI with MR fat estimation may be required for more accurate fat measurement.

2. Liver Size –
The CT scan also provides information about the size of the donor's liver, which is essential to:
● Determine how much liver the patient needs (based on their weight)
● Ensure enough liver remains with the donor
If the patient's weight is high or the donor's liver is too small, donation may not be feasible.

3. Liver Anatomy –
The scan also maps the blood vessels and bile ducts in the liver—this is called liver anatomy.

In the 2nd stage, the donor's MRC is also checked and the distribution of the bile ducts is also examined.

Based on the results of Stage 1 and Stage 2, we determine whether the live liver donor and patient are a match and if liver donation is possible.

Stage 3 and 4 – Fitness Assessment
These stages focus on checking the physical and mental health of the live liver donor.
After all four stages, the donor’s and patient’s reports are compiled into a file and submitted for government authorization.
Once approval is granted, we can proceed with the transplant.

Dr. Rahul Saxena is a Consultant Liver Transplant & Advanced Hepatobiliary Surgeon based at Nagpur. He has an extensive experience of more than 1000 living donors and cadaveric donor liver transplants in both adults and children. He is credited with performing the first Cadaveric, the first living donor, and the first combined liver-kidney transplant in Central India, at New Era Hospital and Research Institute, Nagpur. His team has now successfully performed more than 100 liver transplants at Nagpur.

Video language #Hindi

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