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Home > Divisions > Transplantation > Living Donor Liver Transplant > What is the process for evaluating a donor?
What is the process for evaluating a donor?
Once the potential donor is determined to
be of similar size and compatible blood type, an evaluation
or workup is done to ensure that he or she is medically,
surgically, and psychologically fit for donation.
1. Medical evaluation
The medical evaluation involves an intensive interview to
obtain the donor's medical history. A complete physical
examination is also performed. The donor must not have any
medical problems that would increase his or her risk for
a major operation and the removal of a portion of the liver.
Medical problems that would rule out donation include heart
or lung problems that require medication, current liver
problems or hepatitis infection, a history of cancer, active
alcohol abuse, or any history of very heavy alcohol use,
HIV infection, diabetes of several years' duration requiring
insulin use, and significant obesity. Besides the medical
history and physical examination, many blood tests will
be done to rule out any significant abnormalities and to
make sure the donor's liver function is normal.
2. Surgical evaluation
The liver is one large solid organ. It is made up of 2 lobes
(right and left), which are further divided into a total
of 8 smaller segments (1 through 8).
Figure 1
Each portion has its own blood supply (arteries and veins)
for bringing the blood to and from the liver as well as
its own bile duct draining the bile produced by the liver.
An LDLT can be performed because it is possible to remove
a portion of the liver with its own blood supply and bile
duct intact. This portion can then be reconnected in the
recipient. However, not all people's anatomy is suitable
to splitting the liver in this fashion. So, the purpose
of the surgical evaluation is to determine the anatomy of
the donor's liver and make sure that donation is technically
possible. Special x-rays of the liver, including a computed
tomography (CT) scan and a magnetic resonance imaging (MRI)
scan, will be performed. These x-rays provide information
about the liver's appearance and blood supply. They may
also be used to determine if the liver volume would be adequate
for adult-to-child LDLTs. On rare occasions, these x-rays
are not sufficient and an additional test called an angiogram
is necessary. In an angiogram, a needle is placed directly
into a blood vessel, dye is injected, and then an x-ray
is obtained to more closely look at the liver's blood vessels.
3. Psychological evaluation
The potential donor will also be interviewed by a social
worker from the transplant team to make sure that the donation
is entirely voluntary. The decision to donate should be
made entirely by the potential donor after careful consideration
of the risks and potential complications of the procedure,
with no coercion from anyone.
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