Saturday, October 31, 2009

Thinkin' about being Rickis hero?


No, that's not an "A+" for saying yes... Ricki's finally found out her blood type and it is "A Positive" Whoo hoo!! No pressure here ~ but if you feel compelled to look into being Ricki's hero... We're just making it a little easier for you. Below is the information on being a living donor. And remember... Living donation is a gift that only a few are able or willing to give, but almost everyone can still be a HERO and live on by going to www.donatelife.net and by sharing your wishes to be an organ donor with your loved ones! Live Life *then* Give Life.

Live Donor Liver Transplant
Click here to learn more about Live Donor Liver Transplants

Feature: World's First Adult-to-Adult Live Donor Liver Transplant Without a Blood Transfusion
FAQs: Donor and Recipient | The Operation
Espanol: Trasplante de Higado con Donante Vivo | Cuestionario
Live Donor Transplant Evaluation Forms: English | Spanish

Live donor liver transplantation (LDLT) is a procedure in which a living person donates a portion of his or her liver to another. The feasibility of LDLT was first demonstrated in the United States in 1989. The recipient was a child, who received a segment of his mother's liver. Since that time, LDLT for children has enjoyed wide success and many pediatric programs use this technique.

Live Donor Liver Transplant

In the pediatric experience, survival of both the recipient and the transplanted liver (graft) at 1 year is about 90%. Donor complications have been very few. A rising population of adult patients awaiting liver transplantation has led to the application of LDLT for adult patients, and the preliminary results have been very encouraging. Only a handful of centers in this country perform the procedure.

The transplant team from USC has been performing LDLT at the Children's Hospital of Los Angeles (CHLA) for some time with excellent results. This USC team also performed the first adult-to-adult LDLT in Southern California, and the world's first adult-to-adult LDLT without blood transfusion. Encouraged by these results, we now offer this option as standard treatment in adults who have suitable donors.


Donor and Recipient

Basic facts regarding the Recipient:

  • Patients being considered for LDLT are those who are candidates to receive a cadaveric liver (liver from non-living, unrelated individual) based on the severity of their liver disease and its complications. These patients are placed on the liver transplant waiting list and will not be denied a donor liver if it becomes available prior to LDLT. Thus, failure to find a suitable donor for LDLT will not jeopardize the recipient's chances of receiving a cadaveric liver
  • Patients considered for LDLT will be followed by the same USC liver transplant team who will manage all complications of liver disease with a view to optimizing the patient's condition prior to liver transplant.

Basic facts regarding the donor:

  • The donor could either be a relative (close or distant) or even be unrelated.
  • The blood type of the donor should be the same as the recipient's.
  • The donor should be in good physical and mental health.
  • The decision to be a donor should be made after careful consideration of facts and knowledge of the procedures, the risks and complications.
  • There should be no evidence of financial gain arising out of the donation.
  • The donor must be relatively close in size (or larger) than the recipient.

What constitutes a good donor?

A good donor is someone who is in good physical and mental health, older than the age of 18 and free from:
  • HIV infection
  • Known viral hepatitis
  • Active alcoholism with frequent and heavy alcohol intake
  • Psychiatric illness under treatment
  • History of malignancy
  • Heart and lung disease requiring medications
  • Diabetes mellitus of greater than 7 years duration

What is the process for evaluating a donor?

  • The potential donor will be asked to complete a questionnaire that includes attaching a copy of his or her blood type (to confirm whether this is compatible with the recipient).
  • If the blood type is compatible with that of the recipient and the details on the questionnaire indicate suitability, the donor is evaluated by an internist (liver specialist or hepatologist) who will obtain additional history, perform a physical examination and administer appropriate blood and urine tests.

    BLOOD TYPE COMPATIBILITY CHART

    Blood TypeCan receive
    liver from:
    Generally can
    donate a liver to:
    OOO, A, B, AB
    AA, OA, AB
    BB, OB, AB
    ABO, A, B, ABAB

  • If the physical examination and tests confirm that the donor is suitable and the donor's size (height/weight compared to that of the recipient) is appropriate, a CT scan will be arranged to calculate the volume of liver that will permit a successful outcome. [Prior to having the CT scan the donor must notify the team of any allergies to iodine or radioiodinated contrast.]
  • At this stage, the potential donor will also be interviewed by a social worker from our team. Under some circumstances, a psychiatric evaluation may be appropriate.
  • When complete, the medical and social details of the evaluation are discussed at a conference by the transplant team members.A decision regarding the suitability of the donor will be made at that time. This decision will be communicated to the donor by one of the team members (usually the transplant coordinator). If not selected, physician team members can be contacted for explanation. [All information concerning the donor is kept in strict confidence.]


The Operation

Where does the transplant occur?

  • All adult liver transplants are performed at the USC University Hospital.
  • Pediatric liver transplants are performed in conjunction with Children's Hospital Los Angeles.

When does the transplant occur?

  • The transplant is scheduled at a mutually convenient time for the donor and recipient. In the case of the latter, the team members will decide the optimal time based on condition of the recipient and control of complications. For example, if the recipient develops a sudden fever, the procedure will be delayed until the cause is found and potential infection controlled.
  • The advantage of LDLT is that the procedure can be timed in such a way as to perform the procedure on both the donor and recipient when both are in the best possible condition.

How is the operation performed?

  • After all of the medical issues have been settled and the donor-recipient match-up is completed, a date is selected for the operation.
  • Two teams perform the donor and recipient operations simultaneously.
  • As the diseased liver is removed from the recipient by one team, approximately half of the donor's normal liver is removed by the other team.
  • Once the donor operation is completed, both surgical teams complete the transplant by attaching the half-liver into the recipient.
  • The donor operation usually takes about 5 hours and the recipient operation about 10 hours.
  • Both half-livers (of donor and recipient) grow to be full sized in 6-8 weeks.

What is the post-operative period like for the donor?

  • Prior to the transplant procedure, the donor will receive a detailed description of the procedure and will have an opportunity to discuss the potential risks or side effects of the operation.
  • The donor is usually in the intensive care unit for about 24 hours and in the hospital for 5-7 days. Most patients are up and out of bed (with assistance) by the second or third postoperative day. It is usually necessary to stay off work and usual home activities for a month full time and 2 to 4 weeks part time, depending on the rapidity of the recovery.
BACKGROUND: Liver transplantation is currently the standard of care for patients with end stage liver disease. However due to the cadaveric organ shortage, live donor liver transplantation (LDLT), has been recently introduced as a potential solution. We analyzed and support our initial experience with this procedure at USC. MATERIAL AND METHODS: From September 1998 until July 2000, a total of 27 patients underwent LDLT at USC University Hospital and Los Angeles Children's Hospital. There were 12 children with the median age of 10 months (4-114) and 15 adults with the median age of 56 years (35-65). The most common indication for transplantation was biliary atresia for children and hepatitis C for adults. RESULTS: All donors did well postoperatively; the median postoperative stay was five days (5-7) for left lateral segmentectomy and seven days (4-12) for lobar donation. None of the donors required blood transfusion, re-operation or postoperative invasive procedure. However, five of them (18%) experienced minor complications. The survival rate in pediatric patients was 100% and only one graft was lost at nine months due to rejection. Two adult recipients died in the postoperative period, one from graft non-function and one from necrotizing fascitis. 37% of adult recipients experienced postoperative complications, mainly related to biliary reconstruction. Also 26% of the recipients underwent reoperation for some of these complications.

2 comments:

  1. testing... testing.... is this thing on!

    ReplyDelete
  2. how bout under anonymous.....

    ReplyDelete