What is living liver donation?

A living liver donor is a person who gives part of their liver to someone with liver failure who needs a transplant (the recipient). This could be a friend or family member, or someone they do not already know.

A liver transplant operation is life-saving surgery for patients with end stage liver disease. It is also performed for some patients with primary liver cancer and children with metabolic diseases (affecting the chemical processes within the body).

Volunteering to offer part of your liver is a wonderful thing to do, but it is also an important decision and there are many things for you to consider. We hope this information will answer some of the questions that you may have.

Why do we need more living liver donors?

Liver recipient Naomi Smith competing in the long jump event at the British Transplant Games — Liver recipient Naomi Smith competing in the British Transplant Games

Approximately 900 people in the UK undergo liver transplantation every year.

At the end of each year around 600 people with liver disease on the UK transplant list are not transplanted and are still waiting for a liver – and the numbers are growing.

Fifteen to twenty percent of patients on the transplant list die or are removed each year whilst waiting for an organ.

Unfortunately there are simply not enough livers donated by people who have died for these patients.

The average waiting time for a liver transplant from someone who has died (a deceased donor) is approximately 137 days (4.5 months). For some people with common blood groups such as O the wait can be 244 days (8 months) as there are more blood group O recipients waiting for a transplant. For patients with end stage liver disease, this is a long time.

Could you volunteer to be a living liver donor?

Healthy people who wish to help a loved one or a stranger with liver disease may volunteer to give part of their liver. Volunteer is the key word – this must be something that you choose to do and feel comfortable doing. Anyone volunteering will be asked to undertake a series of tests so that the transplant team can be absolutely sure that you are suitable to donate.

Your health and safety is of primary concern and it is important to be aware from the start that, even if you want to be a donor, not everyone is suitable and you may be unable to donate. It is also important to remember that even if you do volunteer, you can change your mind at any point in the process – right up to the time of surgery.

Who can donate?

Most often living liver donors are a close relative of the recipient, such as a family member, partner or good friend. However, people who do not know anyone with liver disease, but who wish to donate, can also provide part of their liver for someone on the transplant list. These people are known as non-directed altruistic donors.

To find out more about non-directed altruistic liver donation, you can contact your closest liver transplant centre for further advice.

For all other enquiries, it is best to contact the transplant centre where your intended recipient is being assessed for transplantation.

Is there an age limit for donors?

In England, Wales and Northern Ireland, there is no lower age limit specified in law for a person to be considered as a living liver donor. In Scotland, only people over 16 years of age can be legally considered. However, almost all donors are over 18 years old and children are only considered in very exceptional circumstances, with court approval. Children are not considered as non-directed donors.

There is no fixed upper age limit but donors above the age of 45 years will only be considered if they are exceptionally fit and well. Donors are assessed very carefully and your suitability is considered by a team of professionals at the hospital.

How will you know if you are suitable to donate?

You will undergo a number of tests to check that you are fit and healthy enough to donate.

Some people who wish to donate find that they are not able to do so because of the results of the assessment process. Members of the team involved in your assessment will include doctors, coordinators, psychiatrists and independent assessors. They will guide you through the process every step of the way.

What are the tests like?

The Living Donor Coordinator will guide you through the entire process and explain all of the tests that you need to undertake. These are to make sure you are healthy enough to donate and that your liver is working properly. The tests are generally not painful or invasive (but you will be asked for lots of blood samples along the way). They include scans (some including an injection), urine tests, blood tests, X-rays and heart tracing (through wires attached to sticky pads on your skin) and a special test of liver function.

Your test results will be discussed with you when available. If something unexpected is found then some further tests or assessments may also be needed. It is possible that the tests may show a condition or illness that you did not already know about. If this is the case, this will be discussed with you and appropriate referrals and treatment provided.

Donors also undergo a psychological assessment. This is to ensure that you are of sound mental health, because donating part of your liver can be an emotional process, and the risk of any psychological harm to you must be acceptably small.

You will also be assessed by an Independent Assessor, on behalf of the Human Tissue Authority, who is completely independent from your medical team. This is a one-to-one meeting at the end of the assessment process, where you will be asked about your reasons for donating and your understanding of the process. The Independent Assessor is your advocate and ensures you are not being pressurised into donating, or being paid to do so, which would be against the law, and once they are satisfied about your suitability will ask you to sign a declaration. The Human Tissue Authority needs to approve your donation in order for surgery to take place.