- Will I need special preparation for surgery?
- Should I stop drinking alcohol?
- Should I stop taking my medications before the evaluation or the surgery?
- Do I need a special diet before surgery?
- When will I be admitted for surgery?
- What should I bring to the hospital?
- Will I require a blood transfusion during surgery?
- What are the possible complications of the donor's operation?
- How big is the incision?
- How much of a donor's liver is removed?
- Will my gallbladder be removed?
Once you complete your evaluation and we decide to proceed, there is not much additional testing. We may need to repeat some blood tests, if they were done more than 30 days before your surgery date. You also must give a sample of your blood to our blood bank within 72 hours of surgery. We will ask you, your recipient and your immediate family to come in two or three days before the surgery for a final pre-transplant review, for any minor tests needed and to answer any questions you may have.
If you are going to be a liver donor, you should stop drinking. If you have a history of heavy alcohol use, it is very important to tell our doctors. Alcohol use may not preclude you from being a donor, but you may need a liver biopsy to be sure your liver has not sustained any damage. You should not resume drinking alcohol after surgery until advised to do so by the transplant team.
You should not stop any prescription medication unless advised to do so by a doctor. You should avoid aspirin or non-steroidal medications, such as Advil or Motrin, for seven days before a liver biopsy or surgery. These medications can affect the blood's ability to clot and put you at higher risk of bleeding complications. Instead, you may take Tylenol if needed. Women who take birth control pills should stop taking them 30 days before surgery because of the increased risk of blood clots after surgery. We advise you to wait for a minimum of three months after surgery before you resume taking birth control pills.
You can eat and drink normally until noon the day before the surgery. You will consume a liquid diet from noon until midnight then nothing until surgery. You will be given a laxative the day before surgery. If you regularly take any medications, we will discuss these during the appointment before surgery.
You and your recipient will be admitted to the hospital on the day before the surgery. Please arrive at the hospital by noon.
Bring only minimal belongings and no valuables. Because we have your insurance information, there is no need to bring any documentation with you unless we specifically ask you to. Leave all jewelry and other valuables at home or give them to your family for safekeeping. You may want to bring a toiletry bag.
Blood transfusion during this surgery is uncommon, but it may be necessary. As a precaution, we will ask you to provide two units of blood before the surgery. If you do need a transfusion, we can then use your own blood. There may be a shipping charge if you donate blood at your local blood bank. Quite often, insurance doesn't cover these costly charges. Should this be the case, arrangements can be made for you to donate the sample at the UCSF Blood Donor Center. If you should have a great deal of blood loss during surgery, you may need blood from the blood bank.
As with any surgery involving general anesthesia, there are possible complications of the anesthesia itself including heart complications, stroke, and blood clot formation in the legs or lungs. Other risks associated with surgery on the abdomen are bleeding, infection and failure of the wound to heal. With liver surgery, complications include bleeding, bile leaks or injury to the bile ducts. There also is a risk that the remaining portion of your liver will fail and you will need an urgent liver transplant yourself. There is even a risk that you might die. We will discuss these risks with you in more detail during the evaluation.
The incision is a large one and is the same for the donor and recipient. It is called the "Mercedes" incision.
Usually, about 40 percent to 60 percent of a donor's liver is removed. The liver is divided into a right lobe and a left lobe. The anatomical division between the lobes permits surgeons to divide the liver into two distinct parts that can function independently of each other. The right lobe comprises about 60 percent of the total liver volume and the left lobe comprises approximately 40 percent. When the recipient is a child, a piece of the donor's left lobe, called the left lateral segment, is removed. In adults, the larger right lobe, or right lateral segment, is removed. The operations on the donor and the recipient take place at the same time, in separate operating rooms.
When adults donate to adults, the gallbladder is removed because it is in the path of the right lobe of the liver. When adults donate to children the gallbladder is usually not removed, because the gallbladder is not an obstacle to the left lobe of the liver.