NewYork-Presbyterian. The University Hospital of Columbia and Cornell.

Transplantation

Living Donor Transplants

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During living donor liver transplantation, surgeons remove a portion of a healthy living person's liver for transplantation into a recipient. This procedure is made possible by the liver's unique ability to regenerate: the partial liver in both the donor and recipient grow and remodel to form complete, functioning organs.

Living donor liver transplants help all kinds of
people. Read stories about a few of them.

Because of the scarcity of donor organs, living donors are an important part of the care we provide. The Living Donor Liver Transplant Program at NewYork-Presbyterian Hospital is one of the largest and most experienced living donor liver programs in North America:

• We have performed more than 220 living donor transplants since the program's inception.
• We have completed more left-lobe donations (use of the smaller lobe of the liver) than any other living donor liver program on the continent, enabling our surgeons to remove smaller amounts of tissue and helping donor recovery.
• Our center is the only one to offer laparoscopic surgery to remove liver tissue from the living donor, using smaller incisions and speeding recovery. We introduced fully laparoscopic donation for all pediatric living donor liver transplants in 2009 and continue to use this approach for all adult-to-child transplants.
• Up to 20% of the liver transplants we perform are from living donors – far greater than the 2% to 5% national average.

Our program achieves excellent outcomes for donors and recipients which exceed national and expected outcomes for liver transplantation. According to the most recent SRTR data, our recipients have a 97.1 % one-year survival rate after transplantation and a three-year survival of 93.3%. Additionally, nearly all donors have reported feeling very satisfied or satisfied with donating.

Earlier Transplantation, Better Outcomes

A living donor offers the possibility of earlier transplantation to those in need. More than 18,000 people are waiting for liver transplantation, but just over 6,000 deceased donor livers become available each year. By improving access to transplantation, particularly in regions such as New York that have longer waiting lists, living donor liver transplantation may reduce a patient's risk of dying by 20% to 40%.

Recipients of livers from living donors generally fare better than those who receive livers from deceased donors because they are in optimal health at the time of transplant, and the tissue they receive is usually from a young, healthy donor.

Living Donor Liver Transplantation Via Laparoscopy

The program at NewYork-Presbyterian Hospital/Columbia University Medical Center is the only one in the country to perform living donor liver transplantation via laparoscopy in select donors. We have used this approach to perform living donor liver transplantation from an adult to a child, and we are working to expand this program to adult-to-adult transplants.

Scarring from laparoscopic versus traditional
living donor transplant. (Click to enlarge)

The benefits of the laparoscopic approach for the donor include:

• smaller incision and reduced recovery time – from 4-8 weeks to just 2-3 weeks
• less pain and fatigue
• decreased use of analgesia
• reduced risk of complications
• faster recovery of the donor and reduced stress on the family

Who Can Donate?

A healthy family member, spouse, or friend may volunteer to donate a portion of his or her liver. As much as 60% of an adult liver may be donated to an adult recipient, and 20% to 25% may be donated to a child.

Benjamin Samstein, M.D., has
led the Living Donor Liver
Transplant Program since
2008 and introduced the
use of laparoscopy.

The general criteria for a living liver donor include:

• good general health
• a blood type compatible with the recipient's
• an altruistic motivation for donating
• being a family member or someone emotionally close to the recipient

Medical evaluation of living donors takes place at the state-of-the-art Comprehensive Transplant Outpatient Center located at NewYork-Presbyterian/Columbia. This evaluation includes:

• blood tests
• physical examination
• abdominal ultrasound
• MRI
• social work and psychiatric consultations

Support Services

While achieving excellent clinical outcomes is vital, we view caring for the donor as central to our mission.

Daniel Cherqui, M.D.,
performed the first
laparoscopic living donor
liver surgery in 2002 and
joined NYP in 2009.

• We offer specialized nursing care (featuring nurses trained in the special needs of donors), nutritional support, smoking cessation, weight loss guidance, and pain management for donors.
• Our program features a full-time coordinator dedicated solely to the Living Donor Liver Transplant program.
• Our Donor Mentoring Program enables donors to seek emotional support and advice from others who have donated.
• We also monitor donors for years after donation to assess their well being and track their outcomes.

A wide range of educational and support services are available for both donors and recipients. The Hospital's dedicated Independent Donor Advocate Team carefully evaluates potential organ donors and advocates on their behalf to ensure that donation would cause them no harm.

The National Living Donor Assistance Center (NLDAC), established by the U.S. Health Resources and Services Administration (HRSA), provides financial assistance for travel, lodging, and meals to those who want to donate an organ and would otherwise not be able to afford these expenses.

Jean Emond, M.D., was a
member of the team that
pioneered living donor
liver transplantation.

A Commitment to Research

NewYork-Presbyterian/Columbia is the only institution in New York City participating in the national multicenter NIH-funded Adult to Adult Living Donor Liver Transplant Cohort Study (A2ALL), which is focusing on the factors influencing the outcomes of living donor liver transplants for both donors and recipients. Researchers are comparing outcomes of this procedure with those for patients who receive livers from deceased donors.

Auxiliary Liver Transplants

Patients with fulminant liver failure – acute liver failure usually due to a medication overdose or virus – traditionally have had limited options: intensive medical care that enables rapid recovery of their own liver or liver transplantation. In a newer procedure, auxiliary liver transplantation, surgeons attach a portion of a healthy donor's liver to a portion of a recipient's diseased liver.

Eva Urtasun Sotil, M.D., is
board-certified in Transplant
Hepatology.

The donor liver supports the patient during recovery, clearing toxins and preventing brain injury. After the patient's own "native" liver recovers, the donor liver usually withers. Whereas liver transplantation requires patients to take immunosuppressant medications for the remainder of their lives, auxiliary transplants do not.

NewYork-Presbyterian Hospital was one of the first institutions to perform this procedure, which now accounts for a substantial proportion of liver transplants in children today.