Where Will my New Liver Come From?
The Organ Shortage
There is a severe shortage of organs for transplant. This means that the wait for a liver transplant
can be many years. Patients may die while waiting for an organ. The UW Transplant Program
has long been a leader in trying to find new ways to increase the number of good organs that can
be used for transplant. When you are told you need a liver transplant, you have options as to
where your new liver will come from. It is vital that you explore these options fully.
Donation after Brain Death
The most common type of organ donor is a person who suffered a head injury that caused brain
death. “Brain death” occurs when someone does not get enough oxygen to the brain, causing the
brain to stop working. This is often due to trauma or a stroke. Doctors can tell when someone
is brain dead by testing certain reflexes controlled by the brain and by using machines that look
at blood flow to the brain. The brain controls breathing so people who are brain dead are in a
hospital on a breathing machine called a ventilator. Because of the breathing tube and certain
medicines, the person’s body can function even after brain death. This allows the heart to keep
beating and supply the liver and other organs with blood and oxygen until a transplant team can
arrive. Once the liver is removed, it should be transplanted within 12 hours into a recipient.
Livers from these types of donors are often referred to as “standard donor livers.”
Donation after Circulatory Death
Sometimes a patient’s trauma is so severe that doctors cannot save their life, but they do not meet
the measures for “brain death.” The doctors then discuss with the patient’s family whether or not
to remove life support. If the family chooses to remove life support, the machines are turned off.
The patient is allowed to die peacefully. Sometimes these patients can be organ donors.
Transplant teams are called and are present when the life support is turned off. After the
patient’s heart stops beating and is declared dead by the doctor, the transplant teams can remove
the organs. This is called Donation after Cardiac Death (DCD). Because the heart has stopped
beating in these donors, there is a lack of blood flow for a short time to the organs as they are
removed. This can lead to some damage in the liver. This damage can cause some increased
complications to the patient who receives this liver. In most cases these complications can be
treated. However, there is a higher rate of early failure of the liver transplant when compared to
standard donor livers. With failure, a second liver transplant is needed. Patients will be asked if
they are willing to accept a DCD liver at their evaluation visit. Patients will sign a consent form
about this. Patients can change their mind about this at any time. If you choose not to accept this
type of organ, you will not lose your place on the list. Accepting a DCD liver will increase your
chance of getting a transplant sooner.
Split Liver Transplant
In a split liver transplant, a liver from a deceased donor is divided into two segments. Each
segment goes to a patient on the waiting list. This can be done because the liver regenerates
itself after the transplant. It will grow to normal size within weeks. However, the patients
getting the segments must meet size criteria to get a smaller piece of a liver versus a whole liver.
Because this is a more complex surgery, receiving this type of liver can result in increased
complications. In most cases these complications can be treated. But, there is a higher risk of
failure of this type of transplanted liver when compared to standard donor livers. With failure, a
second liver transplant is needed. Accepting a split liver may increase your chance of getting a
“Increased Risk” Donors
You may be offered an organ from a deceased donor that is thought to be at increased risk for
spreading certain infections according to the 2013 Public Health Service (PHS) guidelines.
Donors are considered “increased risk” because of what the PHS deems to be an increased risk
behavior such as prostitution, intravenous drug use, or homosexuality. It is not the norm to
accept organs from such donors unless we feel that the good far outweighs the would-be risk.
Blood tests are done on potential donors to look for a virus such as HIV, Hepatitis B, or Hepatitis
C. No test is perfect, and false negative results rarely occur. Using data from organ, tissue, and
blood donors we know there is a small chance, 1 in 60,000 to 1 in 2,000,000 that an infectious
agent could be passed on. We believe that the risks of getting this type of liver are very small.
The transplant coordinator will inform you at the time that the liver is offered if it is from a
increased risk donor. You can then decide whether to accept this type of liver. If you choose not
to accept the liver, you will not lose your place on the waiting list.
Hepatitis C Positive Donors
In rare occasions (about 1% of all liver transplant performed at UWHC) we receive livers from
donors who are known to have Hepatitis C. We make sure these livers are healthy to transplant,
typically by doing a biopsy of the donor liver. There are now medicines to treat Hepatitis C. We
feel these livers can safely be given to patients that already have Hepatitis C if they have not
been treated for this disease. If you are being treated for Hepatitis C with anti-viral medications,
we would not want to give you a Hepatitis C positive donor liver. The outcomes after receiving a
liver from a donor with hepatitis C for a patient that has hepatitis C are no different than getting a
liver without hepatitis C. One advantage for patients is that they may get an offer for a liver
sooner. When you are placed on the waiting list your coordinator will discuss with you if you
are eligible to get a hepatitis C donor liver. If you choose not to accept the liver, you will not
lose your place on the waiting list.
Hepatitis B Core+ Donors
In rare occasions (< 1% of all liver transplants performed at UWHC) we receive livers from
donors who are found to have a possible past infection of Hepatitis B. We make sure these livers
are healthy to transplant, typically by doing a biopsy of the donor liver. We feel these livers can
safely be given to patients.. Patients who receive a liver from a donor with a past infection of
hepatitis B need to take an antiviral medication for a period of time after the transplant to provide
further protection against getting hepatitis B from the donor. The outcomes after receiving a liver
from a donor with hepatitis B for are no different than getting a liver without hepatitis B. One
advantage for patients is that they may get an offer for a liver sooner. If you choose not to accept
the liver, you will not lose your place on the waiting list.
What will I be told about my donor?
Patient confidentiality laws limit how much we can tell you about your donor. We cannot tell
you the donor’s age, gender, or personal or health history. Guidelines for allocating livers are set
by the United Network for Organ Sharing (UNOS). The Organ Procurement Organization
(OPO) informs the UW Transplant Program when a liver is found and who is number one on the
UNOS list to receive the liver. The OPO has a thorough screening for all would-be donors to
attempt to find any illness that could affect the transplant organ or the patient who receives it.
Screening for such an illness can be limited by time constraints between the time that the donor
was injured and the organ obtained. We use our best knowledge and judgment to attempt to
ensure every organ we transplant will work and will in no way harm the patient who receives it.
Besides deceased donor transplants, patients may receive a liver from a living donor. In a living
donor transplant, a piece of a healthy person’s liver is transplanted into the recipient. This can be
done because the liver regenerates itself in both the donor and recipient after the transplant. Both
the donated segment and the remaining section of the donor liver will grow to normal size within
weeks. Living donors can be related or un-related, and are often family members or close friends
of the recipient. Benefits of living donation include being able to have a planned surgery and
knowing the donor. However, because this is a more complex surgery, receiving this type of
liver can result in increased complications. In most cases these complications can be treated.
Patient survival statistics after living donor liver transplant are similar to those undergoing
deceased donor transplants.
How do I choose?
There are risks and benefits of receiving each of the above types of livers. Members of the
transplant team can provide more information about this topic. They can help you choose the
type of transplant that may be best for your own case.
Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 1/2016. University of Wisconsin Hospital
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#6697.