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Living-Donor Liver Transplantation: How it’s Saving Lives

Vinay Kumaran, MBBS, MS, M Ch discusses Living-Donor Liver Transplantation and How it’s Saving Lives.
Living-Donor Liver Transplantation: How it’s Saving Lives
Featuring:
Vinay Kumaran, MBBS, MS, M Ch
Dr. Vinay Kumaran was born in Bhopal, India and raised in Delhi, where he went on to study at one of the highest-rated medical schools in India, Maulana Azad Medical College. Fellowship trained in multi-organ transplantation, Dr. Kumaran served as Director of Liver Transplant at Delhi’s Sir Ganga Ram Hospital, where he was involved in many first-of-its-kind procedures in India, such as a dual-lobe living donor liver transplant, a combined liver and kidney living donor transplant, a living donor intestinal transplant, and others. 

Learn mroe about Vinay Kumaran, MBBS, MS, M Ch
Transcription:

Scott Webb: I'm an organ donor, but like many of you, I don't plan on donating my organs until I'm no longer here to miss them. Joining me today to discuss the benefits and relatively low risks of being a living liver donor is Associate Professor of Surgery and Surgical Director for Living Donor Liver Transplantation at the Hume-Lee Transplant center, Dr. Vinay Kumaran. This is Healthy with VCU Health. I'm Scott Webb. So, Dr. Kumaran, thanks so much for being on today. Lots to talk about. We know that April is National Donate Life Month, and we'll come back around to that later. Let's start here. What does it mean to be a living liver donor?

Dr. Kumaran: Liver is an interesting organ in the sense that it has a lot of reserve. So, it's actually possible to remove most of the liver. What's left will be enough to do what it needs to do, and it regenerates so it will grow back to its full size in a few weeks. So, this gives us an option of taking out part of a liver from someone who wants to help out a patient with liver failure and replace their liver with this partial liver. So, that's what's involved in a living donor liver transplant.

Host: Who's eligible to be a living liver donor? And do donors have to be relatives necessarily?

Dr. Kumaran: Not necessarily. Anyone who knows the patient and wants to help them out and is basically willing to undergo an operation to have part of their liver removed – to help out the patient – is eligible to be a donor. Of course, there are physical requirements, so there's an age limit, which is from 18 years below, which you cannot consent to undergo the operation. To 60 years beyond which age itself becomes a risk factor for undergoing surgery. And of course, we don't want someone who's got a medical condition, which would increase their risk of undergoing surgery. So, it shouldn't be someone who's got diabetes or heart disease or any other condition, which would prevent them from having the surgery safely. And of course the liver itself should be normal. So, you don't want someone with a fatty liver or someone with a hepatitis donating.

Host: So what are the advantages to receiving a liver from a live donor? Is there difference between a, you know, how or who you receive the liver from?

Dr. Kumaran: There are advantages. The allocation of livers from deceased donors, from braindead donors is based on giving the liver to the person who needs it the most. So the patients on the waiting list are ranked according to the severity of their liver disease, and the liver goes to the sickest patient on the waiting list. So that's intended to save lives, but it's not good for the individual patient because they have to wait until they are sick enough to be at the top of the list before they can get the transplant. So because they are sick at the time of transplant, they tend to have a longer hospital stay. They're more likely to have complications. They take longer to recover. If they could have the transplant earlier in the course of the disease, before they got sick enough to be at the top of the list, they would have an easier recovery. Plus, if you could do the operation as an elective procedure, you can optimize the condition of the patient so that they are in the best possible physical condition to tolerate a big operation, like a liver transplant. So it's certainly safer for the recipient. The disadvantage of course, is that someone else who does not need surgery by themselves has to have surgery to help out the patient, so that there is an element of risk for the donor. But the risk as such is very low. It's a very safe operation.

Host: So let's talk about this procedure, which I know is very complex and this may be a tricky thing for you to do, but can you briefly tell listeners what's involved in this procedure, and what type of team of specialists do you assemble for something like this?

Dr. Kumaran: So the most important component of the operation is the donor operation because that's a healthy person who doesn't require the operation themselves. So you have to be very safe with them. So the operation has to be designed in such a way that we can separate the liver into two halves, one of which can be removed and given to the recipient and the other half can be left behind for the donor. So the anatomy of the liver is fairly complex and every operation is different. We need a fairly detailed, 3D model of the liver, which we get from CT and MR information. And we use that to plan how we are going to split the liver. And then there is some work on that partial liver before we can actually put it into the recipient. Unlike liver from a brain dead donor, it doesn't come with long length of the blood vessels and so on. The blood vessels are small and they are thin, so they have to be extended. So we have to do some work on that partial liver before we put it into the recipient. So it's a considerably more complex operation than a deceased donor transplant. But if it can be done safely, then there are advantages to the recipient in terms of both short-term and long-term outcomes.

Host: Really cool. Really amazing. So I think you mentioned this earlier, but let's go back over this again. How long is the recovery period for both the donors and recipients?

Dr. Kumaran: In practical terms, for the donor, the donor wakes up at the end of the surgery, and is kept under close observation, typically in the ICU overnight. The next day they would typically go to the floor, and they would basically start liquids and later on solids. They would be ready to go home in about five to seven days. They would typically be, they need to go back to work if it doesn't involve much physical exertion in something like six to eight weeks. There is a restriction on lifting heavy objects for three months after surgery. That's basically to allow the healing to complete itself, to make sure the scar is mature, and doesn't get stretched and leads to lead to hernia later on. For the recipient, typically the recipient comes out of the OR still asleep, and we move them to the ICU without waking them up. Typically, we wake them up the next day. The ICU stay would be about two to three days. And the recipient’s hospital stay tends to be somewhere between seven to 10 days. And it takes them also about six to eight weeks before they feel back to their normal energy and stamina levels. And they, of course, anyone with upper abdominal surgery has this restriction on lifting heavy weights for three months. And the recipient of course will need to be on some medication to ensure that their body does not reject the transplanted liver. But the donor doesn't require any long-term medication as such.

Host: So it sounds like it's roughly the same stay in the hospital, maybe just a little bit longer for recipients and again, roughly the same length for recovery with some restrictions. That's really amazing. That's the last thing I wanted to talk to you about today, Doctor, is that we know that donors are heroes and maybe the word hero gets thrown around a little bit too much, but in this case I think it's really appropriate. I'm wondering if you would share your thoughts on donors and how these selfless acts save lives.

Dr. Kumaran: Yeah. I think donors are amazing people. It kind of restores your faith in humanity that there are people who will agree to undergo major operations like this in order to help out someone else – to try and save someone's life. And all the donors I have known so far have been really enthusiastic about the process, and they've gone into it with very little doubt about the process. It's amazing how well the recover from this and how good they feel about having done something to help out someone in such a profound way.

Host: Yeah. I think that sums it up. I mean, it really is this profound act of saving lives and I'm just in awe of them that they could make that decision, elect to do something like this to help save someone's life and really the work that you all are doing, at Hume-Lee and VCU. Really fantastic. Thank you so much, Doctor. For additional information about living donor liver transplantation, visit VCUhealth.org. This is Healthy with VCU Health. I'm Scott Webb. Thanks for listening.