How to Qualify as a Living Liver Donor

A USC Transplant Institute physician explains the living-liver-donation process: requirements, recovery and the life-changing impact of this vital gift.

When it comes to organ donation, livers are in short supply nationwide. Currently, approximately 10,000-13,000 people need a liver transplant, while only 10,000-11,000 livers become available annually. 

“There is a critical shortage of livers for transplant around the country,” says transplant hepatologist Helen Hyosun Han, MD. Dr. Han is the medical director of the USC Living-Donor Liver Program, part of Keck Medicine of USC and the USC Transplant Institute. 

Today, the average wait time for a liver transplant is 11 months — if a donated liver becomes available at all.  

The good news is that living organ donors can help increase the number of liver donations. Because the human liver regenerates, living liver donation allows healthy individuals to donate a portion of their liver to someone, such as a loved one or an anonymous recipient. 

Who can donate part of their liver? 

“Generally, anyone age 18 to 55 is considered an ideal donor,” Dr. Han says. “Other requirements include blood type compatibility, good health and a support system to help the donor during the recovery period after surgery.” Older donors in good health may also be eligible to donate, she adds. 

Certain conditions can disqualify potential donors, however, including active cancer, poorly controlled health issues and recent pregnancy. 

There are two main types of donors: 

• Directed donors: First-degree relatives and people who know the recipient either personally or through other means such as church, employment or social media from friends, church members or colleagues who discovered someone in need. 

• Non-directed (anonymous) donors: People who have learned about donation through social media, advertisements and other means. They tend to be blood donors and public service–minded people.  

Liver donor requirements 

As Dr. Han describes, the living-liver-donation process begins with a thorough evaluation to ensure both the donor’s safety and the likelihood of transplant success. It includes a questionnaire about medical, family, social and surgical history, followed by blood typing and liver function tests.  

In addition, an independent liver donor advocate ensures the donor isn’t being coerced into donating. Qualified candidates undergo a two-day evaluation, including meeting with specialists and undergoing imaging, heart testing and reviews of risks and benefits. A committee of health care professionals makes a final determination about whether someone is an eligible donor. 

Is your liver compatible for donation? 

Beyond analyzing blood type, surgeons calculate the donor’s liver volume compared to the recipient’s weight. Donors typically provide about two-thirds of their liver for an adult recipient. For child recipients, the amount of donated liver is much less. 

The USC Transplant Institute can also help facilitate organ exchanges between donor-recipient pairs. Dr. Han points to a recent paired-exchange kidney and liver transplant in which two donors weren’t compatible donors for their siblings; however, each donor was able to donate to the other’s sibling instead.  

Does your liver grow back after donation? 

The donor’s liver-regeneration process can complete in as early as four to six weeks but as late as 12 weeks. After this time, the regenerated liver will return to full function. “During surgery, we must leave the donor at least 30% of their liver for proper regeneration,” Dr. Han adds. 

She adds that despite the liver’s regenerative ability, donors are advised not to donate their liver more than once because, anatomically, the blood vessels and bile ducts were disrupted during the original donation. This can cause abdominal adhesions that could complicate future donations. 

What to expect after a liver donation: recovery and financial considerations 

Living liver donors need follow-up care for six to 12 weeks after their surgery. During this time, donors can get help arranging housing, caregiving and other expenses.  

“The recipient’s insurance covers the cost of the donor evaluation, surgery, hospitalization and follow-up surgical appointments,” Dr. Han says. The USC Transplant Institute also provides a support network to donors that includes social workers and living liver donor advocates. 

Occasionally, donors may experience some pain or mood changes after surgery, but 95% of donors say that any lingering issues clear up fully within the first year, Dr. Han says. Importantly, she highlights, “Most say they would donate again if they could.” 

What you should know before becoming a living liver donor 

Dr. Han says the most important things to understand about living liver donation are: 

• Living liver donation is available in Southern California, although not at all transplant programs. Patients and potential donors must know where they can access this lifesaving procedure, such as at the USC Transplant Institute. 

• Donors have excellent outcomes after donation, and most report a sense of well-being and purpose, feeling closer to the recipient. 

• Non-directed (anonymous) donation benefits adults and children and opens the door to those who feel called to donate without a particular recipient in mind. 

The need for living liver donors is critical, and the impact of donation is profound. Finding a transplant center with excellent outcomes and comprehensive support throughout the process gives living liver donors the opportunity to make an extraordinary difference with minimal long-term impact on their own health and well-being. 

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