Liver Transplant: What Donors and Recipients Need to Know

If you’ve been diagnosed with serious liver disease, there may come a time when your doctor says a transplant is your best option. Our body is capable of regenerating its liver. A liver transplant is advised when the liver of an individual no longer works well enough to sustain them. Liver transplant is a life-saving surgery for those who have liver failure.

A liver transplant is not just a surgery. It’s a second chance. It has transformed the way we treat end-stage liver disease, offering hope to thousands of patients and their families worldwide.

Within this blog, we discuss the main alternatives to liver transplant and their respective uses, allowing patients and their families to gain a clearer understanding of their available treatment options.

When Is a Liver Transplant Needed?

You may need a liver transplant when your liver causes a lot of damage to its normal functions. This can happen slowly or quickly. The most typical reasons are:

●       Chronic liver disease (cirrhosis): from hepatitis B or C, long-term alcohol use, fatty liver disease, or autoimmune hepatitis.

●       Acute liver failure: sudden shutdown due to infections, medication overdose (like paracetamol), or autoimmune causes.

●       Liver cancer (HCC): if it meets transplant criteria.

●       Inherited diseases, like Wilson’s disease or hemochromatosis.

●       Cholestatic liver diseases, such as primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), or biliary atresia in children.

Your doctor may recommend a transplant when no other treatment works and your survival without one is unlikely.

Types of Liver Transplantation

1. Deceased Donor Liver Transplant (DDLT)

●       Whole liver transplant – the entire donor liver is transplanted.

●       Split liver transplant – one liver is divided for two patients (usually an adult and a child).

2. Living Donor Liver Transplant (LDLT)

A portion of liver from a healthy donor is transplanted into the patient.

●       Right lobe transplant – usually for adult recipients.

●       Left lobe transplant – usually for children or smaller adults.

●       Left lateral segment – usually for young children.

●       The extended right lobe – includes extra vessels for better blood flow.

●       Monosegment or refuced left lateral segment - for infants

3. Auxiliary Liver Transplantation

Part of a donor liver is added while keeping the patient’s liver in place.

●       APOLT – auxiliary partial orthotopic transplant.

●       Heterotopic transplant – donor liver placed in a different location.

Specialised Liver Transplants for Certain Conditions

●       Liver Cancer (HCC) – if within safe limits, may involve pre-transplant treatment.

●       Acute Liver Failure – emergency transplants for sudden liver shutdown.

●       Metabolic disorders – such as Wilson’s disease or urea cycle defects.

●       Cholestatic diseases – including PBC, PSC, and biliary atresia.

●       Polycystic liver disease – when large cysts cause symptoms.

●       Emerging indications – including certain rare cancers and paediatric tumours.

Who Can Be a Living Liver Donor?

A living liver donor is an individual who donates a part of the liver (from 40-70% for adults) to an individual in need. He or she may be a relative, friend, or even a philanthropic stranger.

To be eligible to be a liver donor, you:

●       Should be between 18 and 60 years of age

●       Should be healthy

●       Should have healthy liver (there are multiple tests to ascertain)

●       Should know about the surgery and risks

●       Should be mentally and emotionally prepared to donate

●       Not be diabetic, have high blood pressure, heart disease, cancer, or infections

●       Match in blood type with the recipient of the liver

●       Have a body weight (BMI) of less than 35

●       Don't use drugs or alcohol in an abusive manner

Physicians will conduct examinations to ensure that it is safe for you to give and that your liver is a suitable match.

The Liver Transplant Process: Step by Step

Having an idea of what to expect prior to, during, and following a liver transplant can assist you in feeling more ready and less stressed. Here's how the process typically works:

1. Preparing for the Surgery (Pre-Transplant)

The patient goes through some medical procedures such as blood work, imaging tests, and visits with doctors to determine whether they are healthy enough for a transplant.

These also indicate the extent to which the liver is damaged and how quickly the transplant must be done.

If a living donor transplant is to be done:

●       A donor is selected who has the same blood type and body size as the patient.

●       The donor also undergoes health screening to make sure it's safe to give an organ.

2. During the Surgery

●       The damaged liver is removed.

●       A healthy liver (or part of one) is transplanted.

●       The operation can take 6–12 hours, performed by a specialist surgical team.

3. Post-Surgery (After the Surgery)

For the Recipient:

●       The patient is hospitalized for some weeks while physicians observe recovery.

●       Immunosuppressant drugs are initiated to prevent the new liver from being rejected by the body.

●       Other medications manage pain and stop infections.

●       The patient is taught about his medications and potential side effects.

●       Ongoing follow-up appointments, blood work, and in some cases, liver biopsies are needed to monitor the health of the liver.

For the Donor:

●       Typically remains hospitalized for around a week, or shorter if minimally invasive surgery (laparoscopy) is performed.

●       The donor recovers with the assistance of the medical staff.

Benefits of Living Donor Liver Transplants

Living donor transplants have some significant advantages:

●       Shorter waiting time than waiting for a deceased donor liver.

●       Surgery can be planned at the optimal time.

●       The new liver becomes functional immediately.

●       Quicker recovery and fewer complications.

●       Good choice for extremely ill patients or those who may decline rapidly.

●       Donor and the recipient can plan well ahead of time.

Risks of Liver Transplant

Though usually safe, liver transplants do involve some danger for donors and recipients:

●       For patients: Risk of infection, bleeding, rejection of the new liver, or complications such as blood clots or pneumonia. Regular medication and visits help control these risks.

●       For donors: Risks may include infection, leakage of bile, bleeding, hernia, or scar tissue. Physicians carefully monitor donors and offer constant care through recovery.

Life After a Liver Transplant

●       Getting a liver transplant is life-changing for the better, so that the recipient can lead a normal life. After surgery, patients must:

●       Take immunosuppressant medicines daily to stop rejection.

●       Attend regular follow-ups with their doctor.

●       Watch for signs of infection or liver problems.

●       Maintain a healthy lifestyle to keep their new liver working well.

●       Donors also need to follow recovery instructions and attend checkups.

Care at ALPS Clinic

Your liver is vital for your health. It works every day to keep your body running, and nothing can replace it. When it starts to fail, the effects can be serious. Liver disease can happen for many reasons, and sometimes a transplant is the only option. At ALPS Clinic, we care for both donors and patients, ensuring safe and successful results.

If you’re considering a liver transplant or donation, book a consultation with our liver surgeon in Singapore today.