Organ transplantation is an operation of moving an organ from one body to another, for the purpose of replacing the recipient's damaged or absent organs due to disease or injury.

 

Organ transplant is classified into deceased donor transplantation and living donor transplantation. South Korea is a leader in living liver transplantation and shows the world's highest post-operative survival rate.

 

Living donor liver transplantation

 

 30% of a liver will grow back to its original size in just three months, so part of a liver can be removed

 

The process

 

A. Evaluations for Liver donors

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A donor surgeon informs the families considering LDLT of the medical risk and benefit of the procedure for both the donor and recipient. The ethical issues and potential psychological and social consequences will be discussed with the donor, coordinator, medical social worker, and psychologist. Apart from informed consent, potential right liver donors need to fulfill the following essential criteria:

 

(1) A volunteer with an ability and willingness to comply with a long-term follow-up

 

(2) Age between 16 and 60 years old

 

(3) Blood group compatibility with the recipient

 

(4) A relationship between the recipients within the third degree of consanguinity or an intense emotional relationship

 

(5) No known medical disorders that would significantly increase the perioperative risk

 

Candidates fulfilling these criteria are evaluated according to the evaluation protocol for a living liver donor. This includes an assessment of the general health and an accurate estimation of the liver volume, quality and anatomy. The evaluation is divided into in three phases. During phase 1, the general condition of the potential donor is evaluated. The assessment includes the medical history, body size, psychosocial circumstance, liver function test, biochemistry, hematology, coagulation profile, urine analysis, serology for hepatitis A, B, and C, chest radiograph, and electrocardiography. During phase 2, the potential donor undergoes complete medical evaluation and imaging study for the liver quality. The laboratory assessment includes tumor markers and the serology for virus. Other examinations include an esophagogastroduodenoscopy for all, mammography and pap smear for female donors > 40 year-old, and a sigmoidoscopy for donors > 40 year-old. A CT scan and MR imaging is performed to evaluate the liver size and quality, and vascular and biliary anatomy. The third phase is devoted to invasive procedures required to investigate the potential problems discovered during phases 1 and 2. This includes a liver biopsy, or additional consultations and procedures. A preoperative liver biopsy is taken from those donors suspected having steatosis from imaging studies in order to exclude those with severe hepatic steatosis. A conventional hepatic angiography and endoscopic retrograde cholangiography is not routinely performed. The donors are advised to stop smoking and drinking. However, the presence of mild systemic diseases, such as well-controlled mild hypertension or diabetes, is not necessarily a contraindication. The evaluation process is usually taken whole day or two days.

 

B. Donor surgery and postoperative recovery

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In adult-to-adult LDLT, right hemiliver may be donated. Donor right hepatectomy is considered if the estimated remnant liver volume is enough (> 30% of the whole liver) and the liver biopsy shows mild steatosis (< 30% macrovesicular steatosis). The accepted donors are admitted one day before surgery, and will be discharged 7 days after operation. The liver donor will be fully recovered within 2 ~ 3 weeks.

 

C. Evaluations for recipients

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Candidates of LDLTs are evaluated according to the evaluation protocol for a LDLT recipient. This includes an assessment of the general health including cardiopulmonary function and mental health, and a malignancy in the liver. The evaluation is divided into in two phases. During phase 1, the general condition is evaluated. The assessment includes the medical history, body size, psychosocial circumstance, liver function test, biochemistry, hematology, coagulation profile, urine analysis, serology for hepatitis A, B, and C, chest radiograph, and electrocardiography. The potential recipient undergoes complete medical evaluation and imaging study of the liver. The laboratory assessment includes tumor markers and the serology for virus. Other examinations include an esophagogastroduodenoscopy for all, mammography and pap smear for female donors > 40 year-old, and a sigmoidoscopy for donors > 40 year-old. A CT scan and MR imaging is performed to evaluate the liver size and quality, and vascular and biliary anatomy. The 2nd phase is devoted to evaluation of the liver malignancy and staging. This includes systemic evaluation of metastasis of primary liver malignancy; PET CT scan, whole body CT scans, bone scan, and/or biopsy of the tumor. The evaluation process is usually taken two to three days.

 

D. Recipient surgery and Postoperative recovery

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The recipient is admitted for several days in ICU and transferred to the transplant ward within 7 days, in general. If the patient’s recovery is uneventful, the recipient can eat and walk within 5 days, and can be discharged within 2 weeks. The recipient must be followed up at an outpatient clinic for 6 months and then can be referred to a local clinic.

 

Estimated cost of the living donor transplantation is 137.000-150.000 USD

 

Korean Hospitals leading in organ transplantation