Living donors can provide their right liver and just over one quarter of their left liver, or left lateral liver segment to the recipient. The type of surgery that will be recommended will depend on many factors that will be discussed with you.
A 5 to 10 inch incision (cut) is made either, below your right rib cage or straight down the middle of your abdomen. The operation is the same no matter what part of the liver is removed. The operation begins with a reassessment of your abdominal anatomy. Your gallbladder is removed to inject dye to re-check bile duct anatomy. There are usually no ill effects from removing your gallbladder; it is not an essential organ for your body to have.
Your liver is then divided leaving sufficient length of bile ducts and blood vessels in the graft (donated portion of liver) to re-connect in the recipient.
The portion of the donated liver is then removed from your body, and another x-ray of your bile ducts is done to make sure your remaining bile ducts are intact. Dissolving stitches are used to close the incision.
This operation lasts about 5 to 8 hours and the hospital stay is usually 5 to 7 days. The liver grows back quickly and is restored to normal liver size by one year. Most of this growth occurs within 6 weeks. Liver function is normal within 2 weeks after donation.
If something is found that may put your safety or the recipient's safety at risk, your liver will not be removed. This happens less than 3% of the time (small chance) in our program.
Read our guide below to learn more about your living liver donor surgery, or click on the topic that matters most to you. If you have questions or need more information, talk to our transplant assessment coordinator.
Please stop eating and drinking by midnight on the night before your operation. Your stomach needs to be empty.
You will be admitted to the hospital the morning of your operation (usually at 6:00 am). Your surgery will be performed during the day.
Surgical Admission Unit (SAU)
Toronto General Hospital
Peter Munk Building – 2nd Floor, Room 310
TGH Maps & Directions
All hospital entrances are open by 6 am. However, the University Ave. entrance is easiest to access.
- Nurses and doctors will examine and prepare you for the operation.
- An intravenous (IV) line (a needle into a vein in your arm) will be started, to give you fluids. Your blood pressure and temperature will be checked.
- Our transplant team will perform a final assessment to ensure you are fit for your operation.
- After you have been taken into the operating room and put to sleep under general anesthesia:
- An arterial line (a needle into a vein in your arm) will be started, to watch your blood pressure.
- A nasogastric tube will be placed through your nose into your stomach to drain gastric juices.
- A catheter will be placed into your bladder to drain your urine.
- A catheter in the vein in your neck to monitor vein pressure during surgery.
Every effort will be made to arrange a date and time for your operation that is best for you. However, operations may be cancelled if medical issues exist with the donor or the recipient. Sometimes, there are circumstances beyond our control that may require the operation to be cancelled or postponed.
You and your family may feel shock, disappointment, and sadness when this happens. All of these feelings are normal. You should call your
transplant assessment coordinator to talk about any concerns you have about a cancellation.
- Following your operation, you will be in the Post Anesthetic Care Unit (PACU) or recovery room for about 2 to 4 hours. You will then be moved to either the 6th floor (Inpatient Unit) or 10th floor
Transplant Unit for recovery.
- Your catheter will remain in your bladder to drain your urine until you are able to walk to the bathroom. You will receive IV fluids until you are able to take in enough food and fluids. The nasogastric tube may remain in place to keep your stomach from feeling bloated. Your diet will be gradually changed from liquids to more solid foods, as tolerated. All of these tubes will removed during the first few days of recovery.
- Once you have recovered from the anesthetic, you may feel some pain at your incision. The incision will become less painful over the first couple of weeks, but it will take several weeks for the muscles and nerves to heal completely
- You may also feel stiffness in the joints of your upper body after lying on the operating table for a long period of time. This will resolve as you gradually move around during your recovery.
- Our pain management team will work with you during and after surgery to make sure your pain is well managed. Your pain will be managed by Patient Controlled Analgesia (PCA). This lets you control the number of doses as well as the timing of the pain medication. The medication will be given to you intravenously (IV) until you are able to tolerate oral medication.
- Start some deep breathing and coughing exercises. We'll show you an exercise called
incentive spirometry
- Wiggle your toes and move your feet. This helps the blood in your legs to circulate.
- Sitting up in a chair, performing self-care, and walking in the hallway are excellent ways to improve your strength and help you avoid blood clots.
- You will be able to shower while you are in the hospital.
Learn more about your stay
- You can expect to be in the hospital for up to 7 days.
- Eating a healthy diet by following Canada's Food Guide will help give you a balance of protein, fats, and carbohydrates and help you to maintain a healthy body weight.
- Avoid alcohol and smoking for 8-12 weeks after your surgery.
- You might get tired easily. Listen to your body and don't do more than you can handle.
- We recommend that patients take 6 to 8 weeks off work regardless of the surgical procedure.
- Some patients, particularly those who are self-employed, return to work as early as 3 weeks after surgery, and should only perform light duty, such as deskwork.
- Patients who work for a company and who are given time off usually take off 6-8 weeks. If your work does require heavy lifting or strenuous exercise, may be delayed for a total of 12 weeks. You may also return to work with modified duty.
- Don't lift heavy things for 6 weeks after your operation. Anything over 5 kilograms or 10 lbs. is too heavy.
- You can use small weights of 1 to 2 pounds to increase arm strength but be careful not to strain your shoulder joints.
- Lifting larger amounts may result in stress to your incision and can affect your healing.
- Walking is the best exercise. Try to increase the distance and speed you walk.
- In winter, many people walk in malls to avoid icy surfaces and cold conditions or they use a treadmill if they have access to one.
- Do not to take anti-inflammatory medication such as Advil® or Ibuprofen following a liver donation.
- Tinzaparin must be injected daily to prevent blood clots. For your safety you must complete the full 6 week course of this treatment. You will be taught to do this while you are in hospital.
- Percocet or Tylenol # 3 or extra strength Tylenol can be taken as prescribed for relief of incisional pain. If this does not control your pain, please contact the living donor office for further instructions. Please do not exceed recommended dosing. If pain persists please contact the living donor office.
- Discuss readiness for driving at your clinic appointment.
- You must not drive while taking narcotic pain medication. You need to be sufficiently strong, and flexible enough to move your leg and foot on the pedals, and be able to check your blind spot.
- Always wear your seatbelt when you are driving or riding in a vehicle. If the belt causes discomfort where it crosses your incision, place a towel under the belt.
- If you're driving long distances,
stop every 30 minutes to stretch your legs and walk around to prevent blood clots.
- We will not provide letters to excuse you from wearing your seatbelt.
- We recommend that you do not travel outside the country for at least three months to avoid the potential issues of having a health problem outside the country that would result in a personal charge for health care.
- Discuss readiness for air travel at your appointment. It is highly recommended that you do not fly for at least 6 weeks after your surgery due to risk of blood clots.
- If you are coming from a far distance to have your surgery, speak to your coordinator about options for local accommodations and instructions around air travel.
If you have any of the following symptoms please call your living liver donor coordinator or go to the nearest emergency room.
- Fever (over 38C or 100F)
- Increasing redness or swelling around the incision
- Yellow skin or eyes (jaundice)
- Shortness of breath
- Uncontrolled pain
Call your living liver donor coordinator at 416 340 4800 ext. 6581
After you leave the hospital, your living liver donor coordinator will give you weekly phone call to make sure your recovery is going well.
When
About 1 month after your operation
Where
Ambulatory Transplant Clinic
Toronto General Hospital
Peter Munk Building – 12
th Floor
TGH Maps & Directions
Please check your appointment card for location.
What to Expect
You will be asked to have a blood test before you come to your appointment. You will meet with your surgeon to determine how your incision is healing and how well you are recovering.
When
3 months after your surgery, you will see your living liver donor coordinator and/or surgeon who assessed you pre-operatively for a check-up.
Where
Ambulatory Transplant Clinic
Toronto General Hospital
Peter Munk Building – 12
th Floor
TGH Maps & Directions
Please check your appointment card for location.
What to Expect
You will be sent a request to do a blood test 1 week before your scheduled appointment. This may be done at a lab close to your home if you live far from the hospital. You will also receive an MRI appointment time 1 week before the scheduled clinic appointment, which is done to confirm complete growth of the liver. The results of the blood test and MRI will be talked about at your clinic appointment.
Following your 3 month check-up appointment, you will be sent back to the care of your family doctor. It is suggested that you see your family doctor for a yearly liver check-up through blood tests.
The donor team will be on hand to talk about any concerns or answer any questions that you might have throughout the donation process.
To change an appointment, call the living liver donor coordinator at 416 340 4800 ext. 6581
