World Organ Donation Day 2024 Guidelines For Live Liver Donors

In India, the law allows relatives — either close or distant—of a patient in need of a liver transplant to donate a part of their liver. Generally, donors are between 18 to 50 years of age, although in certain situations, the upper age limit can be relaxed. Individuals below 18 can’t donate their organs," says Dr Rajiv Lochan.

The doctor points out that donors must be in good physical and mental health, and their blood type should be compatible with the recipient. While incompatible transplants are possible, they are less common and are indicated in certain situations only. "People with chronic diseases like diabetes or other liver ailments aren’t eligible for donation. However, minor illnesses, like well-controlled hypertension (on a single tablet) and hypothyroidism, are not necessarily a contraindication and individuals with such ailments can still donate a part of their liver," says Dr Lochan.

"In our Unit, all Live liver donors undergo an interview with our transplant coordinator, followed by a psychosocial assessment. They are then reviewed by the liver transplant team, mainly surgeons and hepatologists," says Dr Lochan.

He adds that donors also complete a detailed health questionnaire to identify any unknown aspects of their health and lifestyle that might increase their risk. These factors are critical, as donor safety is paramount in such an endeavour. "After these assessments, donors undergo a comprehensive medical examination and consultation with the transplant team. This includes a 5-stage evaluation - blood tests, a CT scan to assess liver anatomy, volume and quality of the liver, and subsequently, a cardiopulmonary evaluation. Once the donor is matched with the recipient, the risks and benefits are carefully discussed in an attempt to achieve “tripartite equipoise” where donor safety is paramount, the recipient needs are met and optimum recipient outcome is achieved," says Dr Lochan.

The primary concern is the safety of the donor, as the operation poses no direct health benefit to them, apart from the satisfaction of helping the recipient achieve good health and a better quality of life for numerous decades, says the doctor. He adds that the aim (and the challenge) of the treating team is that in pursuit of this recipient's need, "we do not compromise donor safety and autonomy (the ability to withdraw consent from the donation at any time and that there is no undue pressure ie the donation is entirely voluntary) and also recipient outcome is not impaired."

Another important step is to discuss the decision to donate with an independent counsellor – this could be a close relative, a friend, or an individual physician acting as a donor advocate, separate from the transplant team. "This aims to address the emotional and psychological aspects of donation, including the potential outcomes for the recipient," says Dr Lochan.

Regarding legal and ethical considerations, hospital coordinators, surgeons, and hepatologists will discuss and guide you through informed consent and the rules under the Human Organ Transplant Act, which regulates live liver donation in India.To prepare for the donation, there are three specific aspects to focus on. Dr Lochan lists the following points:

Healthy Diet: In the weeks leading up to the transplant, focus on a balanced, nutrient-rich diet. Avoidance of carbohydrates and sugar, which can lead to fat accumulation in the liver, is extremely important. A diet high in protein with moderate or low fat and minimal carbohydrate is recommended. Scientific evidence promotes such dietary recommendations for optimal health before the donation.

Regular Exercise: Maintain a regular exercise routine to boost fitness and maintain or develop resilience and endurance. Walking for 20 - 30 minutes 4 - 5 times a week is beneficial. Moderate cardiovascular exercise 3 - 4 times a week, in consultation with the medical team, is also recommended.

Avoid Alcohol and Tobacco: It’s extremely important to avoid alcohol and tobacco in the weeks or months leading up to the donation and to continue this for many weeks or months post-operation.

Handling financial and practical considerations, such as insurance and work leave arrangements, are also important. Building a strong support network with family and friends is key, experts advise. "Connect with others who have undergone the donation process to gain valuable information about the hospital stay and recovery. The treating team will be able to help with this. Don’t hesitate to ask questions to your medical team. Being well-informed and educated about the entire process is the key to navigating the transplant journey," says Dr Lochan.