How Does a Living Donor Liver Transplant Work?
Here is how a liver transplant is done from a live donor. Surgeons remove a portion of
the donor's liver usually the right lobe, about 60–65% and, in an adjacent theatre,
remove the recipient's diseased liver and implant the donated segment, connecting it to
the recipient's blood vessels and bile duct. The two operations run in parallel. Within
6–8 weeks both the donor's remaining liver and the recipient's new liver segment regrow
to full functional size. That regeneration is what makes a living donor liver transplant
possible.
The world's first living donor liver transplant was performed in 1989. In the decades
since, it has become a mature, standardised procedure carried out routinely at
high-volume centres including ours in Delhi NCR.
Living Donor vs Deceased Donor Transplant
Both procedures save lives; the right choice depends on your condition and whether a
suitable relative can donate.
A living donor liver transplant
- Planned, elective surgery, performed at the optimal time for the patient
- Shorter wait typically 2–6 weeks from donor clearance
- Fresh, thoroughly evaluated liver with no cold-storage preservation injury
- Lets the family take an active part in saving a loved one's life
- Depends on organ availability through NOTTO wait time is unpredictable
- Suits patients with no living donor, or whose relatives are not a match
- Prioritised by MELD score and medical urgency
In India, living donor transplants make up the large majority of all liver transplants
performed which is why deep experience in LDLT matters so much when you choose a
transplant centre. For a single donated organ shared between two recipients, we also
perform split liver transplantation, and for larger recipients a dual-lobe liver
transplant using grafts from two donors.
Who Can Be a Living Liver Donor? Donor Criteria & Requirements
Donating part of your liver is an act of love and courage. Donor safety is our absolute first priority we will not proceed with a donor who does not meet our safety criteria, whatever the urgency.
Criteria
| |
✔ Eligible |
✖ Not eligible |
| Age |
18–55 years |
Under 18 or over 55 (case by case) |
| Relationship |
First/second-degree blood relative or spouse |
Unrelated donors (barred in most cases under Indian law) |
| Blood group |
Compatible or ABO-incompatible with a special protocol |
Incompatible without desensitisation |
| BMI |
18–30 (healthy weight range) |
Over 30 higher surgical risk |
| Liver health |
No fatty liver, fibrosis or liver disease on imaging |
Fatty liver, existing liver disease or abnormal LFTs |
| General health |
No uncontrolled diabetes, heart disease or active cancer |
Serious systemic illness raising surgical risk |
| Mental health |
Psychologically assessed, willing, fully informed consent |
Coercion or inability to give informed consent |
Indian legal requirement
Under the Transplantation of Human Organs and Tissues Act (THOTA) 1994, liver donation in India is permitted only from close relatives (spouse, parents, siblings, children, grandparents) or with special committee approval from someone with a documented close emotional relationship to the recipient.
Even when a potential donor does not initially meet every requirement, our team explores every option including ABO-incompatible transplants with desensitisation and dual-lobe donation from two relatives to find a safe solution.
Who Qualifies as a Recipient? Recipient Criteria
The living donor liver transplant recipient criteria we assess include:
- Irreversible or end-stage liver disease cirrhosis, chronic hepatitis, or acute liver failure
- Liver cancer within accepted transplant criteria
- A MELD score confirming transplant need, assessed alongside cardiac and pulmonary fitness see our post-transplant monitoring and follow-up programme
- No active, uncontrolled infection or other condition that would make surgery unsafe
The Donor Evaluation Process
Every potential donor undergoes a comprehensive, independent, multi-disciplinary evaluation. The donor's interests are protected separately from the recipient's care team. Assessments include:
-
Blood tests:
Full blood count, liver and kidney function, coagulation, blood group and cross-match, viral hepatitis, HIV, CMV, EBV
-
Liver imaging:
Triphasic CT or MRI to map anatomy, liver volume and vessels and to rule out fatty liver
-
Cardiac & pulmonary:
ECG, echocardiogram, chest X-ray, lung function and anaesthesia review
-
Psychological evaluation:
To confirm voluntary, fully informed consent and rule out coercion
-
Surgical planning:
3D volumetric analysis to confirm the graft is enough for the recipient while leaving the donor a safe remnant
The full donor evaluation takes a minimum of 2–3 weeks. If a donor is found medically or psychologically unfit at any stage, the assessment stops and alternatives are explored.
The Living Donor Liver Transplant Procedure & Surgery
The living donor liver transplant procedure involves two simultaneous operations: one for the donor and one for the recipient, performed by Dr. Ashish George and the team in adjacent, state-of-the-art theatres.
The donor surgery
- Right lobe (≈60–65% of the liver) removed via advanced open or laparoscopic technique
- Surgery duration ≈ 6–8 hours; hospital stay 7–10 days
- The remaining left lobe maintains normal function and starts regenerating immediately
The recipient surgery
- Diseased liver fully removed (hepatectomy); donor segment implanted and reconnected
- Surgery duration ≈ 8–12 hours, one of the most technically demanding operations in surgery
- The new liver typically begins working within minutes to hours
After surgery, recipients begin immunosuppressive therapy to prevent rejection, supported by close follow-up. Children needing a transplant are cared for through our paediatric liver transplant programme, and patients with combined liver and kidney failure may be evaluated for a combined liver and kidney transplant.
Risks of a Living Donor Liver Transplant
A living donor liver transplant is a major operation, and being clear about the risks is part of informed consent. In experienced, high-volume centres these risks are low and carefully managed.
For the donor: bleeding, infection, bile leak, or a longer-than-expected recovery. Serious complications are uncommon, and long-term studies show donors return to the same life expectancy and quality of life as the general population.
For the recipient: rejection, infection, bile-duct or vascular problems, and side effects of immunosuppression; most of which are treatable when caught early through structured monitoring.
Choosing a team that performs a high volume of living donor liver transplants is the single biggest factor in keeping these risks low.
Living Donor Liver Transplant Survival & Success Rates
In experienced centres, the live donor liver transplant survival rate is excellent. Our one-year success rate for living donor liver transplant is above 95%, and most recipients return to normal life within 3 to 6 months. The success rate of a living donor liver transplant depends on the recipient's condition, graft quality and the surgical team's experience, which is why centre selection matters.
- 95%+ one-year success rate for living donor transplants at our centre
- Donor mortality is very low and among the lowest-risk major operations donors undergo
- Most recipients resume work and daily activity within 3 to 6 months
Recovery After Living Donor Liver Transplant
Recovery for the donor
- Hospital stay 7–10 days; light activity within 2–3 weeks
- Full return to work and normal life in 4–6 weeks for most donors
- The remaining liver regenerates to ~95% of its original size within 6–8 weeks
- Follow-up at 1 week, 1 month, 3 and 6 months, then annually
Recovery for the recipient
- Liver ICU monitoring 3–5 days; total hospital stay 14–21 days
- Lifelong immunosuppressive medication with regular blood tests and imaging
- Return to work and daily activities typically in 3–6 months
- Balanced, low-salt diet and no alcohol, ever
