About 20% of patients on the liver transplant waiting list will die or become too sick before receiving a transplant. This grim statistic not only reveals the shortage of deceased donor livers available for transplant. It also points to a problem with prioritizing liver transplant recipients.
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Sadly, patients often struggle to gain priority on the transplant list because scoring guidelines (known as “model for end stage liver disease,” or MELD) are based on blood work alone. MELD scores range between 6 and 40. The higher the score, the higher the priority for a deceased donor liver.
What MELD doesn’t take into account
Many patients suffer from complications related to liver disease. For example, when liver disease advances, patients start having fluid in the abdomen, mental status changes or confusion, bleeding from a rupture of an enlarged vein in the gastrointestinal tract, and muscle wasting.
These serious problems don’t increase the MELD score. Thus, even when a patient has severe symptoms, if his or her MELD score is low, transplant organs will go to higher priority candidates.
“For patients with low MELD scores and severe symptoms, a living donor liver transplant is a potentially life-saving option because time is especially critical,” explains Koji Hashimoto, MD, PhD, Director of Living Donor Liver Transplantation and Pediatric Liver Transplantation.
Living donor liver transplant allows patients to get the organ they need before they become too sick to undergo a transplant.
Here, Dr. Hashimoto discusses some of the key advantages of living liver donation, and how to start the conversation if you’d like to pursue the option.
Q: What are the advantages of using a living donor?
A: The main advantages of a living donor include:
- Shorter wait times. Once you identify a living donor, you can schedule the transplant — before you get severely ill.
- More options for children. Compared with adults, children require smaller livers to fit their body size. But, there are few deceased donor livers available that would fit a child’s body. Since a small section of the liver is taken from living adult donors, this option offers more chances for young patients to get the right amount of liver needed.
- Lower rejection rates. While not yet proven scientifically, the rejection rate tends to be lower for livers from living donors, particularly if they are a blood relative. This is likely due to their similar genetic background.
- Longer-lasting organs: Livers from living donors tend to last longer than those from deceased donors, probably because donor livers from healthy and stable living donors have better quality compared with deceased donor livers.
Q: How easy is it to find a compatible living donor?
A: To be eligible, the donor must be a healthy adult between ages 18 and 60 who has the desire to save a life. (For children in need of a liver, adults up to age 60 may qualify to donate.) Also, the donor must not have a history of major health problems.
In addition, the patient’s blood type must be the same as or compatible with the donor. For example, when a recipient is blood type A, a donor has to be blood type A or O. Rh blood type (positive vs. negative) does not matter.
If you need a liver transplant, finding a living donor will be difficult if you are hesitant to ask for help.
Q: How should you start the conversation?
A: Start discussing your condition with family and friends shortly after your diagnosis. When people know about your situation, they are more likely to volunteer to help.
If you are shy to ask someone to be a donor, you can ask a friend or family member to help you look for a living donor.
Once you identify a potential donor, he or she should call your local organ donation office to schedule a qualifying phone interview.
Donors who qualify will need to complete an in-person living donor evaluation, which includes blood tests, imaging (CT scans and MRI), heart tests, etc.
Q: Can you use social media to spread the word?
A: If you want to reach out to people outside your immediate circle, try sharing your story on Facebook, Twitter or Instagram. Your post should include relevant details about your condition, with clear instructions on how to contact the donation office.
Your social media audience may be especially inclined to help children in need. To maximize the response, share your post with the public — not just your friends.
You may be pleased at the response you get. Thanks to liking and sharing features, a single social media post can yield a large number of volunteer donors.