47142 Donor hepatectomy (including cold preservation), from living donor; total right lobectomy (segments V, VI, VII and VIII)

Name of the Procedure:

Donor Hepatectomy (Including Cold Preservation), from Living Donor; Total Right Lobectomy (Segments V, VI, VII, and VIII)

• Common Names: Living Donor Liver Right Lobectomy, Right Lobe Hepatectomy

Summary

Donor hepatectomy involves the surgical removal of the right lobe of the liver from a living donor, intended for transplantation into a recipient. This procedure includes cold preservation techniques to maintain the viability of the liver tissue before transplantation.

Purpose

The procedure addresses severe liver diseases in recipients, such as cirrhosis or liver failure, by providing a healthy liver segment from a live donor. The goal is to improve the recipient's liver function and overall health through liver transplantation.

Indications

• End-stage liver disease or liver failure in the recipient.
• Cirrhosis, liver cancer, or other severe liver conditions in the recipient where transplantation is deemed necessary.
• Suitable living donor with compatible liver anatomy and no contraindications.

Preparation

• Pre-procedure fasting for at least 8 hours.
• Adjustment or discontinuation of certain medications as advised by the healthcare provider.
• Comprehensive evaluation of both donor and recipient, including blood tests, imaging studies, and psychological assessments.

Procedure Description

1. The donor is administered general anesthesia.
2. A surgical incision is made in the upper abdomen to access the liver.
3. The right lobe of the liver (segments V, VI, VII, and VIII) is carefully dissected and separated from the rest of the liver.
4. Blood vessels and bile ducts supplying the right lobe are meticulously divided and secured.
5. The removed liver segment is cooled and preserved in a specialized solution until it is transplanted.
6. The donor's remaining liver is examined to ensure proper function and hemostasis before the surgical site is closed.

Duration

The procedure typically takes between 4 to 6 hours.

Setting

The procedure is performed in a hospital operating room specifically equipped for transplant surgeries.

Personnel

• Transplant surgeon
• Assistant surgeons
• Anesthesiologists
• Surgical nurses
• Operating room technicians

Risks and Complications

• Common risks: Infection, bleeding, bile leaks.
• Rare complications: Liver failure in the donor, thrombosis, organ rejection in the recipient.
• Pain management and infection control post-surgery are crucial.

Benefits

• The recipient receives a healthy liver segment to replace their diseased liver, significantly improving their liver function and overall quality of life.
• Donors generally experience liver regeneration, with their remaining liver regrowing to near-normal size in a few months.

Recovery

• Donors may need to stay in the hospital for about 1 week post-surgery.
• Full recovery typically takes about 6 to 8 weeks, with restrictions on heavy lifting and strenuous activities.
• Follow-up appointments are necessary to ensure proper healing and liver function.

Alternatives

• Deceased donor liver transplantation.
• Medication management and supportive treatments for liver disease.
• Liver dialysis (short-term).

Pros and Cons:

• Deceased donor organs may have longer wait times.
• Living donor transplantation offers immediate availability and planned surgery, but involves risks to the donor.

Patient Experience

• Patients experience significant postoperative pain, which is managed with medications.
• Donors may feel weakness and fatigue during the early recovery phase.
• Psychological support may be beneficial due to the emotional aspects of the donation process.