Liver transplantation is the surgical replacement of a diseased liver with a healthy liver. The indication for this operation is end-stage liver disease, characterized by patients suffering from reduced liver function, muscle loss, fatigue, encephalopathy, signs of portal hypertension (see portal hypertension surgery), poor blood clotting and jaundice. A variety of liver diseases can lead to end-stage liver disease. There are generally two main categories: those cases caused by viruses (Hepatitis B and C) and/or alcohol and those caused by problems concerning the bile ducts (primary biliary cirrhosis and primary sclerosing cholangitis). There are other causes of end-stage liver disease, but they are less frequent. Prior to transplantation, a multidisciplinary liver transplant team evaluates potential liver recipients.
After an evaluation is completed, the patient is placed on the liver transplant waiting list with UNOS (United Network for Organ Sharing). The waiting time depends on the patient blood type, size and general medical condition.
There are different sources of donor livers. Usually the liver is obtained from a cadaveric donor (a person diagnosed as "brain dead" but whose other organs and systems are functioning properly). Due to a continuous shortage of donor livers and the high incidence of liver disease, the waiting time is increasing every year. Hundreds of people die each year while waiting for a cadaveric liver to be offered. Donor livers also can be obtained from a family member or a friend who donates a portion of his/her liver to the patient (see living-related donor).
In the case of a cadaveric donor organ, the transplant center receives a liver offer from UNOS for a specified patient. The patient is then notified and admitted to the hospital. While the donor team is procuring the donor liver, the recipient team begins to prepare the patient. The diseased liver is removed and the healthy liver is put in its place. The operation usually takes 6-8 hours. After the operation the patient begins taking medications to prevent the new liver from being rejected by the body. Complete recovery may take several weeks. The quality of life for transplant patients usually improves dramatically and most lead healthy, normal lives.