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Anyone who is sound of mind, aged between 18 and 55 years old, clinically healthy in accordance with some very strict criteria established in living donor protocols and, after being informed of the risks and benefits associated with the donation process, still definitely wishes to be considered a liver donor.
The donor and recipient have to be compatible in terms of their blood group.
Most donors are relatives (parents, siblings, spouses, other relatives), but they may also be people with a close relationship with the recipient (friends, workmates). Donors must make their decision in the absence of any external pressures or coercion. A donated organ is a free gift. It is illegal to sell organs for transplant.
The age of the donor is not in itself a reason to contraindicate a transplant. In addition to their age, a potential donor should also be assessed in terms of their overall health, how well their organs function and the appearance of each organ at the time of their removal.
Donor–recipient compatibility is determined in function of blood group and body weight.
Blood group. The recipient of the liver and the donor must present a match according to the ABO blood group system. So patients with group A blood can only receive organs from donors with group A blood, for example. The blood group may be identical or only compatible in living-donor transplants. This means that a group A patient could receive a liver transplant from a donor with either group A or group O blood.
Body weight. The patient and donor must present a relatively similar body weight in order to ensure the portion of liver transplanted is neither too large (it might not fit into the recipient’s abdomen) nor too small (it might not be enough to keep the recipient alive / to last the recipient’s lifetime). This point is particularly important in the case of living-donor transplants because only one hepatic lobe can be harvested for transplant.
Women of childbearing age may lose their menstruation for some time after the transplant, but this does not mean they can never fall pregnant as they will continue to ovulate. It is very important that female patients do not get pregnant during the first year post-transplant. From 1 year on, the possibility of becoming pregnant should be assessed individually with your hepatologist and gynaecologist.
Patients have to take immunosuppressants for the rest of their lives. Over the years and depending on your state of health, your doctor may decrease the dose and quantity of immunosuppressive agents. The risk of rejection will always be present, however, in minoritary and selected cases, the medication may be withdrawn.
Yes, immunosuppressants have side effects that depend on the type of medicine and dose taken. The main effects are hypertension (high blood pressure), high blood sugar (diabetes), reduced kidney function, visual disorders, decreased reflexes, low blood cell count, high cholesterol, drowsiness and gastrointestinal irritation. Other less significant side effects are hair growth, tremors, headaches, acne, and redness and swelling of the gums.
Some patients may suffer a recurrence of the liver disease they had before the transplant, for example in the case of viral hepatitides, cholangitis, autoimmune diseases, etc. Therefore, it is important to follow the prescribed treatment correctly and contact your doctor at the first sign of any symptoms.
Transplant patients cannot receive live, or attenuated, vaccines (e.g., varicella, measles, rubella and oral polio vaccine) because they are immunosuppressed, in other words, their body’s defence mechanisms are low.
However, they can receive killed, or inactivated, vaccines or inert microbe vaccine: diphtheria, tetanus, pneumococcal, anti-hepatitis A and B. Patients should get an annual flu vaccination.
They are advised to contact their reference hepatologist before receiving any vaccinations.
Transplant patients can have pets. They should avoid any that can transmit diseases, such as exotic animals. The pets must be vaccinated and taken to the vet for annual check-ups. Patients must exercise thorough handwashing measures.
There is no average post-transplant recovery time; it always depends on each individual. Your doctor will authorise your discharge from hospital and you should be able to return to work gradually. You should not feel like someone who is ill, as you are now physically and psychologically prepared to follow a life similar to anyone else.