Dr Wong Jen San
Consultant Hepatobiliary & Pancreatic Surgeon
MBChB (UK), MMed (S’pore), MSc (S’pore), FRCS (Edin), FAMS
Liver transplants are life-saving procedures for individuals with severe liver diseases such as cirrhosis, liver failure, or certain types of liver cancer. They involve replacing a damaged liver with a healthy one from a donor.
There are two main types of liver transplants: living donor transplants, where a portion of the liver is donated by a living person, and deceased donor transplants, where the liver comes from someone who has passed away. To make the best treatment decisions and plan for a positive outcome, let us explore the key differences between these two options.
Liver Transplant From a Living Donor
A living donor liver transplant involves surgically removing a portion of a healthy person's liver and transplanting it into someone with liver failure. Thanks to the liver’s ability to regenerate, the donor’s remaining liver and the recipient’s transplanted portion can both grow back to normal size within about two months.
To be considered as a liver donor, individuals must meet several strict health and psychological criteria.
Age and Health Requirements
Donors must generally be between 18 and 65 years old. They need to be in good overall health, which includes maintaining a healthy body mass index (BMI) and having no history of serious medical conditions such as liver disease, diabetes or cardiovascular issues that could pose a risk during surgery.
Evaluation Process
The prospective donor, who is typically a family member or close friend of the recipient, will undergo a thorough medical and psychological evaluation. This process ensures they are physically and mentally suitable for the procedure and have given their informed consent to donate.
Liver Transplant From a Deceased Donor
Deceased donor liver transplantation utilises organs from individuals who have died, typically from brain death or cardiac death, and previously consented to organ donation. Singapore operates under the Medical (Therapy, Education and Research) Act (MTERA), under which all citizens and permanent residents aged 21 and above are automatically considered potential organ donors unless they choose to opt out.
Recipients of deceased donor organs are selected from waiting lists based on medical urgency, blood type compatibility, organ size matching and geographical proximity.
Key Differences Between Living and Deceased Donor Liver Transplants
Choosing between a living or deceased donor transplant involves weighing urgency, risks, costs and long-term outcomes. Consulting with a liver transplant specialist is essential to determine the most suitable path forward for both the recipient and, in the case of living donation, the donor.
Organ Availability
Singapore has a low deceased organ donation rate. This results in long waiting lists, with some patients waiting for months or even years for a suitable match. Living donor transplants completely bypass this issue. Since the surgery is planned, both the donor and recipient can be optimally prepared, greatly reducing uncertainty and wait times.
Risks
For living donors, surgical risks include bleeding, infection, bile leaks, and, in rare cases, serious complications such as liver failure. Most donors can gradually return to their normal activities after a recovery period of about 6 to 13 weeks.
For recipients, the usual transplant-related risks apply, including rejection, infection and surgical complications. However, receiving a liver from a healthy, carefully screened living donor often leads to better early outcomes compared to organs from deceased donors.
In contrast, the quality of organs from deceased donors can vary depending on factors such as the donor's age, medical history and cause of death. Additionally, longer cold ischaemia time (the period during which the organ remains outside the body) can affect graft function and increase the risk of complications, including primary non-function or biliary issues.
Recovery Time
Living donors generally need about two to six weeks for initial recovery, with most able to return to work within 6 to 12 weeks. On the other hand, recipients of deceased donor organs often face longer recovery periods, especially when the transplanted organ has experienced extended ischaemia times or comes from marginal donors. In such cases, complications may arise, potentially leading to prolonged hospital stays and delayed recovery.
Cost Considerations
Both types of transplants involve significant costs, although insurance coverage and government subsidies can help reduce the financial burden. Living donor transplants may have higher upfront expenses since they require two separate surgical procedures: one for the donor and one for the recipient. Patients are encouraged to consult with the hospital’s financial counsellors to better understand their coverage, available subsidies, and payment options.
Success Rates
In most centres, five-year survival rates for both types of liver transplants are above 80%. However, outcomes vary depending on factors such as the recipient’s overall health and the quality of the donor organ. Living donor transplants generally demonstrate better short-term outcomes, with higher one-year survival rates, lower rejection rates, and fewer complications compared to deceased donor transplants.
That said, over the longer term, deceased donor transplants may show a slight advantage, with survival rates edging higher at the five-year mark.
Choosing Between Living and Deceased Donor Liver Transplants
The decision to proceed with either a living or deceased donor liver transplant is complex and should be made in close consultation with a liver transplant surgeon.
Key considerations include:
Urgency of Treatment
Patients with rapidly worsening liver disease may benefit from a living donor transplant, as it reduces the risk of mortality while waiting for a deceased donor organ. Conversely, patients with more stable conditions may be able to wait safely for a deceased donor transplant. Donor Availability and Willingness
For living donor transplantation, family dynamics and the willingness of potential donors are crucial. Cultural and religious beliefs may also play a role in both living and deceased donor decisions. Ethical and Legal Guidelines
In Singapore, only altruistic donations are permitted. Commercial organ trading is strictly prohibited, and donations are generally limited to family members or individuals with a close personal relationship to the recipient.
Ultimately, both options have the power to save lives and give patients the chance of a healthy future, with excellent outcomes in the long run. Choosing the right option should involve a thorough assessment by an experienced transplant team, along with open discussions about the potential risks and benefits.
At our specialist clinic, led by Dr Wong Jen San, we provide personalised evaluations and guidance to help you make the decision that best suits your situation. To schedule an appointment, please call (65) 6235 4088 or email enquiry@liverpancreassurgery.sg.