Living liver donation is a surgical procedure where a healthy person has a portion of their liver removed and transplanted into someone whose liver is failing. The donor’s remaining liver regenerates to near-full size within weeks, and the transplanted portion grows to full size inside the recipient. In 2022, 603 living-donor liver transplants were performed in the United States, making up about 6% of all liver transplants that year. The other 94% came from deceased donors.
The need far outstrips supply. At the end of 2022, more than 10,500 people were on the liver transplant waiting list. Living donation exists in part to close that gap, offering recipients a planned surgery with a healthy organ rather than an unpredictable wait.
Why the Liver Can Be Donated While You’re Alive
The liver is the only internal organ that can regenerate itself. Surgeons remove a section of the donor’s liver (typically the right lobe, which is about 60% of the organ) and transplant it into the recipient. Both the remaining piece in the donor and the transplanted piece in the recipient then grow back to functional size. Most of this regrowth happens within the first few weeks after surgery, though full regeneration can take a few months.
This regenerative ability is what makes living donation possible at all. No other solid organ works this way. A kidney donor, by contrast, simply lives with one kidney for life.
Who Can Donate
Not everyone who volunteers will qualify. The evaluation process is thorough and designed to protect the donor’s health above all else. Basic eligibility requirements include:
- Age: 18 to 65 years old
- Overall health: No major medical or psychiatric conditions
- Body weight: Not overweight, though candidates who lose weight may be reconsidered
- Smoking status: Nonsmoker, or willing to quit at least six weeks before surgery
- Not pregnant
- Medications: Must be able to stop birth control pills at least six weeks before surgery
You don’t need to be related to the recipient, but you do need a compatible blood type. The matching rules follow standard transfusion logic: type O donors are universal and can give to any blood type, while type AB recipients can receive from any donor. Type A can donate to A or AB recipients, and type B can donate to B or AB recipients. Rh factor (positive or negative) does not play a significant role in organ compatibility the way it does with blood transfusions.
Beyond the physical screening, transplant teams also evaluate your psychological readiness. They verify that you genuinely want to donate and that no one is pressuring or coercing you into the decision. This is taken seriously, and the evaluation includes private conversations without the recipient or their family present.
The Evaluation Process
If you pass the initial screening, the transplant center runs an extensive series of tests. These typically include blood work, imaging scans of your liver to map its anatomy, heart and lung function tests, and a psychological assessment. The goal is twofold: confirm that your liver is healthy enough to split and that the surgery won’t put your long-term health at risk.
The evaluation can take several weeks to complete. Not everyone who starts the process finishes it. Some potential donors are ruled out because of unexpected findings during testing, like a liver that’s too fatty or blood vessels arranged in a way that makes safe division difficult. This is a normal part of the process, not a failure.
What Happens During Surgery
The donor operation is major abdominal surgery, typically lasting four to six hours. Surgeons make an incision across the upper abdomen, carefully divide the liver along natural anatomical lines, and remove the section designated for the recipient. The surgical team works to preserve the bile ducts and blood vessels that will remain with the donor’s portion.
Meanwhile, the recipient’s surgical team is often working in a nearby operating room, removing the diseased liver and preparing to implant the donated portion. The timing is coordinated so the donated liver segment spends as little time as possible outside a body.
Recovery Timeline
Expect to spend five to seven days in the hospital after surgery. The first few days involve pain management, monitoring for complications, and gradually getting back on your feet. Walking short distances usually starts within a day or two of surgery.
After discharge, recovery takes an additional six to eight weeks. During that time, you shouldn’t lift anything heavier than 10 pounds for at least six weeks. Most donors can return to work in the six-to-eight-week range, though that depends on how physically demanding the job is. Desk work is realistic sooner than construction or nursing.
Your liver will be regenerating throughout this period. Most donors report feeling significantly better by the six-week mark, with energy levels gradually returning to normal over the following months.
Risks and Complications
Living liver donation is considered safe, but it is not risk-free. The reported rate of complications like infections, incisional hernias, and bowel obstruction ranges from 9 to 19% across studies. Wound-related complications are the most common, occurring in roughly 8% of donors. Bile duct leaks are another known risk, sometimes requiring additional procedures to resolve.
Psychiatric complications, including depression and anxiety after surgery, occur in about 2 to 14% of donors depending on the study. Some of this is related to the physical recovery itself, and some is tied to the emotional weight of the experience, particularly if the recipient doesn’t do well.
Death from living liver donation is rare but has occurred. Estimates place the risk at roughly 1 to 2 per 1,000 donors, though the exact number varies by center and study. This is the single most important risk to understand before deciding to donate.
Who Pays for It
The recipient’s insurance typically covers all medical costs related to the donation. That includes your evaluation, hospitalization, surgery, follow-up appointments, and treatment of any surgical complications. You should not receive medical bills for the donation itself.
There are gaps, though. If the evaluation process uncovers a health issue unrelated to donation (say, a thyroid nodule found on imaging), any testing or treatment for that condition gets billed to your own insurance. You’re also responsible for travel, lodging, and lost wages. Some recipients’ insurance plans cover donor travel costs, but many do not.
If travel expenses aren’t covered, you can apply to the National Living Donor Assistance Center for reimbursement. It’s worth asking the transplant coordinator about this early in the process so there are no surprises. The financial reality of taking six to eight weeks off work is, for many potential donors, a bigger barrier than the surgery itself.
Living Donation vs. Deceased Donation
Most liver transplants in the U.S. still come from deceased donors. In 2022, nearly 8,900 of the roughly 9,500 liver transplants performed used organs from people who had died. Living donation is growing but remains a small fraction of the total.
Living donation offers some advantages for the recipient. The surgery can be scheduled electively rather than performed as an emergency when an organ becomes available at 3 a.m. The organ spends less time without blood flow, which generally improves outcomes. And it shortens or eliminates the wait, which matters when someone is getting sicker by the month.
For the donor, the tradeoff is real: a major surgery with weeks of recovery and a small but nonzero risk of serious complications, all for someone else’s benefit. Transplant teams are transparent about this, and the evaluation process is specifically designed to ensure every donor goes in fully informed and freely willing.