A living donor liver transplant is a surgery in which a healthy person donates a portion of their liver to someone who needs a transplant. Because the liver is the only organ that can regenerate, both the donor’s remaining liver and the transplanted portion grow back to functional size, typically reaching about 80% of original volume within the first six weeks. This makes it possible for one healthy liver to effectively become two.
Living donor transplants offer an alternative to waiting for a liver from a deceased donor. With over 103,000 people on the national transplant waiting list in the U.S., the demand for organs far outstrips the supply. For recipients, a living donor transplant means shorter wait times and the ability to schedule surgery before their condition deteriorates further. Outcomes are also slightly better: five-year graft survival for adult living donor recipients exceeds that of deceased donor recipients, according to the Scientific Registry of Transplant Recipients.
How the Surgery Works
Surgeons remove a portion of the donor’s liver, either the left lobe or the right lobe, and implant it into the recipient. Which lobe is chosen depends primarily on size matching. The left lobe is preferred when it’s large enough relative to the recipient’s body weight. The right lobe, which is bigger, becomes the choice when the recipient needs more liver volume, as long as removing it still leaves the donor with at least 30% of their original liver. The operation takes roughly six hours for each party.
Both surgeries happen simultaneously in adjacent operating rooms. Some transplant centers now perform the donor surgery laparoscopically, using small incisions and a camera rather than a single large cut. This approach has shown similar operative times to open surgery (around six hours) while offering a smaller scar and potentially faster healing.
Who Can Be a Donor
Not everyone who volunteers will qualify. The screening process is thorough, and transplant centers typically accept only a fraction of potential donors. General eligibility requirements include:
- Age: between 18 and 60
- BMI: below 32
- No significant organ disease such as heart or kidney disease
- No active cancer, hepatitis, or chronic infections
- No active substance abuse
Meeting these baseline criteria is just the starting point. The evaluation itself involves blood tests, urine tests, imaging scans (some requiring contrast injections), chest X-rays, heart monitoring, and a specialized liver function test. The process also includes a psychological assessment. Donating a portion of your liver is physically and emotionally demanding, so the transplant team screens for any risk of psychological harm during or after the process. The full evaluation can take several weeks to complete.
Risks for the Donor
Living liver donation is major abdominal surgery, and it carries real risk. A study published in the American Journal of Transplantation reviewing three decades of U.S. data found that about 1 in 1,000 living liver donors die within the first year after surgery. Six of those deaths occurred within 30 days of the operation. Early causes of death include bleeding, cardiac arrest, abdominal infection, and complications from pain management.
Beyond mortality, donors can experience complications like bile leaks, wound infections, blood clots, or temporary changes in liver function. Most of these resolve with treatment, but they can extend the recovery period. Transplant teams walk potential donors through these risks in detail before any commitment is made, and donors can withdraw at any point during the evaluation without consequence.
Recovery and Regeneration
Donors typically spend five to seven days in the hospital after surgery. The first few weeks at home involve significant fatigue and limited physical activity. Most donors can return to work six to eight weeks after the operation, though this depends on whether your job involves physical labor.
The liver’s regeneration is remarkably fast. During the first six weeks, the remaining portion grows back to about 80% of its original size. Growth continues more slowly over the following months, and by one year the liver reaches roughly 90% of its pre-surgery volume. The recipient’s transplanted portion follows a similar growth pattern. Functionally, both livers perform normally well before they reach their full regenerated size.
Outcomes for the Recipient
Survival rates after living donor liver transplantation are strong. Data from the Scientific Registry of Transplant Recipients shows that adult living donor recipients have better long-term graft survival than those who receive a deceased donor liver. At five years, graft failure occurs in about 16% of living donor recipients compared to roughly 20% of deceased donor recipients. The gap widens slightly at ten years. In pediatric transplants, the difference is even more pronounced: five-year patient survival reaches nearly 95% with a living donor compared to about 90% with a deceased donor organ.
Part of the advantage comes from timing. A living donor transplant can be scheduled electively, meaning the recipient is in better physical condition at the time of surgery rather than waiting until a deceased donor organ becomes available, which could take months or years. The transplanted portion also spends less time without blood flow, which reduces the risk of early graft injury.
Who Pays for the Donor’s Care
All medical costs directly related to the donation, including the evaluation, surgery, hospital stay, follow-up visits, and treatment of surgical complications, are billed to the recipient’s insurance. You won’t receive a bill for the transplant-related care itself.
There are costs the recipient’s insurance won’t cover, though. If the evaluation turns up an unrelated medical condition that needs further testing, that goes to your own insurance or comes out of pocket. Travel and lodging expenses during the evaluation period and around the time of surgery are also your responsibility. Some transplant centers have financial coordinators who can connect donors with assistance programs to help offset these costs, and the National Living Donor Assistance Center provides grants for travel and lost wages in certain cases.