Educational Information for Transplant Donors and Recipients

Yale-New Haven Transplantation Center provides recipients, donors and their loved ones with information to help them learn more about the transplantation process.

In addition, our multimedia health library, with its articles, videos, medical animations and more, provides information about hundreds of medical conditions, as well as treatment options. View our health library for information on kidney and liver transplantation.

Transplant Education

Finding a Living Kidney Donor


With more than 80,000 patients registered on the kidney transplant waiting list at the United Network for Organ Sharing in the United States, your physicians or care team may have encouraged you to search for a living donor. Asking your family and friends is the first step in finding a living kidney donor.

An Emotional Journey

There are many emotions associated with needing a transplant and finding a living kidney donor. Fear, sadness, pride, anger and nervousness are just some of the many normal emotions you may feel as you wait for a transplant and consider asking family and friends to donate. You may feel excitement about having more energy and returning to enjoyable activities after your transplant, but you may also feel anxious and worry about the health and recovery of your living donor. You may even feel disappointed and hurt that no one has offered to donate a kidney, or even too proud to ask. 

Once family and friends hear of your need for a kidney transplant, they may consider living donation, but, like you, struggle with a wide range of emotions. Some may be scared of the medical risks and recovery process, and others may even be ashamed that they don’t want to donate. Many though, are likely surprised that you haven’t asked them about living donation, and are unsure about how to approach you. All of these emotions are important to work through as you prepare yourself to ask this important question about living donation. 

Building a Support Team

Support from family and friends will be vital during your transplant process. Bringing everyone together to discuss your treatment options for a “team approach” gives family and friends the opportunity to decline living donation while still playing an important role in your wellness plan. Your support team can include everyone. If someone is not able to, or chooses not to pursue living donation, they may be able to help by keeping track of your medications, handling hospital transportation back and forth, or providing child care. You may also benefit by designating a family member or friend as a resource person who can gather information and help others during their review of your donation request. Your transplant coordinator can also help by providing pamphlets and handouts to help you prepare for this discussion. 

Before You Ask

Because relationships vary, it may be helpful to practice your conversation with your transplant coordinator or dialysis social worker, or even with someone you have already asked. Consider these questions before asking family and friends about living donation: 

  • Who and where will you ask? Is there a family leader you should approach first? Should you talk with certain people in private? Should you hold the conversation in a large group so no one feels pressured?
     
  • How will you ask? Will you have one-on-one conversations, send a group email or hold a group conversation?
  • When should you ask? It may be helpful to set aside a special time for this discussion. Holidays or other celebrations may not provide the best opportunity to have a serious conversation. 

During the Conversation

To help reduce tension and confusion, it may be helpful to make a few clear statements about your feelings and expectations at the start of the conversation: State that you do not want an answer or offer to donate at that moment. By sharing that you respect the depth of your question, you allow your family and friends to thoroughly consider their answer and not respond based on emotions alone.
  • Explain that you will not ask, or bring up the topic again. Let them know they can contact you or your transplant coordinator at 866-925-3897 for more information. By making this statement you let them know that your relationship, both now and in the future, is not based on their response.

  • Let them know that neither of you needs to evaluate medical risk or make medical determinations. Yale-New Haven Hospital transplant coordinators serve as a resource to anyone considering living donation. In addition, your family and friends can contact a coordinator without anyone knowing. Their questions and medical history are kept completely confidential.

  • Offer additional resources about living kidney donation that family and friends can review on their own, including www.donatelife.net. and www.livingdonorsonline.org

Learn More

People who are interested in learning more about the option of living donation should contact Yale-New Haven Transplantation Center at 866-925-3897. A transplant coordinator will share more information about living kidney donation including details about blood work and evaluations, risk factors, the donor surgical experience and recovery process.

Yale-New Haven Transplantation Center has earned a reputation of technical excellence, leading-edge research and a commitment to exceptional patient care that results in successful outcomes. A pioneer in living donor transplants, Yale-New Haven Transplantation Center’s team of world-class physicians and surgeons collaborate to provide comprehensive, expert and compassionate care for patients and donors.

What You Need to Know About Becoming a Donor

In 1954, the first living donor kidney transplant was performed between twin brothers. Since then, the field of living donor transplant has increased dramatically and in 2002, the number of living donor kidney transplants exceeded the number of deceased donor transplants for the first time. This is important since the waiting list for a kidney transplant continues to grow, requiring many patients to wait longer and longer for a kidney transplant.

The donor procedure performed at Yale-New Haven Transplantation Center is the total laparoscopic donor surgery. We are one of the few centers that perform this procedure regardless of which kidney (right or left) is being used or the anatomy of the kidneys. This type of surgery means donors experience less pain, less use of narcotic pain medication and a shorter time to return to work.

This guide will answer many of your questions about living kidney donation and review the process to become a donor. Our staff, physicians and surgeons are always available to speak to you and answer any questions you may have. Considering the idea of donating a kidney is a remarkable act of giving, and our goal is for you to be well informed about all aspects of living kidney donation.

Q. Who can be a kidney donor? Does a donor have to be a relative?

A. Anyone older than 18 years of age who wishes to donate can be considered for organ donation. Though there are persons greater than 70 years old who have donated, many elderly persons a disqualified due to other medical conditions or the status of their own kidneys. A kidney donor does not need to be a related to the recipient of the kidney transplant.

Q. How do I know if I am a match?

A. We perform extensive testing to assure that you are a good match. This testing includes blood type matching and more extensive testing called a crossmatch. If your crossmatch is negative, you are probably a good match.

Q. What is the evaluation process?

A. Once you have decided that you would like to donate, you will have blood testing, an electrocardiogram, a chest x-ray and urine testing. You will meet with one of our kidney specialists who will perform an independent medical evaluation and determine if you are healthy enough to donate. You will also meet with a donor advocate. If your kidney specialist feels that you are potentially a good candidate, you will likely need additional testing. This may include blood pressure monitoring, blood sugar analysis and a CT scan to examine your kidneys.

Q. What is a donor advocate?

A. A donor advocate will meet with you and advocate on your behalf. You can talk to your donor advocate about anything, especially if you are feeling pressured to donate or if you have decided not to donate but don’t know how to best express your wishes. At Yale-New Haven Transplantation Center, we maintain confidentiality of our donor information and will make accommodations that will alleviate you from the pressure you may feel.

Q. How do I get approved for donation?

A. Your approval for kidney donation is through an independent panel of medical specialists, social workers and nurse coordinators called the Donor Advocacy Panel. This panel will discuss all of your testing and make a determination about your ability to donate. It is important to know that your surgeon or the recipient’s surgeon is not involved in this panel because we consider it a conflict of interest.

Q. What are some of the reasons the Donor Advocacy Panel would not allow me to donate?

 A. The most common reason that the Donor Advocacy Panel would not allow you to donate is if your testing shows that you have a risk of developing conditions that could result in poor kidney function in the future. We certainly don’t want you to donate and then develop kidney disease. Other reasons could include active substance abuse, psychiatric problems or other conditions that could make donating risky for you.

Q. May I donate even if the Donor Advocacy Panel says no?

A. No. We will not let you assume that risk.

 Q. After I donate, will my other kidney grow larger?

A. Not exactly. The remaining kidney does increase function; it will provide 80 percent of the kidney function you had prior to donating.

Q. What are the possible complications of surgery?

A. The complications of surgery are similar to other abdominal surgeries, including bleeding, infections, wound drainage, hernia formation, bowel injury, deep vein thrombosis and conversion to an open procedure.

Q. What is the recovery time?

A. You will be in the hospital for about two days. We suggest that you set aside six weeks for recovery from surgery. If your operation cannot be done laparoscopically, your hospitalization will be longer and your recovery time will be longer as well

Q. Will I require a blood transfusion during my surgery?

A. Blood transfusion during this operation is very unusual, although it may be needed in the case of an emergency. We currently do not recommend donating your own blood before surgery, because the need is so rare, however, if this is something you wish to do, we can help arrange this for you. It will require donating your blood weeks prior to the scheduled surgery.

Q. When will I be able to drive after my surgery?

A. We advise you not to drive for at least the first two weeks after the surgery. Before you decide to drive, you must be physically and mentally strong, with normal reflexes. You must not be experiencing any abdominal pain or discomfort. Also, you should not be taking any narcotic medication such as Percocet or Tylenol with codeine, as these can affect your mental alertness.

Q. When can I begin to exercise?

A. As soon as you wake up from the anesthesia, you will begin “exercising.” You will need to take deep breaths and cough to make sure you are getting enough air into all the areas of your lungs. This will help prevent pneumonia. You will also begin to exercise the muscles of your legs by flexing and relaxing them periodically. You will be helped out of bed within 24 hours of your surgery and will begin walking. We cannot stress enough how important walking is to your recovery. Each day, you should be pushing yourself a little bit more. By walking as soon as possible after your surgery, you will help to prevent complications such as blood clots, pneumonia and muscle wasting. We encourage you to continue a program of daily walking when you are home.

Q. When can I lift weights, jog, swim, etc.?

A. You will need to avoid any heavy lifting for the first four weeks, until your abdomen has completely healed. You should not lift any weights greater than 10 lbs. After six weeks, if you are feeling well and are not having any complications, you may begin to return to your normal activities, such as swimming, jogging, aerobics, cycling, etc. Begin slowly and build up gradually. Be very cautious with abdominal exercises.

Q. Are there any dietary restrictions before or after surgery?

A. Generally, there are no dietary restrictions. We recommend that you drink plenty of fluids for the first few weeks following surgery.

Q. Should I stop smoking before surgery?

A. We strongly advise you to stop smoking. Even light smokers who stop smoking will realize benefits and smoother recovery following surgery. Heavy smokers will be ineligible to donate because of their increased risks.

Q. Should I stop drinking alcohol?

A. Heavy alcohol use is defined as greater than two drinks a day. We encourage you to limit your alcohol use during your evaluation process and surgery. After surgery you may consume alcohol only if you are completely off all narcotic pain medication.

Q. Should I stop taking my medication before the evaluation or the surgery?

A. You should not stop any prescription medication unless advised to do so by a physician. You should avoid aspirin or non-steroidal medication such as Advil or Motrin during the evaluation process and after kidney donation. Women who take birth control pills or pills for hormone replacement therapy will be advised to stop taking them because of the increased risk of blood clots during recovery from surgery. They may be resumed after three months.

Q. How soon can I have sex?

A. You will probably want to refrain from sexual intercourse for a couple of weeks until you have less discomfort and are feeling stronger. For the most part, this decision will be based on how you are feeling.

Q. If I want to start a family, how long should I wait after surgery to get pregnant?

A. There is no definite answer to this, but we recommend that you do not become pregnant for at least six months after surgery because you may be at a higher risk for a hernia to develop in one of your incisions if you become pregnant earlier.

Q. Will I be entitled to disability pay?

A. If your job provides disability coverage, we strongly suggest that you discuss this with your benefits department prior to surgery.

Q. Whose insurance pays for my part of the evaluation and the surgery?

A. As a donor, you should not incur any bills for the evaluation or surgery performed at Yale-New Haven Hospital. The recipient’s insurance should cover all the costs. However, your insurance may be billed to obtain a formal denial prior to charging the recipient’s insurance. If you receive a bill, please call our financial coordinator at 866-YALE-TXP.

Q. What is the follow-up after donating?

A. After surgery, we will see you the week after discharge and six weeks after discharge. You will be given a card with instructions to obtain tests from your local doctor. These tests must be sent to us at six months, one year and two years following the surgery. You will also meet with our kidney specialists at six months, one year and two years following your surgery.

How to Proceed as a Potential Living Donor

The sequence of steps to follow if you wish to explore the possibility of donating a kidney to a patient is as follows:

  1. Contact the kidney pre-transplant team directly at 866-YALE-TXP. You will be directed to one of our transplant nurse coordinators who will go through a brief questionnaire with you. A recipient or family member cannot contact our team; the individual who wishes to donate is required to call.

  2. You will be instructed to obtain preliminary blood tests to make sure you are a match with the potential recipient. If you live far away, we will send you information about how to obtain the blood samples for testing at Yale-New Haven Transplantation Center.

  3. If you match, you will be contacted by our kidney pre-transplant team member who will make an appointment for you to see one of our doctors specializing in kidney donation. You will also see your living donor advocate, who will explain his or her role in the living donor process and perform a psychosocial evaluation.

  4. During the process of evaluating you as a potential donor, we will emphasize education. We want you to be well informed about the process, procedure, risks and benefits. Your first meeting with a member of our surgical team will primarily be to educate you and perform a surgical evaluation.

  5. After your work-up is complete, it will be presented to the donor advocacy panel, which will make the decision about approval. Whether you are approved or not, you will be informed in writing within 10 days of the decision.

  6. If you have been cleared to donate, there will be a two-week waiting period for you to think through your decision before we proceed with surgery. This is designed to allow you to fully consider your decision and develop any additional questions.

  7. After this two-week waiting period you will see the surgical team again, who will answer any questions that you may have and get you ready for surgery. This visit typically occurs one week before the surgery.

Finding a Living Liver Donor

With more than 17,000 patients registered on the liver transplant waiting list at the United Network for Organ Sharing in the United States, your physicians or care team may have encouraged you to search for a living donor. Asking your family and friends is the first step in finding a living liver donor.

An Emotional Journey

There are many emotions associated with needing a transplant and finding a living liver donor. Fear, sadness, pride, anger and nervousness are just some of the many normal emotions you may feel as you wait for a transplant and consider asking family and friends to donate. You may feel excitement about having more energy and returning to enjoyable activities after your transplant, but you may also feel anxious and worry about the health and recovery of your living donor. You may even feel disappointed and hurt that no one has offered to donate a portion of their liver, or even too proud to ask. Once family and friends hear of your need for a liver transplant, they may consider living donation, but, like you, struggle with a wide range of emotions. Some may be scared of the medical risks and recovery process, and others may even be ashamed that they don’t want to donate. Many though, are likely surprised that you haven’t asked them about living donation, and are unsure about how to approach you. All of these emotions are important to work through as you prepare yourself to ask this important question about living donation.

Building a Support Team

Support from family and friends will be vital during your transplant process. Bringing everyone together to discuss your treatment options for a “team approach” gives family and friends the opportunity to decline living donation while still playing an important role in your wellness plan. Your support team can include everyone. If someone is not able to, or chooses not to pursue living donation, they may be able to help by keeping track of your medications, handling hospital transportation back and forth, or providing child care. You may also benefit by designating a family member or friend as a resource person who can gather information and help others during their review of your donation request. Your transplant coordinator can also help by providing pamphlets and handouts to help you prepare for this discussion.

Before You Ask

Because relationships vary, it may be helpful to practice your conversation with your transplant coordinator or social worker, or even with someone you have already asked. Consider these questions before asking family and friends about living donation:

  • Who and where will you ask? Is there a family leader you should approach first? Should you talk with certain people in private? Should you hold the conversation in a large group so no one feels pressured?

  • How will you ask? Will you have one-on-one conversations, send a group email or hold a group conversation?

  • When should you ask? It may be helpful to set aside a special time for this discussion. Holidays or other celebrations may not provide the best opportunity to have a serious conversation.

During the Conversation

To help reduce tension and confusion, it may be helpful to make a few clear statements about your feelings and expectations at the start of the conversation:

  • State that you do not want an answer or offer to donate at that moment. By sharing that you respect the depth of your question, you allow your family and friends to thoroughly consider their answer and not respond based on emotions alone.

  • Explain that you will not ask, or bring up the topic again. Let them know they can contact you or your transplant coordinator at 866.925.3897 for more information. By making this statement you let them know that your relationship, both now and in the future, is not based on their response.

  • Let them know that neither of you needs to evaluate medical risk or make medical determinations. Yale-New Haven Hospital transplant coordinators serve as a resource to anyone considering living donation. In addition, your family and friends can contact a coordinator without anyone knowing. Their questions and medical history are kept completely confidential.

  • Offer additional resources about living liver donation that family and friends can review on their own, including: www.livingdonorsonline.org. and www.donatelife.net.

About Living Liver Donation

Asking for a Donor Learn More People who are interested in learning more about the option of living donation should contact Yale-New Haven Transplantation Center at 866-925-3897. A transplant coordinator will share more information about living liver donation including details about blood work and evaluations, risk factors, the donor surgical experience and recovery process.

Yale-New Haven Transplantation Center has earned a reputation of technical excellence, leading-edge research and a commitment to exceptional patient care that results in successful outcomes. A pioneer in living donor transplants, Yale-New Haven Transplantation Center’s team of world-class physicians and surgeons collaborate to provide comprehensive, expert and compassionate care for patients and donors.

All You Need to Know About Becoming a Donor

Usually, organs for transplantation are obtained from deceased donors, after their families give permission. But there are not enough deceased donor organs available for everyone who needs one. As a result, increasing numbers of patients are being added to the transplant waiting list, where many become too sick to undergo the procedure, or die before a liver can be found.

More than a decade ago, surgeons began seeking ways to combat the organ shortage and save more patients. One approach, called living donor liver transplantation, involves surgically removing a portion of the healthy donor’s liver and using it to replace the recipient’s diseased organ, which is first entirely removed. These procedures were first performed using adult donors for children who needed transplants. In addition, surgeons developed methods of splitting a single cadaver liver in two so it could serve two recipients. Yale-New Haven Transplantation Center surgeons were at the forefront of both these surgical advances, and also pioneered living donor liver transplants in adult recipients.

Living donor transplantation is possible because the liver, unlike any other organ in the body, has the ability to grow back or regenerate. It regenerates over a very short period, ranging from several days to six to eight weeks. So when the surgeons remove a piece of the donor’s liver, the part that remains in the donor grows back to its original size.

Q. What are the advantages to living donor liver transplant?

A. The main advantage is that the patient does not have to wait for a liver to become available from the United Network of Organ Sharing (UNOS) waiting list and risk dying before one can be found, or face going into surgery in a much sicker, weakened state. The sicker a patient gets, the greater the chances that there will be complications during the early post-transplant period and the higher the risk of not doing well after transplant.

There may be some additional benefits. The transplant can be scheduled for a time that is medically best for the patient. Since living donors are usually young, healthy adults who have undergone a thorough medical evaluation, the quality of the liver itself may be better. Finally, preservation time (when the liver is without blood) is minimal; minutes, not hours.

Q. What are the possible complications of the donor’s operation?

A. As with any surgery involving general anesthesia, there are possible complications from the anesthesia itself, including heart problems, stroke and blood clot formation in the legs or lungs. There are also risks of bleeding or of bile leaks after surgery. There exists the possibility that the remaining portion of your liver will fail and you will need an urgent liver transplant yourself. There is even a risk that you might die.

While such complications are rare, they do happen, and we will discuss them with you in more detail during the evaluation. The most common complications of this surgery are small bile leaks from the remaining portion of your liver, minor wound infections and gastrointestinal upsets (such as constipation, indigestion, occasional nausea or diarrhea). These usually resolve after a couple of weeks, but may take several months.

Q. How much of the donor’s liver is removed?

A. The liver is divided into a right lobe and a left lobe. The division between the lobes permits surgeons to divide the liver into two distinct parts, which can function independently of each other. When the recipient is an adult, about 40-60 percent of the donor’s liver is usually removed, depending on which lobe is used. Because of its position on the underside of the liver, the donor’s gall bladder is also removed.

When the recipient is a small child, only a piece of the donor’s left lobe (called the left lateral segment) is removed. This segment is approximately 25 percent of the liver. The gall bladder remains intact.

Q. How much time has to pass between removing the piece of liver from the donor and transplanting it in the recipient?

A. Usually, the operations on the donor and the recipient take place at the same time. If the recipient has a liver tumor, he or she will be brought to the operating room first to determine if the cancer has spread outside the liver. If it has, the transplant procedure is cancelled.

Q. Can I be a living donor?

A. Generally, you should be between the ages of 18 and 55. If a donor is between the ages of 18 and 21, parental consent will be required. We prefer donors to be the same size or bigger than the recipient, but sometimes they can be smaller. You must not be pregnant. You should not be overweight, although if you are, you may still be considered a potential donor if you lose weight. You should not have any major medical or psychiatric illnesses. You must also be able to understand the risks of this surgery and be able to comply with our instructions for short- and long-term medical care follow-up.

Q. Do I need to be related to the recipient?

A. No, you do not need to be a blood relation, but because there are risks involved, it is recommended that you have a vital emotional relationship with the recipient. At the current time, “Good Samaritan” (i.e., anonymous) donations are not allowed.

Q. If I am related to the recipient, will he or she have less rejection?

A. In reported studies, there does not appear to be a lower risk of rejection if the donor is a blood relative. The relationship between donor and recipient also does not appear to affect the amount of immunosuppressive medication the recipient will need. You would probably need to be identical twins for the relationship between the donor and recipient to make a big difference.

Q. What is involved in the evaluation process?

A. The purpose of the evaluation is to make sure that your liver is normal and of adequate size, and that you do not have any medical or psychosocial issues that would make this procedure more risky or difficult for you. We also want to make sure you do not have a medical condition that could be transmitted to the recipient. Finally, we want to make sure that you are becoming a donor voluntarily, and that no one is pressuring you or paying you to do this.

Q. Will my recipient be removed from the UNOS transplant waiting list if I am evaluated?

A. No changes will be made to the recipient’s status on the UNOS waiting list until the time of transplant. If a recipient needs to be re-listed for a transplant within one year, previous waiting time can be credited.

Q. Will my evaluation be covered by medical insurance?

A. You should not incur any expenses related to the evaluation, surgery, hospitalization or immediate post-operative care. The majority of insurance carriers will approve a Living Donor Evaluation once the recipient has been accepted as a candidate for liver transplantation. Since most recipient insurance carriers will cover the donor’s medical expenses only for a short period of time, we strongly encourage you to have your own medical insurance coverage before becoming a living donor.

You may, however, incur some expenses for travel and for pain medication after the surgery. If you receive any medical bills related to the evaluation, surgery, hospitalization or immediate follow-up, you should forward them to the Living Donor Coordinator.

Q. May I get my evaluation done by my own doctor?

A. Given the extent of the surgery, it is better that our team perform all the tests and examinations. If you live far from our hospital, we can have some portions of the evaluation done locally, but you will still need to be examined by our physicians. For insurance and billing reasons, it is also easier if the evaluation is done at Yale-New Haven Transplantation Center.

Q. What is the first step in the evaluation process?

A. The first step is to know your blood type. This is a simple test that your doctor can do, or you can go to any blood donation center and they will check it for free. You must be either the same blood type as your recipient, or blood type “O”. Your Rh factor, positive or negative, does not affect your suitability to donate.

Q. What do I do once I know my blood type?

A. Call our Transplantation office at 203-785-2565 and advise the receptionist that you wish to discuss living donor liver transplantation. You will be put in touch with the Transplant Coordinator for the Living Donor Liver Transplant Program. We will do a brief health screening over the phone, and you will have a chance to ask questions. We will also request detailed demographic data (date of birth, address, etc.) and insurance information from you, and schedule an appointment for you with our Living Donor surgeon.

The surgeon will discuss living donor liver transplantation with you, including the potential risks and the statistics on the procedure at our hospital, elsewhere in the United States, and worldwide. After your meeting with the surgeon, you will be asked to sign a consent form to proceed with the evaluation. If you agree to proceed, we will schedule the living donor evaluation for you.

Q. What is the second step of the evaluation?

A. The living donor evaluation involves both medical and psychosocial assessments. The medical assessment will be done by the Living Donor hepatologist (liver specialist) and a cardiologist. The hepatologist will discuss living donor liver transplantation, take a full medical history and do a physical exam. The cardiologist will take a medical history and do an EKG, echocardiogram and sometimes a stress test. The psychosocial assessment will be done by the Living Donor social worker and a psychiatrist.

A routine evaluation also includes extensive blood work, a chest Xray, and an abdominal MRI to measure the volume of your liver and to look at the liver’s blood supply and its bile ducts. Other tests or consultations may also be necessary. A liver biopsy is required in some cases.

Q. Do I need to fast before my appointments?

A. In general, it is not necessary to fast before an appointment, unless we specifically tell you to do so.

Q. Should my family come with me to the appointments?

A. It is important to have your immediate family or next of kin come with you to visit the surgeon, hepatologist and social worker, so they can participate in the process and understand what is involved before you decide to proceed. All these appointments offer the opportunity for you and your family members to ask questions and learn more about the procedure, so you can make an informed decision. Your designated next-of-kin or your designated health care proxy (the person you have chosen to make treatment decisions for you if for any reason you are unable to make them yourself) must participate in the evaluation process and attend the final appointment before the scheduled surgery.

Q. How quickly will I know if I can be a donor?

A. Generally, within two weeks after you complete every component of the evaluation, the Living Donor Team will contact you about the decision. If you meet all the criteria to become a donor, you will need to allow at least two weeks’ reflection time before we will proceed with surgery. This is to give you time to think through your decision to donate part of your liver. It is not a decision you should make lightly. You should consider it very carefully and discuss it with your family.

Q. Who makes the final decision as to whether I can be a donor?

A. Once you have completed the evaluation, the Living Donor Team reviews all your information and makes a recommendation to the Transplant Team at the Donor Review Meeting, which brings together physicians, surgeons, transplant coordinators, radiologists and social workers. The Transplant Team as a whole makes the final decision to proceed. In our decision-making, we put the well-being of the donor ahead of anything else. Your safety is paramount.

Q. If I am cleared to be a donor, who decides when to do the transplant?

A. This decision is made jointly by the Transplant Team, by you and by the recipient. The Transplant Team, particularly the physicians involved directly in your recipient’s care, will determine as accurately as possible the best time to do the transplant, based on the recipient’s medical condition. Once we know this, we ask for your input as to what suits you best, within clinical limits. Usually, Tuesdays are reserved for living donor surgery, since we need to coordinate two operating rooms and two teams of surgeons, nurses and anesthesiologists.

Q. Will the recipient be involved in the donor evaluation process?

A. No. The donor evaluation is kept confidential. As a potential donor, you will have your own team of healthcare professionals, known as the “Donor Advocate Team.” The Donor Advocate Team will be separate from the recipient’s team and will not provide any information to the recipient or any of the recipient’s family members. As a potential donor, it is your decision how much information you wish to share. It is important that you have a support person, other than the recipient, to help you through the evaluation process.

Q. Should the cause of the recipient’s disease affect my decision to donate?

A. You are volunteering, with extraordinary generosity, to donate part of your liver in an attempt to save another person’s life. Before you make this decision, it is important that you understand how likely it is that your sacrifice will actually have that result. Some diseases (such as hepatitis C and cancer of the liver) can recur after transplant.

We will be discussing the recipient’s medical condition with you, what outcome we can expect from the transplant, and what possible additional complications, if any, may be associated with the recipient’s particular disease. Once we discuss all this information with you, only you can make the final decision. We expect that you will understand and respect the confidential nature of these discussions and will be sensitive to maintaining the recipient’s privacy in these circumstances. Your recipient will be aware that we need to have these discussions with you.

Q. Will I require a blood transfusion during my surgery?

A. Blood transfusion during this surgery is very unusual, although it may be necessary. As a precaution, we will ask you to “donate” one unit of your own blood 7-42 days before the surgery. If you do need a transfusion, we can then use your own blood, so you will not be exposed to the risks of a transfusion from someone else.

Q. Should I stop smoking before my surgery?

A. We strongly advise you to stop smoking, even if you are a light smoker. Heavy smokers will be ineligible to donate because of their increased risks.

Q. Should I not drink alcohol?

A. If you are going to be a liver donor, it is best that you stop drinking. If you have a history of alcohol use, it is very important that you tell our physicians. Alcohol use may not preclude you from being a donor, but you may need to undergo a liver biopsy to be sure your liver has not sustained any damage. You should refrain from alcohol use for eight weeks after donation, until your liver is presumed regenerated.

Q. Should I stop taking my medication before the evaluation or the surgery?

A. You should not stop any prescription medication unless advised to do so by a physician. You should avoid aspirin or non-steroidal medications such as Advil or Motrin for seven days before a liver biopsy or surgery. These medications affect the ability of the blood to clot and put you at higher risk for bleeding complications. Instead, you may take Tylenol if needed. Women who take birth control pills or pills for hormone replacement therapy will be advised to stop taking them because of the increased risk of blood clots during recovery from surgery.

Q. How long will I be off work?

A. The minimum amount of time you need to allow yourself to recover is 4-6 weeks. Because people recover differently, with varying degrees of fatigue and pain, you may need as long as 8-12 weeks. We prefer that you be in a position, both financially and from a job security perspective, to be able to take 12 weeks if you need that much time.

Q. Will I be entitled to disability pay?

A. If your job provides disability coverage, then you will most likely be covered. However, because living donor liver transplantation is still relatively new, it is best that you discuss this with your benefits department before you decide to proceed.

Q. How big is the incision?

A. The incision is a large one and is the same for the donor and recipient. It is called the chevron incision.

Q. Will I have a scar after the incision heals?

A. In most cases, the incision heals quickly, leaving a scar that fades over time but will most likely always be visible. If a wound infection develops, you may be left with a wider scar that will be more obvious. Occasionally, people develop what is called granulation tissue. This is over-growing or over-healing of the skin, and it results in a raised, wide scar. This can be corrected by plastic surgery if it bothers you, but it is unlikely that your recipient’s insurance would cover cosmetic surgery.

Q. Will I have much pain after the surgery?

A. Unfortunately, you will have significant pain after this surgery. We will give you pain medication, but you will still be very uncomfortable for at least the first week or so. You will have less pain as each day goes by, but most donors tell us that they still have a significant amount of discomfort for 2-4 weeks after the surgery. Most pain medication is broken down (metabolized) by the liver. Because you have a significantly smaller amount of liver volume right after your surgery, we will monitor you very carefully to make sure we are not giving you too much medication, because doing so could have serious side-effects.

Most pain medicines make you drowsy and can affect your breathing and bowel function. We will try to get the right balance of pain medication to make you comfortable but not drowsy, so you can do your deep breathing exercises, coughing and walking. We may use an epidural catheter inserted before surgery to administer pain medication after the surgery. The anesthesiologist will discuss this with you the morning of the surgery. You will get a prescription for pain medication to take at home before you leave the hospital.

Q. Will I need to take any medications after I donate a part of my liver?

A. You will not need any medications except for pain. If you develop a wound infection, you might need to take antibiotics.

Q. Will I have a normal life after surgery?

A. We expect that you will return to your normal activities within three months after your surgery, provided you do not experience any complications. We do not expect you to have long-term complications, but as this procedure is still relatively new, we cannot yet give you any statistics on the long-term follow-up of donors who have undergone this surgery.

Q. How soon can I have sex?

A. You will probably want to refrain from sexual intercourse for a couple of weeks until you have less discomfort and are feeling stronger. For the most part, this decision will be based on how you are feeling.

Q. If I want to start a family, how long should I wait after surgery to get pregnant?

A. There is no definite answer to this, but we recommend that you do not become pregnant for at least three to six months after surgery.

Q. When can I restart my birth control pills or hormone replacement therapy?

A. We advise you to wait for a minimum of three months after surgery.

Q. How long before my liver grows back to normal size?

A. The liver begins to regenerate almost immediately, with most of the regeneration occurring in the first two weeks after surgery. The expectation is that by eight weeks, your liver will be back to normal or near normal size.

Q. Would I be able to donate part of my liver again in the future to someone else?

A. No. Once you donate a portion of your liver, you cannot do so again.

Q. When will I be able to drive after my surgery?

A. We advise you not to drive for at least the first two to three weeks after the surgery. Before you decide to drive, you must be physically and mentally strong, with normal reflexes and not experiencing any abdominal pain or discomfort. Also, you should not be taking any narcotic medication such as Percocet or Tylenol with codeine, as these can affect your mental alertness.

Q. When can I begin to exercise?

A. As soon as you wake up from the anesthesia, you will begin “exercising.” You will need to take deep breaths and cough to make sure you are getting enough air into all the areas of your lungs. This will help prevent pneumonia. You will also begin to exercise the muscles of your legs by flexing and relaxing them periodically. You will be helped out of bed within 24 to 48 hours of your surgery and will begin walking.

We cannot stress enough how important walking is to your recovery. Each day, you should be pushing yourself a little bit more. By walking as soon as possible after your surgery, you will help to prevent such complications as blood clots, pneumonia and muscle wasting. You are encouraged to continue a program of daily walking when you go home. Remember, the goal is to be back to normal health and activity within two to three months.

Q. When can I lift weights, jog, swim, etc.?

A. You will need to avoid any heavy lifting for the first four weeks, until your abdomen has completely healed. You should not lift any weights greater than 10-15 lbs. After four weeks, if you are feeling well and are not having any complications, you may begin to return to your normal activities, such as swimming, jogging, aerobics, cycling, etc. Begin slowly and build up gradually. Be very cautious with abdominal exercises.

Q. When can I go on vacation or fly?

A. You should not plan any vacations or trips outside the U.S. for at least four weeks and preferably 8 to 12 weeks after your surgery. If you wish to return to your home state, you may be able to do so two to four weeks after the surgery, depending on how you feel and how you are recovering. Remember that if we have any concerns about possible complications, we will want you to return to Yale-New Haven Hospital for evaluation and treatment. It should not be a problem for you take trips or vacations after 8 to 12 weeks. 13.

Q. Once the transplant is scheduled, will it definitely happen?

A. A number of things might happen to delay or cancel the procedure. For example, a recipient’s condition might deteriorate to the point where his or her MELD score becomes too high for living donor transplant (MELD is the scoring system used to establish the patient’s position on the transplant waiting list). Or, the recipient may become too sick for a transplant. The recipient may develop an infection or some other condition that would need to be treated before the transplant could be performed. Finally, the recipient may be transplanted with a liver from a deceased donor, and not need a living donor.

Though it happens rarely, we may even need to postpone the transplant at very short notice (sometimes hours before). For instance, if we have a number of deceased donor transplants that same day, those transplants would take precedence over a living donor transplant. It is impossible to know when deceased donor organs will become available and when they do, they must be used within a short time. Or, if a recipient has liver cancer and we discover during the exploratory laparotomy that the cancer has spread, then we will not proceed with the transplant.

Q. Do I need to do any special preparation prior to surgery?

A. Once you have completed your evaluation and you decide to proceed, you will need to donate a unit of your blood within 7 to 42 days before your surgery. This blood will be stored in case you need a transfusion during surgery. We may also need to repeat some of your blood tests, if they were done more than 30 days before your surgery date. Do not take any aspirin, Advil or Motrin (non-steroidal) medication within seven days of your surgery. There will be a “final review” for you and your recipient and your immediate family two or three days before surgery. This will give you an opportunity to ask any remaining questions you may have.

Q. Do I need any special diet before surgery?

A. Yes. The day before the scheduled surgery, you will be on a clear liquid diet. You must stop drinking at midnight. If you regularly take any medications, we will instruct you about these when you come in for the final appointment before surgery.

Q. Will I need a bowel prep before surgery?

A. Yes. The evening before surgery you will need to give yourself an enema. This can be purchased at your local pharmacy in advance. A bowel prep is necessary to help decrease pain and constipation after surgery.

Q. Will I be admitted the night before surgery?

A. No. You and your recipient will be admitted to the hospital on the morning of the surgery. You will probably need to arrive at 6 a.m.

Q. What should I bring with me on the morning of the surgery?

A. Bring only minimal belongings, which can be given to your family when you go into the operating room. Because we already have your insurance information, there is no need to bring any documentation with you unless we specifically ask for it.

Q. How long will I be in the hospital?

A. The average hospital stay for donors is five to seven days after surgery.

Q. Will I be in the Intensive Care Unit after my surgery?

A. After your surgery, you will be taken to the Intensive Care Unit or the Recovery Room for close observation by the nursing and medical staff. You will remain in this area for two nights. Once we see that everything is stable and that you do not have any bleeding or other complications, you will be transferred to our transplant floor.

Q. Will I be in the same room as my recipient after the surgery?

A. No. You are intentionally separated from your recipient. We want you to focus on getting better and being comfortable. After you are transferred to the Transplant Unit, you may visit the recipient.

Q. How soon will I be able to eat and drink after my surgery? 

A. As soon as your intestines start to work again after the surgery, you will be able to begin to drink and eat again. We will know it is safe you to begin taking sips of water when you are passing gas. If you do not have nausea or vomiting with the sips of water, you will be able to progress to clear fluids, a soft diet, and then a regular diet within a few days. Occasionally, some individuals do not return to normal eating habits this quickly. The less pain medication used and the sooner you begin walking, the faster the bowels return to normal and diet resumes.

Q. Will I have any tubes or drains in me after the surgery?

A. You will have intravenous (IV) lines in you during and after the surgery so we can give you fluids to keep you hydrated and also give you medicine. One of these lines may be used to administer your pain medication after the surgery. You will also have a catheter (drainage tube) in your bladder so we can monitor how your kidneys are working during and after the surgery. Having the catheter in your bladder also means that you will not need to get up to go to the bathroom immediately after your surgery. You may also have one or two small drainage tubes in your abdomen to drain any blood or bile that might ooze after the surgery. When you wake up from surgery you will have a nasogastric (NG) tube in your nose to your stomach. This tube will remain in until we hear bowel sounds, usually the next day. The other tubes and intravenous lines will be removed within two to four days.

Q. Will I get injections of pain medication after the surgery?

A. We use a variety of methods to give pain medication. Sometimes, the anesthesiologist inserts an epidural catheter, which permits numbing medication to be administered directly into the spinal cord to prevent pain. Or you may also have what is called PCA (Patient-Controlled Analgesia). With PCA, you have an intravenous line attached to a computer-controlled pump. You press a button whenever you need pain medication, and the medicine is immediately administered directly into your vein. It is important to realize that you cannot overdose with this system, as the computer controls the amount of medicine you can give yourself. Once you are eating normally, we will switch you to a pill for pain medication. You should always let your nurse know if you are not getting enough pain relief.

Q. When will my sutures or staples be removed?

A. You will be given an appointment to return to the outpatient office approximately 10 days after your surgery to have your incision checked and have any sutures or staples removed. Sometimes, however, the surgeons will instead use strips of special tape called “steri-strips,” which will fall off when the incision is healed.

Q. Will I need to come back to the hospital for check-ups?

A. This procedure is major surgery, and we need to monitor you very closely at first to make sure everything is okay. You must come back for a wound check 10 days after your surgery. You will need another checkup at three to four weeks to evaluate how you are feeling. We would also like to you return to the Transplant office at three months, six months and 12 months after surgery. We will draw blood at each of those visits and at 12 months you will have a CT scan or MRI to check your liver. You may need other appointments as well, depending on how you are feeling. You should continue to have an annual physical exam with blood work with your primary care physician after being a living liver donor.

Q. Must I remain close to the hospital after my surgery?

A. You should remain close to YNHH for at least two to three weeks after your surgery. You also need to be able to return here if you experience any problems during your recovery. If you are from out of town or out of state, you may stay at our nearby Transplant Living Center (866-YALE-TXP). We recommend that you have a relative or friend stay with you, especially immediately after you leave the hospital.

Q. Will I need a nurse to take care of me when I leave the hospital?

A. Although this is a very big operation and you will be extremely tired and weak, you most likely will not need any professional nursing care at home. You will need a friend or family member to do your food shopping, perhaps cook your meals for you, and be available should you run into any difficulties. It is also nice to have some company when you first come home from the hospital. You should have someone available to take you to and from the hospital for your check-up.

Q. Who can I call if I have any additional questions?

A. Call the Transplantation Center at 866-YALE-TXP, and ask for the Liver Transplant Coordinator for the Living Donor program.

To be Evaluated as a Potential Living Donor

Here is the sequence of steps to follow if you wish to explore the possibility of donating part of your liver to a patient close to you who needs a transplant.

Please Note: Your recipient MUST have completed an evaluation as a candidate for a liver transplant and must be placed on the liver transplant waiting list before a donor evaluation can begin.

  1. Confirm your blood type.

  2. Study carefully the materials explaining living donor liver transplantation.

  3. Contact the Living Donor Liver Transplant Coordinator directly at 866.YALE.TXP, and complete a brief health questionnaire. If multiple donors are available, the Transplant Team can help in selecting the most likely candidate. A recipient or family member cannot contact the Living Donor office on your behalf.

  4. The potential donor will be contacted by the Living Donor Coordinator and scheduled for an initial appointment with our Living Donor surgeon. After your meeting with the surgeon, we want you to think about everything that was said and decide if you want to proceed with donation.

  5. If you decide to proceed, the second phase of the evaluation includes appointments with your Donor Advocate hepatologist, social worker, psychiatrist and cardiologist. Evaluation tests include extensive blood tests, MRI, chest Xray, EKG, echocardiogram and possibly a stress test. We may at this time decide that additional tests or a liver biopsy are necessary.

  6. Within one to two weeks after you complete the second part of your evaluation, we will make a decision on your candidacy as a living donor.

  7. Once you have been cleared as a donor, you will need to allow at least two weeks to think through your decision before we proceed with surgery.

  8. If you decide to proceed after your “reflective time,” we will discuss the timing of the transplant with you and the recipient.

  9. In most cases, we expect eight weeks to elapse between the beginning of a living donor evaluation and establishment of a date for surgery. In rare circumstances, a much faster evaluation can be done, but the longer time frame is deliberately used to allow you, the donor, ample time to consider and reconsider your decision.

In addition, our multimedia health library, with its articles, videos, medical animations and more, provides information about hundreds of medical conditions, as well as treatment options. View our health library for information on kidney and liver transplantation.