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Donor hepatectomy is a surgical procedure in which part of the liver is removed from a living donor and transplanted to a patient with end-stage liver disease.

Donor hepatectomy is a surgical procedure in which some part of the liver is removed from a living donor and transplanted to a patient with end-stage liver disease.

The liver is the largest organ in the body that has the capacity to regenerate itself in one month and grows to full size in a couple of months after resection surgery.

A liver can be donated by anyone, although close family and friends as donors are preferred. Sometimes, the liver is taken from a brain-dead donor or dead person with a compatible blood group.

4 lobes of the liver

The liver is divided into four lobes that include:

1. The left lobe
2. The right lobe
3. The caudate lobe
4. The quadrate lobe

The larger right and left lobes can be seen from the front, and the smaller lobes—the caudate and quadrant lobes—are located under the right lobe.

The liver is further divided into eight individual segments (I to VIII) that guide the resection of the liver without damaging other segments or major blood vessels that pass through the liver. These segments are based on how the veins pass across various areas in the liver.

3 types of donor hepatectomies

Hepatectomy is of three types that include:

1. Left lateral hepatectomy: This is the removal of segments II and III with or without segment I.
2. Left hepatectomy: This procedure is the removal of the complete left lobe with segments I, II, III, and IV.
3. Right hepatectomy: Right hepatectomy is the removal of the right lobe with segments V, VI, VII, and VIII.

What are the risks of hepatectomy?

Complications following hepatectomy in a donor include:

• Possible allergic reactions to anesthesia
• Pain and discomfort at the surgical site
• Nausea
• Excessive bleeding during surgery that may necessitate blood transfusion
• Wound site infection
• Formation of blood clots
• Venous thromboembolism
• Pneumonia
• Respiratory failure
• Hernia
• Leakage of bile or issues with bile ducts
• Scar tissue formation
• Death may occur in very rare instances

Despite these complications associated with surgery, the donor will not have any long-term complications from hepatectomy.

• Because the liver regrows back to its regular size completely within a few weeks to months, the donor will not face any long-term issues.
• The donor, in fact, will live well knowing they helped a close relative or friend with end-stage liver disease who may have suffered from severe complications or even death in the absence of a liver transplant.

How is hepatectomy done?

In the past, hepatectomy was done as an open surgery; however, with advancements in medicine and techniques, hepatectomy is now performed through minimally invasive laparoscopic surgery.

Open surgery

• The donor is subjected to various tests and anesthesia assessments before the surgery to prevent unwanted complications.
• During the procedure, an incision is made on the donor’s abdomen, just below the rib cage. Depending on the patient’s needs, a part of the liver is removed without damaging any vessels attached to it. The remainder of the liver is sutured back in place before the incision is closed.
  • Recovery:
    • Because open surgery is highly invasive, the donor requires a seven-day hospital stay following surgery. The donor may experience pain at the incision site, which will be managed with pain medication. Close observation is necessary to look for evidence of liver repair and regeneration.
    • The donor must not put on weight more than five kilograms for at least eight weeks following discharge. The donor may be required to attend the hospital every week and take prescribed drugs. They must practice incision holding and leg motions as instructed.
    • The nicest thing about a liver transplant is that the donor's liver regenerates to about its original size in six to eight weeks. Donors generally show complete personal and professional healing after six to eight weeks.

Laparoscopic hepatectomy

• Laparoscopic surgery is a minimally invasive surgery that doesn’t require long incisions on the abdomen. Four small keyholes are made on the abdomen, and trocars (pointed surgical instruments) are inserted into the abdomen.
• Laparoscopic hepatectomy includes either partial hepatectomy or left lateral segmentectomy. The latest laparoscopic hepatectomy patients had shorter operating times and less bleeding.
  • Recovery:
    • According to the Estimation of Physiologic Ability and Surgical Stress score method, laparoscopic hepatectomy is less invasive than traditional hepatectomy.
    • Patients healed faster following laparoscopic hepatectomy, resulting in a shorter hospital stay.
    • Because it is a less invasive surgery, laparoscopic hepatectomy avoids the problems of traditional hepatectomy in appropriately chosen patients and improves patient quality of life.