The Living Liver Donor Evaluation

What is a living liver donor evaluation?

A living liver donor evaluation is a set of tests to make sure you are healthy enough to have donation surgery, and your liver is healthy enough for a portion to be given to help the recipient (person who needs a liver).

What is the donor evaluation process?

After you contact a transplant center about donating part of your liver and go through the pre-screening process, they will schedule your evaluation. It includes:

• Tests that help the living donor team assess your medical, mental, social, and financial health
• Meeting with an Independent Living Donor Advocate (ILDA) who will help you understand all the risks and benefits of donation

How long does the evaluation process take?

The evaluation may take several months. When it’s done, the living donor team will have a meeting (called a Selection Conference) to decide if you can donate. You can stop the process at any time if you decide living donation is not right for you. 

Who will I meet during the evaluation process?

You will meet your living donor team:

Transplant nurse coordinator is a registered nurse who educates and supports you throughout the process – from your first call to the transplant center, through the evaluation process, the donation surgery, and follow-up after surgery.

Transplant hepatologist is a doctor who specializes in liver diseases. To find out if your body is healthy enough and if donation will be safe for you, this doctor will ask about your medical and family history, do a physical exam, and review your medical tests.

Liver surgeon specializes in liver transplants and surgery of the liver, pancreas, gallbladder, and bile ducts. They will find out if your liver’s size and structure is safe for a portion to be removed.

Nutritionist will check your weight and eating habits, and help you learn about eating healthy foods to heal after donation.

Pharmacist will review your medicines and supplements and tell you if you need to stop or change any after donation.

Social worker, psychologist, psychiatrist will ensure that donating will be safe for you mentally, emotionally, socially, and financially, and will help you plan for the donation process.

Independent Living Donor Advocate (ILDA) is a health professional who protects your interests. They will:

• Make sure you want to donate – without pressure from anyone else. To put your interests first, the ILDA is never involved in the transplant recipient’s care
• Review the importance of follow-up after donation
• Help decide if you have enough social support for a successful recovery after donation

Based on your test results, you may also need to see other specialists.

Will my living donor team also evaluate my intended recipient?

No. Your living donor team is separate from your recipient’s team. This is to protect your privacy and make sure the recipient’s health does not change the team’s decision about your ability to donate. If your team decides you can’t donate or you decide donation is not right for you, your team will not reveal the reason to the recipient’s team

Which tests will I get during the evaluation?

Your evaluation will include medical tests and a psychosocial evaluation.

Medical tests

These medical tests check for health conditions that could raise your risk for liver disease or other health problems after donation:

Blood tests will check:

• Your blood type to see if it matches (is compatible with) your recipient’s blood type
• For any health problems such as anemia or blood clotting, electrolyte, heart, kidney, thyroid, liver, or autoimmune disorders
• To make sure you are not pregnant (if you are biologically a woman of childbearing age)

Urine (pee) tests will check for:

• Blood, protein, or bacteria in your urine that may be a sign of a health problem
• Marijuana or other drugs that may affect your ability to agree (consent) to the donor evaluation and donation surgery

Infectious disease tests will make sure you don’t have any disease that could spread to your recipient (infectious) such as syphilis, tuberculosis, hepatitis, HIV, or viral infections

Cancer screenings will make sure you don’t have cancer that could be given to your recipient. These may include screenings for:

• Women: cervical (pap smear), breast (mammogram), and colon (colonoscopy), depending on your age and how recently you’ve had these screenings
• Men: prostate (PSA) and colon (colonoscopy), depending on your age and how recently you’ve had these screenings
• Lung cancer (CT scan), depending on your age and health history

Chest X-ray will check for lung disease

Heart tests, which may include:

• EKG (Electrocardiogram) to check for a normal heart rhythm
• ECHO (Echocardiogram), an ultrasound of your heart to check that your heart is pumping blood properly
• Cardiac stress test to see if your heart works normally during physical activity

CT scan or MRI of your belly area to:

• Make sure your liver and other organs do not have problems that would prevent you from donating, such as too much fat in your liver, which may cause scarring and affect its ability to grow (regenerate) after donation
• See if your liver is big enough and has the right structure so the surgeon can remove part of it (either the right or left lobe) safely during donation surgery
• Liver biopsy, if the doctor or surgeon needs to check a small piece of your liver under a microscope

Based on these results, you may also need other testing.

Psychosocial evaluation

A psychosocial evaluation is an interview to make sure you have enough support for donation and to prepare for donation surgery. Usually, you will meet with a social worker, psychologist, or psychiatrist. They will:

• Discuss why you want to donate and make sure you are not being pressured
• Make sure you understand the risks and benefits of donation and possible outcomes for the recipient
• Talk about ways you can cope with emotional or physical stress after donation
• Tell you about possible financial effects of donation 
• Find out if you have any mental health issues that may be affected if you donate
• And they may contact a family member, friend, or mental health provider, to better understand if you have enough support to get you through the donation process 

You will also meet with the Independent Living Donor Advocate (ILDA), who will share information to help you make your best decision about donation without feeling pressured. They also support you if you or the living donor team decide not to move forward with donation.  

You are an important member of the living donor team

 Work with your living donor team and ask questions throughout the process so you can make the best decision about being a living liver donor.