Living Liver Donation to a Stranger

What is living liver donation?

Living liver donation is a process where you donate part of your liver to someone whose liver no longer works well (the recipient). Your liver is the largest organ in your body and can regrow (regenerate), so you can safely donate one part (or lobe) of your liver to someone else. You can learn more in Chapter 2 about why to consider being a living liver donor.

What is a non-directed living liver donor?

A non-directed living liver donor is a person who donates part of their liver to a recipient they do not know (a stranger). Other names for non-directed living donors are anonymous donors, altruistic donors, or good Samaritans.

Most liver donations are directed, which means the donor donates to a recipient they know, or know of, such as reading about them in social media.

Non-directed liver donations save lives

Non-directed liver donations:

• Allow a recipient who has no living liver donor to get a liver transplant
• Give healthy parts of livers to children who need transplants

Non-directed donations can help more than one recipient

An exchange program, called a paired donation or a donor chain, allows one donor to help more than one recipient. Here’s how it works:

• Paired donation (or a paired exchange program):

  1. A recipient and their donor are not a good match in size or blood type

  2. This recipient and donor enter a paired exchange program

  3. The program matches them with another recipient donor pair – each of the recipients is a good match with the others’ donor

  4. These 2 recipients swap donors through the paired exchange program, so each recipient gets a better matched liver transplant. This is called a 2-way swap  

• Donor chain:

  1. A group of recipients have donors who they do not match with and are unable to find a 2-way swap through a paired donation

  2. A non-directed donor enters the exchange program. They match with and donate to one of these recipients. Then, this recipient’s original donor donates to another recipient. This starts a chain

  3. The chain continues as each recipient’s original donor donates to another recipient. This helps multiple recipients get transplants 

How do I become a non-directed living liver donor?

To start the donor process:

1. Find a transplant center that does non-directed donations (not all transplant centers do). You can find a list on the United Network for Organ Sharing (UNOS) website. You want to work with a transplant center that has experience in non-directed donation to make sure the process is successful

2. You will have a full evaluation by a living donor team to make sure you are healthy enough to donate. The evaluation will include medical tests and you will be paired with a person called an independent living donor advocate (ILDA). This person’s role is to support you through the living donor evaluation process and your donation decision

3. If you choose to do non-directed donation, the living donor team will pair you with a recipient on their waitlist who is a good match 

Will the recipient who gets my liver find out who I am?

You may or may not meet your recipient in a non-directed donation. There is no law requiring donors to remain anonymous (where the recipient does not know who you are), which means you can choose to share your identity with your recipient. But many transplant centers ask you to wait for a period of time after donation before sharing your identity with your recipient. This is so that you can make your own informed decision about donation and to protect your privacy.

If you decide to share your identity with your recipient (called breaking anonymity), they can choose if they do or do not want to share their identity with you. Each transplant center has its own guidelines about breaking anonymity. 

Can I donate a part of my liver if I already donated a kidney?

Doctors don’t yet know enough about the long-term safety of donating part of your liver after donating a kidney. There are only a few reports of liver donors also donating a kidney.

The surgery for non-directed living liver donation is very different from living kidney donation surgery and you should not compare them to one another. The transplant surgeries for these different organs each have different risks and recovery.

How can I learn more?

To learn about the evaluation process, see Chapter 1 on the living liver donor evaluation.

To learn about donation surgery, see Chapter 4 on surgery for living liver donors.