Living Liver Program Offers More Paths to Transplant

Your liver has hundreds of jobs, from filtering toxins to storing energy to making a protein your body needs to clot blood. It's essential. So when it’s damaged—by fatty liver disease, hepatitis, cancer, or another condition—the effects can be life-altering. In some cases, a liver transplant may be necessary for survival.

However, says Lindsay Meurer, MD, a WashU Medicine gastroenterologist and hepatologist at the WashU Medicine and Barnes-Jewish Transplant Center, “There are more patients in need of liver transplant than there are organs from deceased donors available. We’re doing our best to address this deficit and get people the lifesaving transplants they need.”

Living liver donation, a newly developed transplant program offered at the Transplant Center, is aiming to help close that gap.

At the Transplant Center, transplant physicians, including hepatologists—or liver specialists—surgeons, and nurse transplant coordinators, have dedicated their careers to treating patients who need a liver transplant. In 1985, WashU Medicine surgeons completed the first successful liver transplant surgery in Missouri and perform three times the number of liver transplants as the next-closest center. The care team at Barnes-Jewish Hospital and WashU Medicine continually advances treatments that help restore patients’ liver function and health. Living liver donation is one more procedure aimed at helping people access lifesaving organs.

Why living donation matters

In a deceased donor transplant—a transplant that uses an organ from someone who has passed away—the donor must be a registered organ donor or the family must give consent to donate their organs. The donor undergoes a medical evaluation, and if the organs are suitable for donation, a patient on the national waiting list who may be a match is identified. It’s a complex process, and, according to Mid-America Transplant, an organization that helps facilitate organ donation, only about 1% of registered donors are eligible to donate at their time of death. That’s because a specific set of criteria must be met for donation.

Living liver donation allows patients in need of a new liver to avoid a prolonged wait by identifying a family member, friend, acquaintance, or even an altruistic member of the community who is willing to donate a portion of their liver to them.

Living donors can give a portion of their liver because the organ can regenerate. (However, they can only donate once.) A couple of months after donation surgery, the liver can grow back to nearly its original size for both the donor and the recipient and, for most patients, functions just as well. Liver cells, called hepatocytes, can either expand to replace the part of the liver that’s removed or quickly multiply into more cells.

To determine how severe a patient’s liver disease is, the Transplant Center uses an algorithm called the Model for End-Stage Liver Disease (MELD) and assigns the patient a score. The higher the score, the greater the need for a transplant. However, Dr. Meurer says, there is a group of patients who are symptomatic and experiencing complications due to liver disease, but who have a low MELD score.

“In the context of the deceased-donor liver transplant wait list, these patients will wait for some time for a liver to become available,” Dr. Meurer says. “Unfortunately, during that period of waiting, there’s a risk of their liver disease progressing. The opportunity to offer a living-donor option to that specific group is really exciting because it improves survival by allowing for transplant in a timely manner.”

Added benefits of living-donor transplants include predictability. The surgery is an elective, scheduled procedure whereas if a patient is waiting for an organ from a deceased donor, they may get a call at any time, day or night.

“Having access to a liver transplant earlier can also save patients from struggling with symptoms of liver failure, keeps them from repeat hospital admissions, and all the other challenges that come with later-stage liver disease,” Dr. Meurer says. “Restoring their quality of life is profound for these patients, who immediately have this new lease on life.”

Support with every step

Although the liver can regenerate, the decision to become a living donor is a big one and, like any surgery, comes with a period of recovery. The Transplant Center thoroughly evaluates every potential living donor. Even after the evaluation process begins, potential donors are not obligated to proceed with donation and can decline to donate at any point before surgery. The Transplant Center assigns those interested in learning more about living donation their own coordinator, separate from the patient who needs a transplant. The coordinator will never disclose someone’s reason for not continuing in the evaluation process.

For patients facing liver disease and transplant, Dr. Meurer encourages them to reach out to family, friends, close contacts, and their community to explore possible living donor options.

“We underestimate the benevolent nature of our society,” she says. “In surveys, it’s striking how many respondents say if they were approached, they would be happy to consider becoming a living donor for someone in need.”

Living liver donation is a powerful option, one that offers hope and shortens the wait for some patients. It doesn’t replace the need for deceased donors, but it adds a critical option for patients with advanced liver disease. At the WashU Medicine and Barnes-Jewish Transplant Center, expanding access to lifesaving treatment through living liver donation reflects a continued commitment to advancing care.

For eligible patients and willing donors, it’s a new way forward.

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