Heart Transplantation

Living Liver Donation

Living donor liver transplantation, made possible by the unique ability of the liver to regenerate within 6-8 weeks, is a life saving procedure.

Potential living liver donors are carefully evaluated. Only those individuals who can donate a portion of liver that will likely function immediately are selected.

Since the health and safety of the donor is of paramount concern during the evalution, only those donors for whom a risk of death is less than 0,5% are considered

A potential donor must A potential donor must be free from

Be in good overall health and physical condition

Be older than 18 years of age and younger than 60 years of age

Have a liver that is the right size for the recipient

Have a blood type compatible with the recipient

Have a near normal body weight (BMI less than 35)

HIV infection Known viral hepatitis Active alcoholism with

frequent and heavy alcohol intake

Psychiatric ilness A hystori of cancer Heart and lung disease

requiring medication Diabetes A hystori of previous liver

surgery

The evaluation process

In most cases, the amount of time required to fully assess a potential living liver donor’s health status and compatibility with the recipient 4-8 weeks.

In special circumstances however, such as rapid deterioration of the health of the recipient, this process may take place in as little as 48 hours.

1.Blood type matching2.Liver function test3.Overall health assessment4. Imaging studies : CT, Abdominal ultrasound,

MRI5.Mental and Emotional health assessment

Surgery

During the donor surgery, which typically requires 8-10 hours complete, a segment of the donor liver is removed thorugh incision that is either straigh up and down or in the shape of and inverted “T.

The donor liver is carefully divided into the right and left lobe, making sure there is no damage to the remaining section.

Transplantasi Ginjal

Living Donors

All donors should be evaluated both medically and surgical to ensure donor safety.

First a through history and physical exam is needed to rule out hypertension, diabetes, obesity, infections,cancer, and specific renal/urologi disorder.

Then laboratory testing of blood and urine, chest x-ray, electrocardiogram, and appropiate cardiac stress testing is done.

Different methods to measure GFR and urine protein excretion are incorporated.

Finally, radiographic assessment of the kidneys and vessels is ordered, which is usually accomplished by a CT angiogram.

Standart Evaluation of the potential Live Donor

Historys Hypertension, diabetes, family history, enviromental, exposure, chronic UTI, stones , prior surgery, prior cardiovaskuler or pulmonary events (TB)

Physical exam

Blood preasure, weight/height (BMI), lymph nodes, joints, breast, prostate, caardiovascular disease assessment

Laboratory testing

Urinalysis and culture, electrolytes, BUN creatinine, calcium, phosphorus, magnesium, liver panel, fasting blood glucose, and lipid profile, CBC with platelets, coagulation screen, 24-hr urine, creatinine clearance and protein excretion or GFR measurement (iothalamate clearance)Viral serology: hepatitis C; hepatitis B; Epstein Barr virus;cytomegalovirus; herpes simplex; and RPR (rapidplasmin reagent)Electrocardiogram, chest x-ray

Imaging of the kidney

Computed tomography angiogramMagnetic resonance angiogramCatheter angiogram

Surgical Technique

The most commonly used approach is intraperitoneal laparoscopic donor nephrectomy, primarily due to patient choice. This technique has all but supplanted open donor nephrectomy via an extraperitoneal flank incision due to reports of reduced pain and shorter recovery time.

An alternative is the hand-assisted laparoscopic approach, where the extraction incision is used during the dissection. Nevertheless, in cases with a short right vein or 3 or more arteries, we prefer an open nephrectomy using 12th rib-sparing flank incision.

When multiple renal arteries are encountered, they should be conjoined ex vivo while the kidney is on ice, in order to minimize the number of anastomoses in the recipient and reduce ischemia times. Smaller upper pole arteries (<2 mm) often can be sacrificed, while lower pole vessels should be retained because of a risk to the ureteral blood supply.