Donor Assessment

If the donor and recipient have compatible blood types, the next step for the donor is a medical history review and a complete physical examination.

In the examination, the transplant team doctors may perform the following tests:

• An extensive series of Laboratory Tests (blood tests) for:
  • liver function;
  • if a transmissible disease such as viral hepatitis is present;
  • the presence of any underlying liver disease such as fatty liver;
  • Antibody Screen: an antibody is a protein substance made by the body's immune system in response to an antigen (a foreign substance; for example, a transplanted organ, blood transfusion, virus, or pregnancy). This test is to ascertain the risk of antibodie attacking the transplanted liver, thereby causing rejection by the body.
• Diagnostic Image Studies :
  • A chest X-Ray is performed to screen the donor for any lung disease;
  • A CT scan shows detailed pictures of the internal organs. The scan is used to determine the size of the portion of the liver that can be safely donated, and to check the adequacy of the liver's blood supply. Prior to having the CT scan the donor must notify the team of allergies to iodine or radiological contrast.
  • MeVis Pictures - a state-of-the-art technology from a German company called MeVis Distant Services (MDS). The data from the CT scan of the donor is uploaded to MDS where a team of highly specialised technicians and a radiologist interpret the data and send back detailed information and colour pictures depicting the vascular (blood vessel) anatomy, the volume and the suitability of the proposed liver graft. It is a precise and highly individual diagnostic tool which enables the surgeon to perform the donor operation with utmost safety and confidence. The ACLDT is currently the only institution in Southeast Asia using this technology.
• Sometimes, doctors will conduct a Liver Biopsy as part of the liver donor evaluation process. In this procedure, a needle is used to remove a tiny portion of the donor's liver and studying it under a microscope to assess the quality of the liver tissue and exclude the presence of any possible disease. This will require admission to the hospital for monitoring after the biopsy for a few hours or overnight.
• Psychiatric Assessment is also required to ensure that the donor is mentally prepared for the operation and understands the implication of the surgery and changes associated with living donation. The psychiatrist discusses possible stresses that may result from the procedure and assesses the primary reasons for the donor’s decision to donate.
• Cardiac Evaluation helps to determine if the donor is able to go through the major surgery and may reveal heart damage that was previously unsuspected.
  • Echocardiogram (ECG) is an ultrasound scan of the heart and its valves. This test helps to determine how well your heart pumps and how well the heart valves are functioning.
• Pulmonary Function Tests consist of certain breathing tests to determine how well the lungs are working and diagnose possible problems with the lungs.
• The donor may be required to donate their own blood in case a blood transfusion is needed during/ after the surgery. The collection and reinfusion of the patient’s own blood or blood components is known as autologous blood. In other words, self-donation of blood.
• It is mandatory for all female donors to undergo a complete Gynaecological Examination to ascertain if they are pregnant and free from cervical cancer. For females 32 years and older, a mammogram is also required.
• Our transplant surgeon, Dr K C Tan, will personally review all of the tests and the results performed on the potential donor before deciding whether the surgery is safe. After the surgeon's clearance and confirmation, the surgeon and the donor will then discuss the surgery itself, any potential risks and post-operative follow-up visits.
• A Statutory Declaration by the donor will be taken by the Commissioner of Oaths. It is a written informed consent from the live donor confirming their understanding of the living-donor liver transplantation surgery.

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