Living Liver Donation: Innovation and Family Commitment at UIC
Introduction
When Lukas Borland was first diagnosed with Primary Sclerosing Cholangitis (PSC), a rare genetic disorder causing severe bile duct inflammation and scarring, at the age of 16, he understood it would mark the beginning of a near-decade-long relationship with medical treatment and monitoring.
“Once we figured out where the problems were stemming from, we kind of hit a wall. I was told there was nothing we could do but just wait,” Lukas said.
That changed when Lukas was referred to the liver transplant team at the University of Illinois Chicago (UIC). “In the last decade, UIC has become the referral center for other institutions for robotic transplantation,” said Dr. Mario Spaggiari, Surgical Director of the Liver Transplant Program at UI Health. As one of the few institutes with robotically assisted surgeries, UIC took on Lukas’ case without hesitation. Dr. Spaggiari and his team recognized not just the complexity of his condition, but the opportunity to restore his quality of life. “When they suggested that I come up here, the process really took off,” Lukas said. “It’s definitely been a long time coming to get to his point."
Minimally Invasive, Robotic-Assisted Donor Hepatectomy
A hepatectomy, or liver resection, is a surgical procedure to remove part of the liver. A living liver donor may have up to two-thirds of their liver removed, depending on their health.
The liver is the only organ that has the ability to regenerate. So both the donor and recipient will be able to rebuild theirs to their original size and regain normal function.
Through tests, the graft-to-recipient weight ratio (GRWR) is a key metric in determining how much liver tissue the donor can safely provide and how much the recipient needs for liver regeneration.
Under robotically-assisted hepatectomy, the doctors perform the entire surgery with several millimeter incisions around the midline. Liver resection can be a technically challenging procedure. So robotic-assisted surgery offers enhanced precision and flexibility, which allows for better natural movement through small incisions. This accuracy reduces blood loss and lowers the risk of complications when handling complex liver resection procedures. This is also reflected in less postoperative pain, shorter hospital stays, and quicker recovery.
MELD Score
The MELD score — or Model for End-Stage Liver Disease — is a score that physicians use to determine the urgency of a liver transplant in patients. The score ranges from six to 40, with a higher MELD score indicating major liver dysfunction and mortality, putting those patients at the front of the waiting list for the transplant. Scores are calculated by blood work, but may include age, sex, and a full patient medical history.
The MELD system, while being a valued prioritizing system, may sometimes be very difficult for patients who exhibit symptoms that greatly affect their quality of life. These patients may also be prone to complications while still being lower down the national waiting list.
In Lukas’ case, while he was certainly symptomatic, physicians found that his MELD score was too low for an urgent liver transplant. “I was told by specialists that my best path was for a living donor procedure as opposed to waiting on a list for liver donation.”
Family Donor = Better Compatibility
Upon learning about the need for a living donor liver transplant for her brother, Rachel took the necessary steps to volunteer.
“It’s a scary thing to hear in the moment,” Rachel said. “But I immediately wanted to know the next steps. It was important for us to get moving and figure this out.”
Living donor transplants are often most successful between relatives due to better tissue compatibility and a higher likelihood of matching, but the process is no less grueling.
The donor’s compatibility is determined through a series of blood work, imaging, and countless other tests. “Dr. Spaggiari and his team were always supportive,” Rachel said. “They walked me through every step of the process individually. When I first came out here for testing, we focused on that. Once there was a match, we then moved on to the next portion of the procedure,” Rachel explained. “I felt like a liver specialist by the end.”
When Innovation Meets Support
For Lisa Mariano, liver transplant team nursing manager, this was a deeply meaningful journey for Lukas, Rachel, and the transplant team. “Anytime a transplant team takes on a living donation, they take on double the responsibility. It’s 200% accountability because the team has to make sure the donor and recipient receive safe and adequate care every step of the way,” she said.
“Having a donor and recipient be so committed to each other’s well-being, as well as to the process, our team felt just as supported by Lukas and Rachel as much as we supported them.”
Within days after the surgery, Rachel was discharged and, within a month, her liver had grown back to full size. Though Lukas’ recovery will take some time due to his condition, UIC has offered him a renewed path to better health.
“It’s been up and down, but most days are better than the last,” Lukas admitted one month after his recovery. “Little by little, discomfort goes away and movement comes back…I believe things will get exponentially easier from here.”
Beyond Lukas and Rachel’s remarkable story, UIC has continued to set a new standard for donor and recipient safety, hoping to encourage others to step forward as potential living donors. “UIC was the first program in the world to apply robotic surgery to transplantation,” Dr. Spaggiari said. “We are currently applying robotic surgery to all different types of abdominal transplants.”