How a Liver Transplant Works — From Donor to Recovery

Liver transplant involves two patients, two surgical teams, and two operations happening simultaneously. That is the part most people do not know going in. The donor's surgery runs in parallel with the recipient's in adjacent theatres — both teams working at the same time, coordinating so the transplanted liver spends as little time outside a living body as possible.

Understanding how the operation is structured, what each phase involves, and what the recovery timeline looks like makes the decision significantly less overwhelming. Most families find the unknown more frightening than the reality.

The Liver's Unusual Property — Regeneration

No other solid organ regenerates the way the liver does. Remove roughly 60 percent of a healthy liver and the remaining 40 percent grows back, reaching close to original size within six to eight weeks. This is what makes living donor transplant possible — a family member can donate a large portion of their liver, keep the rest, and recover fully.

The transplanted portion does the same thing in the recipient. Within weeks, both donor and recipient end up with functioning livers.

Who Can Be a Donor

For international patients coming to India, a living related donor is the standard route. The donor must be a close family member — parent, adult child, sibling, or spouse. Indian law requires this, and a Transplant Authorisation Committee reviews every case before surgery is approved. The committee verifies the relationship and confirms the donation is genuinely voluntary.

The donor evaluation is thorough because the donor is a healthy person undergoing major surgery. Blood tests, liver function tests, CT scan of the liver (to assess anatomy and the blood vessels supplying each lobe), cardiac evaluation, lung function assessment, and psychological assessment. If anything raises concern about donor safety, the evaluation committee declines the donation. This step is not negotiable and not rushed.

The Surgery — What Happens for Donor and Recipient

Both surgeries start at the same time in adjacent operating theatres.

1. Donor Surgery

The right lobe of the liver is the standard donation for an adult recipient — it is the larger lobe, comprising roughly 60 percent of the liver's volume. The left lobe is used when the recipient is a child or a smaller adult.

The surgeon mobilises the liver, divides the tissue between the lobes, and carefully divides the hepatic artery branch, portal vein branch, hepatic vein, and bile duct supplying the right lobe. Once divided, the lobe is flushed with cold preservation solution to protect it from ischemic damage and transferred to the recipient team.

Donor surgery takes three to five hours. The donor's remaining liver has normal blood flow restored. Their liver regenerates over the following weeks.

2. Recipient Surgery

The recipient surgery runs longer — eight to twelve hours — because it has two phases: removing the diseased liver, then implanting the healthy one.

The removal phase is often the technically harder part. In patients with advanced cirrhosis, the blood supply around the liver is chaotic — abnormal vessels have formed to compensate for the failing portal circulation. The spleen is often enlarged. Clotting is poor. The surgeon works carefully through dense scar tissue and abnormal anatomy to free the diseased liver from its attachments.

Once the diseased liver is out, the implantation phase begins. The healthy liver lobe is placed in position. Four connections are made:

• Hepatic vein — draining the new liver into the inferior vena cava
• Portal vein — bringing nutrient-rich blood from the gut to the new liver
• Hepatic artery — oxygenating blood supply to the new liver
• Bile duct — the duct carrying bile from the liver to the intestine

Each connection is sutured with great care. The hepatic artery anastomosis is the most technically demanding — the vessels are small and any narrowing or kinking causes serious complications. Some surgeons use microsurgical technique for this connection.

Once all connections are made, clamps are released. Blood flows into the new liver. In most cases, the liver turns from pale to pink within minutes as circulation is restored. It begins producing bile. Blood tests confirm function within hours.

Immediately After Surgery

The recipient goes to the intensive care unit. For the first few days, close monitoring covers:

1. Liver function: Bilirubin, AST, ALT, INR, albumin. The liver function tests typically peak in the first few days as the new liver adjusts, then normalise.

2. Vascular patency: Doppler ultrasound checks blood flow through the hepatic artery and portal vein daily for the first week. Hepatic artery thrombosis — clotting of the arterial connection — is the most feared early complication and requires urgent re-operation or intervention.

3. Rejection: Acute cellular rejection typically occurs in the first few weeks. Diagnosed by liver biopsy if blood tests suggest it, treated with high-dose corticosteroids in most cases.

4. Infection: The immunosuppression that prevents rejection also prevents infection defence. Prophylactic antibiotics, antifungal drugs, and antiviral drugs are standard for the first months.

The recipient spends five to seven days in ICU, then transitions to the ward. Total hospital stay is three to four weeks.

Discharge and the Recovery Period

After discharge, the patient remains in India for further weeks of outpatient monitoring. Blood tests — liver function, tacrolimus level, full blood count — are done twice weekly initially, then weekly. Ultrasound checks continue. Any deviation from the expected trajectory is addressed quickly.

Typically four to six weeks after discharge, the transplant team reviews the patient's progress and clears them to fly home. Before departure, complete documentation is provided — discharge summary, medication list, drug protocols, follow-up instructions, and contact details for the transplant team.

Most recipients are back to normal daily activity within three to six months. The immunosuppression medication — tacrolimus and mycophenolate — continues for life, at gradually reducing doses.

Hospitals in Prime Medical's Network for Liver Transplant

MGM Healthcare, Chennai (JCI, NABH, NABL) — Dr. V Chandrasekaran leads transplant. Experienced with East and West African patients. Chennai is accessible from Dar es Salaam via the direct Mumbai flight and a domestic connection.

Indraprastha Apollo Hospital, New Delhi (JCI, NABH) — Over 3,500 successful liver transplants across the Apollo network. Africa desk. Strong post-transplant monitoring infrastructure.

Fortis Memorial Research Institute, Gurugram (JCI, NABH, NABL) — High-volume liver transplant programme. Advanced interventional radiology for complex vascular complications.

Max Super Speciality Hospital, Saket, Delhi (JCI, NABH, NABL) — One of Delhi's busiest liver transplant programmes.

For patients and families with liver failure from Addis Ababa, Kampala, Mwanza, Banjul, or elsewhere: share liver function tests, imaging, MELD score, and the potential donor's details with Prime Medical Solutions. Dr. V Chandrasekaran and the transplant teams review within 48 hours.

To book a consultation, call the number on our website.