Living transplant between relatives
The review includes two stages. Applicants qualify for liver transplantation if all of the following statements apply to them. The recipient and the donor are related within five generations or married to each other more than 2 years. Both of them are required to over 18 years old and to have the same or compatible blood types. But even incompatible blood type graft can still achieve comparable results after special treatment.
- The requirements of being living donors
(1) The adult donor has to be related by blood within five generations to the recipient, spouse of five generations to the recipient, spouse of the recipient, and five generations to the spouse. According to the law, the spouse needs to be in the marriage with the recipient for at least 2 years, or having children with the recipient. The statement applies to all married couples except for the ones who are diagnosed with liver transplant criteria after 1 year of marriage.
(2) The minor donor who is over 18 years old can donate part of the liver to the recipient related by blood within five generations with the written consent of his or her legal representative.
- The age requirements of being living liver donors
According to the law, the donor needs to be over 18 but no upper limit of age. The donor is better to be under 60 years old in order to prevent complications before, during and after the surgery.
- The blood type requirements of being a living liver donor
The blood types of the donor and the recipient can be the same,
compatible or incompatible.
- The liver size of the living donor
The donating parts may be different depending on the liver sizes and liver structures of the donors. In general, the donor needs to follow the two principles below:
(1) In order to offer enough liver function to the recipient, the size of the donating liver hasto be asleast 0.8% of the donor’s body weight.
(2) In order to stable the function of the donor’s liver, the remaining liver of the donor has to be at least 30% of its original size. The liver function of the donor will recover within 2-4 weeks. The time for liver growing to the normal size depends on each
patient’s condition. Approximately, the liver will grow to 80% of the original size after 8-12 months. The donor can be discharged from the hospital within 1-2 weeks if no complications happen. The donor can be back to his/her normal life after 1 month. The doctor will give you further explanations after you pass the primary review.
ABO-incompatible liver transplantation may result in an immune respond of B cell and then cause rejections. Therefore, it is necessary to have B cell antibody (rituximab) before the surgery, plasmaphresis before or after the surgery and inject IVIG, before and after the surgery. The successful rate is comparable with same or compatible blood type grafts. The cost of the medicine before and after the surgery and plasmaphresis depends on each patient’s condition. The cost is around NT$ 100,000 to 200,000.
Taiwanese and residents：
Taiwanese and residents please refer r to the standard charge of outpatient clinic and emergency service.
Foreigners who do not have the national health insurance will be charged by international medical standard fee.
- Registration: NTD $500
- Examination fee: NTD $1500
- Special service fee (you will have a coordinator helping atsite): NTD $200 per visit
- Psychiatric consultation: NTD $2,500
- You may be charged by other medicine tests and treatments
2、Stay in hospital：
- Inpatient examination and nursing fee: three times the price of the national health insurance standard charge
- General service fee: NTD $5,000 per stay
- NHI covered services/treatments: 2.21 times the price of the national health insurance standard charge
- Self-paid services/treatments: 1.7 times the price of the self-pay standard charge from department of health, Taipei city government. .
Depending on the treatments, we will estimate the medical cost. You will need to pay the deposit before staying in the hospital. The patient will only pay for the service and treatments they use (the hospital will return the rest of the money)
- Exchanging new Taiwanese dollar
- Credit card (VISA card, Master card and china unionpay card)
The evaluation of being a living liver donor
It takes 4-8 weeks from completing the evaluation to performing the surgery. With emergent cases, the evaluation will be complete within 48 hours.
Step. 1 (clinic)
- Blood test：blood type, the function of the kidneys and the liver, hepatitis ABC, syphilis, AIDS, blood counting, hemostasis
- Image check: liver transplant CT, 3D image synthesis (NTD $3,OOO, self-pay)
- Female needs to take urine tests. Pregnant women are not suitable to donate their livers
Step. 2 (staying in the hospital)
- Blood test: tissue matching, cross-comparison test, virus check (the virus quantity of hepatitis B is NTD $3,000, self-pay), latent tuberculosis infection (NTD $2,5OO, self-pay), tumor indexes, Human T-lymphotropic virus (HTLV-I/HTLV-II) and thyroid function
- Image check: bile ducts CT (NTD $7,200 for the developer, self-pay), whole abdomen ultrasound, chest x ray, and breast check (female)
- Other: Electrocardiography and liver function check
- Consultation: evaluation with psychologists and social workers and consultation of Gynecology for female
The possible outcomes of evaluations:
- Liver function disorder：
There are many reasons for liver function disorder. The common is the patient who has fatty liver disease with drinking history. In order to donate a liver, the fatty infiltration of the liver must be lower than 10%. Also, the size of the liver (deducting fatty infiltration) has to be enough for donation. The patient with fatty infiltration more than 10% needs diet controlling, intensive exercising and body weight reduction for 1-2 months. Then, the patient will take CT or biopsy to evaluate the improvement. The patient with intermediate fatty liver disease is not suitable for transplant. It will endanger the life of the donor and the recipient.
- The liver size of the living donor is too small：
The safety of the donor is very important for living-donor liver transplant. If the size of the donor’s liver is too small, the remaining liver may be unable to properly function after the surgery. It will endanger the donor’s life. The solutions could be looking for another suitable donor, or increasing the size of the liver with nourishing and exercising. The amount of the increasing size is depending on each patient’s condition.
- The anthropotomy variance of the donor and the recipient：
The anthropotomy variance of the donor and the recipient will increase the complexity and the danger of the surgery. The transplant team will make choices based on their specialties, technology and the safety of the patients.
The duration, risks and complication
The duration depends on the donating part (left lobe, left or right liver lobe) and the variance of the blood vessel and bile duct. It normally takes 6-10 hours. The death in the surgery is approximate 3/1000. Some donors may have jaundice for a short period of time. In general, the incidence of complications is 5%-10%. The common complications are bile leaks, narrow bile duct, narrow blood vessel and wound infections. The common complications, incidences and solutions:
- Biliary leaks or narrow bile ducts (1~3.3%): normally, it can be healed by nasobiliary drainage or percuteneous transhepatic cholangio drainage. In rare cases, it needs to place an endoscopic in a bile duct, and then have percuteneous transhepatic cholangio drainage or surgery again.
- Fever (3.2%): it is normally caused by atelectasis, and it will be decreased by breathing training and cough with phlegm.
- Infection (3.3%): such as respiratory infection, wound infection, urinary tract infection, vertical Transmission caused by catheters. The treatment will be giving
stronger antibiotics. Severe infections are rare.
- Hands or lower limbs dysesthesia or limb weakness (3%): due to the long period of time lying down during the surgery, the nerves of limbs may be damaged. It can
be recovered after 3-month rehabilitation.
- Bleeding after surgery(0.8-3.2%): transfusion can reduce the bleeding. Sometimes, it is needed to have another surgery to stop bleeding.
- Peptic ulcer disease (1%): the donor may have peptic ulcer disease because of pressure. It normally can be treated by taking medicine, but in severe cases, the
pressure may occur gastrointestinal bleeding.
- Ileus (3.6%): after the surgery, the adhesion and enteroparalysis may cause ileus. It normally can be treated by resting gastrointestinal tracts, hydrating and replenishing electrolytes. In rare cases, surgical treatment is needed.
- Pneumothorax or pleural effusion (3%): normally conservative treatment and percuteneous transhepatic cholangio drainage will reduce the conditions.
- Malignant portal vein thrombosis (0.5%-0.7%): it normally needs another surgery to remove thrombosis, and sometimes it will need to place stents.
Nursing care plan
The liver function of the donor will recover within 2-4 weeks. The duration for liver growing to the normal size depends on each patient’s condition. Approximately, the liver will grow to 80% of the original size after 8-12 months. The donor can be discharged within 1-2 weeks if no complications happen. The donor can be back to his/her normal life after 1 month. The doctor will give you further explanations after you pass the primary review
Applying for medical records/certificate of dianosis
The duration and procedure of applying for medical records
- Counter service
- Applying online (taking about 2~7 business days) willsave your time instead of waiting in the hospital. However, when pick up the copies, you need to bring your id to the counter and pay.
- You can directly apply at the medical counter without registration or seeing a doctor.
- When applying for your copies, please tell us the term, the services/treatments and the duration of your record. If you do not know how to find the information, you may ask your doctors for help when visiting them.
- You need to pick your copies within 1 month after informed. If you do not do so, you will need to reapply.
- For videos or images copies, please apply at the image counter 8 of radiation department on the 8 th floor in the Zhongzheng building.
- Please bring your ID and related documents, take a number at the counter and wait your turn.
- Fill out the application form.
- The staff will verify you application.
- Pay and collect your copies.
- For the requirements of applicant and enclosed documents, please refer to Here
The duration and procedure of applying for certificates of diagnosis
- The patient applies for certificates of diagnosis while staying in hospital will need to prepare the draft made by your doctor. Then, bring it to division of medical affairs admission (the inpatient counter on 1st floor in the Zhongzheng building) for an official copy.
- Chinese copy：NTD $100 for the first copy；NTD$50 for the second and more copies English copy：NTD $200 for each copy.
- Outpatients who needs to apply for the certificates of diagnosis please refer to Here
- For reissuing certificates of diagnosis (same copy from the one you have applied before), you need to provide your identification (as the list below) and an application. (Download：(application）
- For the requirements of applicants and enclosed documents please refer to Here
After discharged, please turn for your check-up every once or twice a week depending on your condition. After 3~6 months, you may return every 2 month (please follow the instructions given by the doctor). If you have any discomforts or confusions outside of the hospital, please contact the transplantation team at 02-2875-7625, or make an appointment online