Before<unk> ,<unk> -support therapy might be indicated (bridging-to-transplantation). Artificial<unk>  support like<unk>  dialysis or bioartificial<unk>  support concepts are currently under preclinical and clinical evaluation. Virtually all<unk>  transplants are done in an orthotopic fashion; that is, the native<unk>  is removed and the new<unk>  is placed in the same anatomic location. The transplant operation can be conceptualized as consisting of the hepatectomy<unk>  removal) phase, the anhepatic (no<unk>  phase, and the postimplantation phase. The operation is done through a large incision in the upper abdomen. The hepatectomy involves division of all ligamentous attachments to the<unk> , as well as the common bile duct, hepatic artery, hepatic vein and portal vein. Usually, the retrohepatic portion of the inferior vena cava is removed along with the<unk> , although an alternative technique preserves the recipient's vena cava ("piggyback" technique). The donor's blood in the<unk>  will be replaced by an ice-cold organ storage solution, such as UW (Viaspan) or HTK, until the allograft<unk>  is implanted. Implantation involves anastomoses (connections) of the inferior vena cava, portal vein, and hepatic artery. After blood flow is restored to the new<unk> , the biliary (bile duct) anastomosis is constructed, either to the recipient's own bile duct or to the small intestine. The surgery usually takes between five and six hours, but may be longer or shorter due to the difficulty of the operation and the experience of the surgeon. The large majority of<unk>  transplants use the entire<unk>  from a non-living donor for the transplant, particularly for adult recipients. A major advance in pediatric<unk>  was the development of reduced size<unk> , in which a portion of an adult<unk>  is used for an infant or small child. Further developments in this area included split<unk> , in which one<unk>  is used for transplants for two recipients, and living donor<unk> , in which a portion of a healthy person's<unk>  is removed and used as the allograft. Living donor<unk>  for pediatric recipients involves removal of approximately 20% of the<unk>  (Couinaud segments 2 and 3). Further advance in<unk>  transplant involves only resection of the lobe of the<unk>  involved in tumors and the tumor-free lobe remains within the recipient. This speeds up the recovery and the patient stay in the hospital quickly shortens to within 5–7 days. Radiofrequency ablation of the<unk>  tumor can be used as a bridge while awaiting<unk> . Cooling Between removal from donor and<unk>  into the recipient, the allograft<unk>  is stored in a temperature-cooled preservation solution. The reduced temperature slows down the process of deterioration from normal metabolic processes, and the storage solution itself is designed to counteract the unwanted effects of cold ischemia. Although this "static" cold storage method has long been standard technique, various dynamic preservation methods are under investigation. For example, systems which use a machine to pump blood through the explanted<unk>  (after it is harvested from the body) during a transfer have met some success (see Research section for more). Living donor<unk>  Volume rendering image created with computed tomography, which can be used to evaluate the volume of the<unk>  of a potential donor Living donor<unk>  (LDLT) has emerged in recent decades as a critical surgical option for patients with end stage<unk>  disease, such as cirrhosis and/or hepatocellular carcinoma often attributable to one or more of the following: long-term alcohol use disorder, long-term untreated hepatitis C infection, long-term untreated hepatitis B infection. The concept of LDLT is based on (1) the remarkable regenerative capacities of the human<unk>  and (2) the widespread shortage of cadaveric<unk> s for patients awaiting transplant. In LDLT, a piece of healthy<unk>  is surgically removed from a living person and transplanted into a recipient, immediately after the recipient's diseased<unk>  has been entirely removed. Historically, LDLT began with terminal pediatric patients, whose parents were motivated to risk donating a portion of their compatible healthy<unk> s to replace their children's failing ones. The first report of successful LDLT was by Silvano Raia at the University of Sao Paulo Faculty of Medicine in July 1989. It was followed by Christoph Broelsch at the University of Chicago Medical Center in November 1989, when two-year-old Alyssa Smith received a portion of her mother's<unk> . Surgeons eventually realized that adult-to-adult LDLT was also possible, and now the practice is common in a few reputable medical institutes. It is considered more technically demanding than even standard, cadaveric donor<unk> , and also poses the ethical problems underlying the indication of a major surgical operation (hemihepatectomy or related procedure) on a healthy human being. In various case series, the risk of complications in the donor is around 10%, and very occasionally a second operation is needed. Common problems are biliary fistula, gastric stasis and infections; they are more common after removal of the right lobe of the<unk> . Death after LDLT has been reported at 0% (Japan), 0.3% (USA) and <1% (Europe), with risks likely to decrease further as surgeons gain more experience in this procedure. Since the law was changed to permit altruistic non-directed living organ donations in the UK in 2006, the first altruistic living<unk>  donation took place in Britain in December 2012. In a typical adult recipient LDLT, 55 to 70% of the<unk>  (the right lobe) is removed from a healthy living donor. The donor's<unk>  will regenerate approaching 100% function within 4–6 weeks, and will almost reach full volumetric size with recapitulation of the normal structure soon thereafter. It may be possible to remove up to 70% of the<unk>  from a healthy living donor without harm in most cases. The transplanted portion will reach full function and the appropriate size in the recipient as well, although it will take longer than for the donor. Living donors are faced with risks and/or complications after the surgery. Blood clots and biliary problems have the possibility of arising in the donor post-op, but these issues are remedied fairly easily. Although death is a risk that a living donor must be willing to accept prior to the surgery, the mortality rate of living donors in the United States is low. The LDLT donor's immune system does diminish as a result of the<unk>  regenerating, so certain foods which would normally cause an upset stomach could cause serious illness. Donor requirements CT scan performed for evaluation of a potential donor. The image shows an unusual variation of hepatic artery. The left hepatic artery supplies not only left lobe but also segment 8. The anatomy makes right lobe donation impossible. Even used as left lobe or lateral segment donation, it would be very technically challenging in anastomosing the small arteries. Any member of the family, parent, sibling, child, spouse or a volunteer can donate their<unk> . The criteria for a<unk>  donation include: * Being in good health * Having a blood type that matches or is compatible with the recipient's, although some centres now perform blood group incompatible transplants with special immunosuppression protocols. * Having a charitable desire of donation without financial motivation * Being between 20 and 60 years old (18 to 60 years old in some places) * Have an important personal relationship with the recipient * Being of similar or larger size than the recipient * Before one becomes a living donor, the donor must undergo testing to ensure that the individual is physically fit, in excellent health, and not having uncontrolled high blood pressure,<unk>  disease, diabetes or heart disease. Sometimes CT scans or MRIs are done to image the<unk> . In most cases, the work up is done in 2–3 weeks. Complications Living donor surgery is done at a major center. Very few individuals require any blood transfusions during or after surgery. All potential donors should know there is a 0.5 to 1.0 percent chance of death. Other risks of donating a<unk>  include bleeding, infection, painful incision, possibility of blood clots and a prolonged recovery. The vast majority of donors enjoy complete and full recovery within 2–3 months. Pediatric<unk>  In children, due to their smaller abdominal cavity, there is only space for a partial segment of<unk> , usually the left lobe of the donor's<unk> . This is also known as a "split"<unk>  transplant. There are four anastomoses required for a "split"<unk>  transplant: hepaticojejunostomy (biliary drainage connecting to a roux limb of jejunum), portal venous anatomosis, hepatic arterial anastomosis, and inferior vena cava anastomosis. In children, living<unk>  donor<unk>  has become very accepted. The accessibility of adult parents who want to donate a piece of the<unk>  for their children/infants has reduced the number of children who would have otherwise died waiting for a transplant. Having a parent as a donor also has made it a lot easier for children – because both patients are in the same hospital and can help boost each other's morale. Benefits There are several advantages of living<unk>  donor<unk>  over cadaveric donor
Liver transplantation
Pancreas transplantation
Hepatoportoenterostomy
Percutaneous hepatic perfusion
Hepatic artery embolization
Biliary endoscopic sphincterotomy
Islet cell transplantation
Pancreatectomy