People who have donated part of their liver for transplant can experience physical and psychological complications years after the operation, according to a German study.
Almost half of the 83 liver donors surveyed had complaints ranging from pain and digestive problems to depression three or more years after surgery - but nearly all said they'd donate again, the study in the Annals of Surgery said.
In a living-donor liver transplant, a team of surgeons removes a lobe of the donor's liver to implant in the recipient. The remaining portion of the donor's liver regrows to full size within two months.
"There is a risk for some long-term complaints, which may be potentially controllable by workup modifications, improvements in surgical techniques and a thorough follow-up of donors at the transplant centres," said Georgios Sotiropoulos, lead author and professor of surgery and transplantation at University Hospital Essen in Germany.
Transplant surgeons say they would rather not have to put a healthy person at risk, but there aren't enough organs available to provide livers for everyone who needs them.
Organs from living donors also have some advantages over the alternative, a liver from a cadaver, for a number of reasons, including that the donation can occur at the best time for the recipient.
The average age of donors in the German study was 36, and their average time since donation was six years.
In the study, 31 per cent of donors complained about having diarrhea or an intolerance to fatty foods and about 10 per cent complained of gastroesophageal reflux. A small number of donors had discomfort at the incision site or in their ribs.
Three donors reported bouts of severe depression, two of them requiring hospitalisation, and one patient had a worsening of pre-existing psoriasis.
Of the 83 donors surveyed, 39 reported no lingering symptoms or problems. But three young and otherwise healthy men said they had been turned down for life insurance because there's so little data available on the long-term effects of living liver donation.
While the study did not have a control group, its findings are consistent with past research, said Jean Emond, vice chair of the Department of Surgery and director of the transplant centre at New York Presbyterian/Columbia Hospital in New York.
"I think the conclusions are cautious and reasonable. We need to keep a close eye on these people," he said, adding that there needs to be psychological support before and after the procedure.
About 4,500 liver donations have been made in the United States by living donors since the first surgery in 1989, according to the national transplant database. The first such donations were made to children, who require a smaller piece of the liver.
Emond, who assisted with the first live-donor liver surgery, said the risk of death after donating a large portion of the liver is about one in 1,000.
"The ethical standard has to be that you do it because it's the right thing to do for the patient with full and informed consent, he added.