Appendix II

Live Adult Liver Donation Process Map

Recipient meets criteria for live donor adult liver transplantation.
the next step is
Potential donor with vital emotional relationship presents to transplant center as potential donor.
the next step is
Potential donor has initial meeting with surgeon who would perform donor surgery.
the next step is
Potential donor is evaluated by independent donor advocate team.
the next step is
Independent donor advocate team:
  • structures process of informed choice and protects interests and well being of potential donor;
  • explains surgery, and medical, psychosocial, and financial implications of procedure;
  • refers potential donor to previous donors;
  • evaluates intellectual and emotional capacity of potential donor;
  • performs independent medical and psychosocial evaluations of donor;
  • determines potential donor’s choice is voluntary and ensures no monetary compensation is involved in decision.
the next step is
Independent donor advocate team makes decision:
  • if no, process ends.
  • if yes, donor is referred to the transplant team for further evaluation.
the next step is
Potential donor undergoes any further required medical/surgical evaluation by the transplant team.
  • if donation contraindicated, process stops.
  • if donation cleared and recipient meets criteria for live adult liver donation, process continues.
the next step is
Potential donor has reflection and reaffirmation period of two weeks to make decision.
the next step is
Potential donor signs consent form; independent donor advocate team member witnesses signing.
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Donor surgery occurs.
  • Two liver transplant attending surgeons with live donor adult transplant experience attend the procedure.
  • A third liver transplant surgeon is present in recipient operating room.
  • Qualifications for surgical and anesthesia team are met.
the next step is
Day 0-1:
  • Donor sent to ICU or PACU for initial recovery.
  • RN ratio 1:2.
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Day 2 - discharge: transferred from ICU or PACU if stable:
  • Donor sent to transplant unit if stable and cleared for transfer.
  • RN ratio 1:4.
  • Donor is evaluated at least daily by qualified liver transplant attending.
  • Pain management is a priority.
  • 24/7 continuous coverage of service (including off hours shifts) by PGY2 or higher level physician or PA/ NP.
  • Any donor with abnormal vital signs or unusual signs/ symptoms identified by the RN is evaluated immediately and senior medical staff notified within 30 minutes.
the next step is
Donor discharged with pain medication and information on:
  • permitted and restricted activities;
  • diet;
  • wound care;
  • 24-hour contact telephone number for problems;
  • instruction for family members.
the next step is
Follow-up:
  • post-op visits with surgeon;
  • coordination with donor’s primary care physician;
  • donor recognition;
  • periodic survey of donor’s physical condition;
  • data submitted to statewide and/or national registry.