In a domino liver transplant, a person with a metabolic disorder receives a donor liver and then donates their original liver to another person whose liver is damaged from cirrhosis or cancer.

Domino liver transplants have been performed by surgeons since the mid-1990s.

The goal of a domino liver transplant is to help alleviate liver shortages for those who need them.

In this article, we take a closer look at domino liver transplants, including the potential benefits of this procedure, as well as recovery, potential side effects, and the outlook for donors and recipients.

Domino liver transplants are primarily used to treat younger adults with hereditary metabolic disorders, such as familial amyloidotic polyneuropathy (FAP). The procedure involves the donation of one liver and the receipt of another liver.

For example, if a person has an inherited metabolic disorder that prompts the need for a new liver, they’ll receive a liver from a deceased or living donor. Their current liver is then donated to another person whose liver has been severely damaged from scarring or cancer.

The person who receives and donates a liver is considered the “domino donor.”

Infographic of a domino liver transplantShare on Pinterest
Medical Illustration by Bailey Mariner

People who receive livers from domino donors tend to be older adults or adults who have liver disease or liver cancer. If you have end stage liver disease, you may receive a liver from a domino donor as a way to decrease the amount of time you have to wait for a deceased liver donor.

While domino donors have inherited metabolic diseases, researchers believe that the risk of dying from the underlying liver disease you may have is far greater than the risk of developing metabolic syndrome.

Furthermore, if you do develop metabolic syndrome as a result of domino liver transplant, the effects are considered to be minimal.

If you’re a domino donor waiting for a deceased donor liver, you’ll be placed on a waiting list and contacted as soon as a match is found. At this point, you’ll need to go to the hospital for your liver transplant immediately.

On the other hand, if you’re receiving a liver from a living domino donor, you’ll have more time to prepare. In fact, you may schedule your domino liver transplant 4 to 6 weeks in advance.

On the day of your liver transplant, you can expect to go through the following steps:

  1. Before surgery, a medical team will take your vitals. An anesthesiologist will then administer a general anesthetic, so you’re asleep during the procedure.
  2. During the procedure, a surgeon will remove your liver and replace it with a donor’s liver. In all, the entire process may take about 12 hours to complete.
  3. After surgery, you’ll be placed in a room in the intensive care unit (ICU), where you’ll be carefully monitored. The medical team will continue to take your vitals, and they’ll also take blood work to ensure your new liver is functioning properly.
  4. Unless any negative effects arise, you’ll then be moved to a regular hospital room. You’ll stay there for several days before you’re discharged to complete the recovery process at home.

Shortly after your liver transplant, you’ll be discharged to a hospital room where a medical team will closely monitor your condition.

On average, you can expect to go home 2 weeks after your surgery, and you may resume most of your usual activities within a few months.

Additionally, a doctor will prescribe immunosuppressants that you’ll start taking immediately after your liver transplant. These help to reduce the potential risk of your body rejecting the liver.

If you’re the second recipient in a domino liver transplant, one potential risk is that you may develop metabolic disorders in the future.

However, such risks tend to be minimal and may take a long time to develop. One older 2008 study reported that, at the time of publication, only 2 out of more than 500 domino liver transplants using FAP livers caused related symptoms.

Also, as with other types of liver transplantation, this procedure may have the following risks:

  • infection
  • excessive bleeding
  • blood clots in the new liver
  • bile duct damage
  • failure or rejection of the new liver

Overall, recipients of domino liver transplants have high chances of long-term survival. The risk of death associated with underlying end stage liver disease is far greater than the possible risk posed by a newly transplanted liver from a domino donor.

It’s also important to note that domino donors tend to be children or young adults, while recipients of domino liver transplants are middle-age or older adults. According to one recent study of domino liver transplant in people over 60 years old with liver cancer, the average 5-year survival rate was 79%.

This is compared with a 72% 5-year survival rate for traditional liver transplants from deceased donors. In such cases, there’s also a 53% estimated 20-year survival rate.

How common are domino liver transplants?

Domino liver transplants are becoming an increasingly common way to treat both those with inherited metabolic disorders and adults with end stage liver diseases or cancer.

In fact, in 2019, more than half of the liver transplants reported to the FAP World Transplant Registry were domino liver transplants.

Can a donor liver be divided?

Yes. While most adults receive an entire liver as part of the transplant process, sometimes a deceased donor liver is split into two, and a child might receive the smaller portion.

If you’re a liver donor who is not donating your liver to a domino recipient, this means you may only need to donate a portion of your liver. In fact, you may be able to retain 30% of your original liver, with the rest regenerating within a year.

How risky is it to be a living liver donor?

As a living liver donor, you can expect to modify your usual activities for several weeks to months as you recover from surgery.

In all, there’s a 10% risk of experiencing major negative effects, such as internal injuries, and there’s an up to 35% risk of experiencing minor negative effects, such as an infection.

What disqualifies you from a liver transplant?

You may be disqualified from a liver transplant if you have other underlying conditions that could impact the success of a new liver. These include alcohol use disorder, bile duct cancer, and diseases or cancers of other organs.

A domino liver transplant involves removing the liver from a younger person with a metabolic disease and transplanting it into an older person with severe liver disease. In such cases, the domino donor receives a new liver from a deceased donor.

The biggest benefit of a domino liver transplant is that it allows more viable livers to get to those who may be on a waiting list to receive them, without the exclusive need for deceased donor livers.

Still, like other forms of liver transplantation, this is considered a major surgery that entails a lengthy recovery.

Whether you’re a domino donor or recipient, It’s important to discuss the procedure with a doctor so you know what to expect in terms of recovery and potential risks.