Key points
- The graft may be the right lobe, the left lobe or the smaller left lateral segment, chosen to suit the recipient's size while leaving the donor enough liver.
- Donor surgery can be done open, laparoscopically or robotically in carefully selected donors; the safety principles are the same.
- Donor safety comes first. Most donors have no lasting problems, but complications such as bile leak occur and the risk of death, though very low, is not zero.
- Most donors stay in hospital about a week, regrow most of their liver volume within a few months and return to desk work in about four to six weeks.
Which part of the liver is donated?
The liver is divided into eight segments with their own blood supply and bile drainage, which is what allows a surgeon to remove part of it safely. The part taken depends on the size of the recipient and the size and anatomy of the donor's liver, measured beforehand on CT volumetry.
| Graft | Segments | Approximate share of donor liver | Usually for |
|---|---|---|---|
| Right lobe | 5, 6, 7, 8 | About 55–65% | Adult recipients |
| Left lobe | 2, 3, 4 (± caudate) | About 30–40% | Smaller adults, adolescents |
| Left lateral segment | 2, 3 | About 15–25% | Infants and young children |
Right-lobe donation is the larger operation and carries more risk for the donor than left-lobe or left lateral donation, simply because more liver is removed. When a left-lobe graft is large enough for an adult recipient, some teams prefer it for that reason. The decision is made case by case. Donation for children is discussed on the paediatric liver transplant page.
Open, laparoscopic and robotic donor hepatectomy
Open donor surgery
Done through an incision across or down the upper abdomen. It is the long-established approach, suitable for all graft types and all anatomies, and remains widely used.
Laparoscopic donor surgery
Done through several small keyhole cuts, with the graft removed through a lower abdominal incision (often a horizontal cut below the bikini line). It can mean less pain, a smaller scar and a quicker return to activity in suitable donors.
Robotic donor surgery
A form of minimally invasive surgery in which the surgeon controls robotic instruments from a console, giving magnified 3D vision and wristed instruments. It is available at selected centres for carefully chosen donors.
Minimally invasive donor surgery is not suitable for every donor. Unusual blood vessel or bile duct anatomy, a large graft or previous abdominal surgery may make the open approach safer. In any keyhole operation, the surgeon may convert to open surgery if that is safer during the procedure — this is a safety decision, not a failure. Dr Bappaditya Har performs laparoscopic and robotic donor hepatectomy as well as open surgery, and will explain which approach suits a particular donor after the scans are reviewed.
What happens on the day of surgery
- 1
Admission
The donor is usually admitted a day or two before surgery for final checks and consent. By this stage the full donor evaluation and legal approvals are complete; see who can be a liver donor.
- 2
The operation
Under general anaesthesia, the surgeon confirms the anatomy with ultrasound and dye studies, divides the liver along the planned line and separates the graft's artery, portal vein, hepatic vein and bile duct. The operation usually takes several hours.
- 3
Handing over the graft
The graft is flushed with cold preservation fluid and passed to the recipient team working in the adjoining theatre.
- 4
Waking up
The donor is monitored in a high-dependency or intensive care area for the first day or so, with pain relief through an epidural or drip.
How safe is liver donation?
Donor safety is the first consideration in living donor transplantation; a donor who is not safe to proceed is declined, even if they are the recipient's only option. Most donors recover fully without complications. Across large international series, a minority of donors — more often after right-lobe donation — experience complications, most of them minor and treatable.
- Bile leak from the cut surface of the liver: the most common significant complication; usually settles with a drain or an endoscopic stent.
- Wound problems, chest infection, or blood clots in the legs or lungs — reduced by early walking and preventive measures.
- Bleeding needing transfusion or, rarely, a return to theatre.
- Temporary liver dysfunction — mild jaundice or fluid in the first days — which settles as the liver regrows.
- Incisional hernia later, more likely after open surgery.
The risk of a donor dying is very low but real. International reports estimate it at roughly 1 in 500 or lower for right-lobe donation and lower still for left-sided grafts. Any honest transplant team will discuss this with the donor directly, in private.
Recovery, regeneration and returning to work
| Time after surgery | What to expect |
|---|---|
| Days 1–3 | Sitting out of bed and walking with help; drips and catheter removed step by step; eating light food. |
| About 5–8 days | Discharge from hospital for most donors, if blood tests are settling and pain is controlled with tablets. |
| 2–4 weeks | Tiredness improves; walking longer distances; follow-up blood tests and a clinic check. |
| 4–6 weeks | Most donors return to desk-based work and light household activity; driving once pain-free and able to brake sharply. |
| About 3 months | Heavy lifting, manual work and strenuous exercise usually allowed; the liver has regrown to near its original volume. |
Liver regeneration begins within days. Most of the lost volume returns in the first six to eight weeks, and the liver reaches close to its original size within a few months — though the shape changes. Donors do not need long-term medicines because of donation, and a healthy donor can later have children, work and live normally. Our article can you live with half a liver? explains regeneration in more detail.
Donors should return to hospital immediately with:
fever with shivering; increasing abdominal pain or swelling; yellowing of the eyes; vomiting that does not stop; redness or discharge from the wound; sudden breathlessness or chest pain; or a painful, swollen calf. These can signal a bile leak, infection or a blood clot.
Meeting the donor team in Kolkata
Donors are assessed and counselled at Narayana RN Tagore Hospital, Mukundapur, by a team that includes the transplant surgeon, hepatologist, anaesthetist, psychologist and transplant coordinator. The donor always has the chance to ask questions privately, away from the recipient's family. To start the process for a living donor liver transplant, send reports on WhatsApp (+91 70420 39420) or call 080675 06860.
Frequently asked questions
How long does liver donor surgery take?
Typically several hours, depending on the type of graft, the anatomy and the approach. The recipient's operation runs in parallel in the next theatre.
Is laparoscopic or robotic liver donation safer than open surgery?
In suitable donors at experienced centres, minimally invasive donation offers a smaller scar and often less pain with a comparable safety profile. It is not suitable for every donor, and safety — not the size of the scar — decides the approach.
How long will the donor stay in hospital?
Most donors go home after about five to eight days, if recovery is straightforward.
Does the donated liver grow back?
Yes. The remaining liver regrows to near its original volume within a few months. The transplanted part also grows in the recipient.
When can a liver donor go back to work?
Most donors return to office or desk work in about four to six weeks and to heavy physical work in about three months, depending on the type of surgery and how recovery goes.
Will the donor need medicines for life?
No. Donors do not need anti-rejection medicines. Pain relief and a few supportive medicines are used for a short time after surgery, and donors attend follow-up checks.
Related reading
Living Donor Liver Transplant →
A family member donates part of their liver; both recover.
Who Can Be a Liver Donor? Eligibility, Tests and the Legal Process in India →
Living liver donor eligibility in India — age, blood group, BMI, fatty liver, liver size — the donor tests, THOTA approval and the right to withdraw.
Can You Live With Half a Liver? How Liver Regeneration Works →
Yes — a healthy liver regrows after part is removed. How regeneration works, how much can safely be taken, and what it means for donors and patients.
ABO-Incompatible Liver Transplant in Kolkata →
When the only willing donor has a different blood group: how ABO-incompatible liver transplant works, desensitisation, the extra risks and who is suitable.
Paediatric Liver Transplant in Kolkata →
Liver transplant for children in Kolkata: biliary atresia, metabolic disease and acute liver failure, a parent as donor, and growth and school afterwards.
This page is general patient information, not a diagnosis or a substitute for a consultation. Treatment decisions depend on each patient's reports and examination. Read our medical disclaimer and editorial policy.