ROCHESTER, Minn. — Simultaneous bariatric surgery and liver transplant for patients who are severely obese is safe and improves long-term health outcomes, according to a recent Mayo Clinic study. This combined approach offers a needed solution for these patients who are often denied a lifesaving liver transplant due to their weight.

The 10-year study, published in the Journal of Hepatology, compared patients who received only a liver transplant with those who underwent both a liver transplant and bariatric surgery.

The combined approach resulted in sustained weight loss, reduced risk of type 2 diabetes and lower risk of fatty liver disease recurrence. Importantly, the combined procedure posed no additional risks compared to liver transplant alone.

"We've been amazed by the transformation our patients experience," says Julie Heimbach, M.D., director of Mayo Clinic Transplant Center in Minnesota and the study's senior author. "This dual approach prevents long-term obesity complications like diabetes, heart disease and cancer, while also preventing fatty liver disease recurrence."

How obesity and liver disease are connected

The percentage of liver transplant candidates in the U.S. with obesity continues to climb, with more than 41% of candidates having a body mass index above 30 in 2022. Obesity puts people at risk of developing metabolic dysfunction-associated steatotic liver disease, or MASLD, formerly known as nonalcoholic fatty liver disease. It's a condition where excess fat accumulates in the liver, which can lead to inflammation, scarring and advanced liver disease. Patients with a body mass index of 40 are more likely to be denied a transplant due to their weight.

"Since MASLD is a leading cause of liver failure, it only makes sense to protect the precious, lifegiving new liver from the same damage that led to the patient needing a transplant in the first place. Safely combining the two procedures protects the transplanted liver and can provide profound health benefits to these patients," says Todd Kellogg, M.D., Mayo Clinic bariatric surgeon and the study's co-author.

What about using new prescription medications for weight loss?

New weight loss medications, such as GLP-1s, are being used to help some pre-transplant and post-transplant patients manage their weight. Still, Mayo Clinic experts say bariatric surgery remains an important option for patients with severe obesity due to its safety, proven effectiveness and lasting results. Another recent Mayo study related to kidney transplant patients supports this.

"The patients that we're talking about really have a significant amount of extra weight. The issue with the GLP-1 medications is they are effective in terms of weight loss as well as other benefits which are being identified, but they may not get these patients with severe obesity to their lasting goal of a healthier weight," Dr. Heimbach says.

Bringing together experts from different medical specialties is essential when treating these patients, says Ty Diwan, M.D., Mayo Clinic transplant surgeon and the study's co-author.

"This study shows that caring for these complex patients extends beyond the transplant itself," Dr. Diwan says. "Multidisciplinary care is required to maximize patient outcomes, and that is what we see in this data. By bringing together experts in very different fields, we've improved patient care and overall health outcomes."

Additional resources:

• Mayo Clinic Minute: Dual procedure combines liver transplant, bariatric surgery

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Heather Carlson Kehren, Mayo Clinic Communications, newsbureau@mayo.edu

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This dual procedure is especially helpful for patients with metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease. MASLD happens when fat builds up in the liver, often without symptoms. It's mostly caused by obesity — defined as a body mass index (BMI) of 30 or higher. In advanced stages, MASLD can lead to serious liver damage that requires a transplant.

Watch: The Mayo Clinic Minute

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"Metabolic-associated steatotic liver disease is the most common liver disease, not only in the United States but worldwide," says Dr. Heimbach.

As obesity rates rise, so does the need to treat patients with MASLD.

"When we have excess fat that builds up in the liver, this can lead to inflammation and scarring and even advanced liver disease," she says.

It won't cause complications for everyone, but, for some, it can progress to cirrhosis.

"When a patient develops cirrhosis, they can then need a liver transplant," Dr. Heimbach says.

And having extra weight can be a reason patients might not be eligible for transplant. At Mayo Clinic, the approach is to help patients with obesity as well as transplant.

"We consider both liver transplant and what's called a sleeve gastrectomy, which is a type of weight-loss operation that can be used as a tool to help patients be successful in managing not only their liver disease with a liver transplant, but their obesity with the sleeve gastrectomy," Dr. Heimbach explains.

The procedures are done simultaneously with multiple teams working together. Dr. Heimbach says it's about providing patients the care they need.

"I'm excited about what transplant offers to all of our patients, which is to be able to return to the life that they had before they got sick. And for patients who were carrying extra weight, not only are they healthy again, but now they're able to really fully enjoy and be fully participating in their life," she says.

Additional Resources:

• Study finds long-term health benefits from bariatric surgery and liver transplant

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As a transplant surgeon, Timucin Taner, M.D., Ph.D., is a world-renowned physician and researcher. He has authored more than 100 peer-reviewed publications, performed pioneering surgeries and received numerous awards and honors. As an educator, Dr. Taner is training the next generation of transplant surgeons — just as he was trained when he began his residency in general surgery at Mayo Clinic School of Graduate Medical Education (MCSGME) 15 years ago.

In his role as division chair of transplantation surgery, Dr. Taner takes pride in Mayo's strong legacy of transplant surgery training. Mayo Clinic in Rochester has been training transplant fellows continuously since 1979, making it one of the oldest training programs in the United States.

A fellow is a graduate of medical school who has already finished their residency. Doctors pursue a fellowship to gain expertise in a specialized area of medicine, such as transplant surgery. During a fellowship, a doctor follows a specialist closely to get even more education in a single field of medicine.

"We really are preparing our fellows to become leaders in the field,” says Dr. Taner, "and every year, the interest and applications from our residency programs increases."

Mayo Clinic's abdominal transplant surgery fellowship, which Dr. Taner completed himself, offers a multidisciplinary approach that makes for well-rounded training, with fellows getting to work with hepatologists, nephrologists and endocrinologists. This is a strength of the program, according to Dr. Taner, as it ensures that fellows can take care of a patient not only in the operating room but also in the pre- and post-operative periods. Additionally, fellows must do a certain number of kidney, liver and pancreas transplants to be certified as an abdominal transplant surgeon.

An educational journey

After completing a medical degree, Dr. Taner earned his Ph.D. in transplant immunology. While in his doctoral program, he decided to become a transplant surgeon, beginning with a General Surgery residency with MCSGME in Rochester. After residency, he stayed at Mayo to complete the fellowship in abdominal transplant surgery. Dr. Taner looked at 10 other fellowship programs but ultimately decided there was no better program than Mayo's.

“I was truly ready when I took my first call on staff about a month after I finished my fellowship,” he says. “I still think it was one of the best training programs back then, as it is now.”

Part of what helps prepare fellows for the rigors of transplant surgery is the program's team-based approach. Nurse practitioners and physician assistants are incorporated into patient care, allowing the fellows to focus more on the surgical aspects of their training. Since Dr. Taner's time as a fellow, there is now a greater emphasis placed on the use of robotics in surgery. But what hasn't changed, he says, is the tremendous investment Mayo makes in training its surgical fellows.

The next generation of transplant surgeons

Omar Haque, M.D., M.P.H., understands that investment. Dr. Haque is a fellow in the Abdominal Transplant and Hepatopancreatobiliary (HPB) Surgery Fellowship in Rochester. He graduated from Mayo Clinic Alix School of Medicine and, after completing his surgical residency in Boston, was eager to come back home to Mayo Clinic for his fellowship.

"This was my top choice for fellowship. There is a long line of outstanding surgeons who trained here," says Dr. Haque. "I knew and trusted the Mayo environment, and it still felt like I was a part of the family here. Plus, if Dr. Taner was chosen to lead this institute, then it must be in good hands."

Very few institutions offer a dual fellowship in abdominal transplant and HPB surgery in two years, says Dr. Haque, who appreciates the versatility that this training offers him. The program is dual accredited by the American Society of Transplant Surgeons (ASTS) and the Americas Hepato-Pancreato-Biliary Association (AHPBA), which structures the training to include four rotations: donor procurements, kidney transplant, liver transplant and HPB surgery.

Since his fellowship began, Dr. Haque says he has received outstanding technical training and has been pleasantly surprised with how much operative autonomy Mayo Clinic gives its fellows. Eight months into a two-year fellowship, Dr. Haque feels independent in the majority of transplant operations, which is something he says is rare among other transplant fellowships.

In addition to being drawn to the world-class surgical training and the values of Mayo Clinic, Dr. Haque admits there was another factor in making his fellowship decision.

"Dr. Taner is one of the major reasons I came here. Not only is he one of the most technically talented surgeons I've ever come across, but also one of the most humble and kind," says Dr. Haque. "He is always there to support his fellows and treats everyone fairly, and that's really special coming from your chair."

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About Mayo Clinic School of Graduate Medical Education
MCSGME currently offers fellowships in three transplant surgical specialties, spanning all three Mayo campuses. Fellows perform hundreds of organ transplants annually and are active in transplant practice in the U.S. and abroad.

Mayo Clinic Graduate School of Medical Education is one of the nation’s oldest and largest institutions of graduate medical education and has more than 2,000 learners enrolled in programs across the country. Of those more than 300 programs, 197 are accredited by the Accreditation Council for Graduate Medical Education (ACGME), and 95 percent of Mayo’s GME training programs are above the national average in board passage rates.  

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When Tiffany Coco steps into a room at Mayo Clinic Transplant Center in Arizona, she focuses on the patient's needs beyond the medical updates.

"Often, patients put their best face forward with the physicians," says Coco, "And when they talk to us, they let their guard down and open up about how transplant affects their day-to-day life."

As a licensed clinical social worker embedded in multidisciplinary care teams, Coco uses her clinical expertise to assess patients' emotional, psychological and social needs to help them navigate their transplant experience.

Coco leads a team of 20 social work professionals who work alongside nursing and medical staff to deliver an unparalleled experience to patients and organ donors before, during and after their care at Mayo Clinic. Her commitment to this work is deeply personal.

From personal loss to professional calling

At age 15, Coco experienced a tragic loss when her mother passed away unexpectedly. Following this, her family faced a difficult decision: They chose to donate her mother's organs.

"I've been that family on the other side of the conversation," she says. "We woke up that morning not knowing our world would change forever that afternoon, that my mom was going to be gone and we would have to make that decision."

Coco had known from a young age that she wanted to pursue a career helping people; her experience as a donor family solidified her resolve and led her to social work. During graduate school, she began an internship at Mayo Clinic, which led to a full-time role. She joined the Transplant Center in 2013.

"Transplant is a second chance at life ― for the patient, their family and their community," Coco says. "No matter how many transplants I witness, it amazes me each time because I know there is another family that gets a chance that mine didn't."

Helping patients on 'a journey of cautious hope'

Across Mayo Clinic, more than 480 social workers in the Department of Nursing serve patients in all care settings. Social workers are licensed professionals whose work ranges from therapy and counseling to crisis intervention and connecting patients to resources to meet basic needs such as housing, child care and transportation.

In transplant care, social workers help patients and families navigate the emotional, financial and logistical challenges surrounding organ transplantation and left ventricular assist device (LVAD) therapy.

Coco calls the patients' experience "a journey of cautious hope" that begins well before the procedure day and sometimes ends without a transplant.

One of the most sensitive areas her team helps patients navigate is the experience of receiving an organ from a deceased donor.  

"To prepare for a transplant, you're preparing for a wave of emotions. It's the excitement. It's the nerves. It's worry. It's everything at once," Coco says. She helps them realize the donor's death would have happened regardless, and the decision to donate is a beautiful gift.

Coco and her team conduct comprehensive psychosocial assessments to identify factors that may affect care outcomes — such as a patient's occupation, housing situation, literacy skills and family dynamics — and bring their insights to the care team.

They serve patients during pre-transplant planning, the patient's hospital stay and post-transplant follow-up, sometimes providing lifelong support.

"We truly do walk along the journey, and we, as the social workers, are there making sure that they have a journey to walk on," says Coco.  

"If they don't have a house to go back to after their care, or if they have to choose between meds and meals, that's not quality of life." 

Holding patients' stories until they can carry them again

Coco says that from the time she first came to Mayo Clinic, she has been inspired by its culture of accountability and excellence. She admires the way healthcare professionals show deep respect for each patient as a person. This means remembering patients' stories and celebrating transplant anniversaries with them, sometimes 15 years or more after their procedures.

"A patient is not just their diagnosis. It's not just a heart patient ― it's Mr. John Doe, and his motivation for a transplant is to walk his daughter down the aisle. Or Miss Jane Doe, who wants to finish her degree and get married. These stories are the motivation that we hold for patients while they're going through it, and that we give back when they're ready to carry them again."

On her arm, Coco wears tattoos of the organs she's seen in her career. They're a visible reminder of the work she's devoted her life to and of how she is honoring her mother.

"Though I wish I still had my mom, her legacy lives on in not just those lives that were impacted through her organ donation but the patients I come in contact with and impact in a different way," she says.

"I went from being a little 15-year-old girl just trying to figure out her place in the world to being the supervisor who guides the helpers."  

Learn more

• Learn about social work at Mayo Clinic in Rochester and medical social worker careers.

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April is Donate Life Month 

ROCHESTER, Minnesota — The traditional way to treat people with advanced kidney disease has been to use dialysis to remove waste from the blood while patients wait several years for kidneys from deceased organ donors. At Mayo Clinic, transplant surgeon Dr. Mikel Prieto and colleagues advocate for a different approach called preemptive transplantation: Kidneys from living donors are allowing many people with advanced kidney disease to receive transplants before their kidneys deteriorate so much that they need dialysis. 

Chronic kidney disease afflicts roughly 1 in 10 people worldwide and causes millions of deaths each year, according to the International Society of Nephrology. Kidneys filter waste and excess fluids from the blood that the body then expels in urine. Kidneys also help control blood pressure. In chronic kidney disease, kidneys gradually lose their effectiveness. Dangerous levels of fluid, electrolytes and waste can build up. Dialysis has traditionally been the next step.  

Dialysis removes waste and extra fluids from the blood, restores electrolyte levels (helping muscles, the heart and the brain work well) and aids blood pressure control. Depending on the type, dialysis can take place at home or at a dialysis center. If the patient is a candidate for a kidney transplant, dialysis can be a bridge to transplant. Dialysis takes hours multiple times per week and often requires significant lifestyle changes and dietary restrictions. Dialysis may occur for years if a patient is waiting for a kidney from a deceased donor.  

Dialysis extends life but unfortunately it often doesn't yield great quality of life, explains Dr. Prieto, who performs pediatric and adult kidney transplants and is surgical director of the pediatric kidney transplant program at Mayo Clinic in Minnesota.   

"People on dialysis may feel kind of lousy for the most part. Although some manage to stay working and engaged in their other activities, a small percentage of patients on dialysis have a full, normal life," Dr. Prieto says. "Second, your body deteriorates because even though dialysis keeps you alive, it does not do a fantastic job at cleaning out all the waste. So, if someone is on dialysis for seven years and you look at their arteries, they may be a 40-year-old, but their arteries and blood vessels look like a 70- or 80-year-old. You want to minimize the amount of dialysis if you can."  

That is where living kidney donors come in. A living kidney donor is someone who donates a healthy kidney on behalf of a family member, friend or even a stranger. If the living donor's kidney isn't a direct match for an intended recipient, it can become part of a paired donor chain. The incompatible donor's kidney goes to someone who is a match, and the donor's intended recipient receives a kidney from a different and compatible donor. Donor chains can include several donor-recipient pairs. 

"Typically, unless you are really hard to match, we'll find a matching kidney for you within weeks or two to three months," Dr. Prieto says. "When you come for a transplant evaluation, we will ask whether you have or could have a living donor. If you don't, we will explain how to find one."  

There are other potential advantages to donor chains: The living donor and the kidney recipient, frequently spouses or close relatives, can be each other's caregivers after surgery. Participation in separate donor-transplant chains can ensure that their surgeries do not occur at the same time.    

Mayo Clinic campuses in Arizona, Florida and Minnesota have extensive experience with living donor kidney transplants and living donor chains. At Mayo Clinic in Minnesota, roughly half of the patients who receive kidney transplants get them from living donors before their kidneys decline so much that they need dialysis, Dr. Prieto says. 

"Most people know for years in advance that they are going to need dialysis at some point, or a transplant," he explains. "It's much better to plan for a transplant now because waiting times for a deceased donor can be years. During that waiting time, your kidney function keeps deteriorating."  

Patients typically become candidates for a kidney transplant when their kidney function drops below 20%. Dialysis usually starts when function reaches around 10%. If you start thinking about transplantation at this time, it is often too late, and you will be on dialysis awhile, Dr. Prieto says.  

"So that's the sweet spot: transplant between 20% and 10% of kidney function. That's what we call preemptive transplantation," Dr. Prieto says. "That's what we try to do here at Mayo. If we time things right, we can do the transplant and avoid dialysis altogether." 

Dr. Prieto and Mayo Clinic are early adopters of living kidney donation, paired donation and donor chains. In the U.S., the National Kidney Registry facilitates living kidney donation and donor chains. Mayo Clinic is a member institution and Dr. Prieto serves on the registry's medical advisory board. 

Many of the patients Dr. Prieto treats have autosomal dominant polycystic kidney disease, an inherited condition in which clusters of cysts grow and substantially enlarge kidneys, potentially causing kidney failure. Symptoms often appear in middle age. In the conventional approach, such patients would have their kidneys removed, go on dialysis, and then months or years later have a kidney transplant.  

Dr. Prieto has perfected a technique that spares people with polycystic kidney disease multiple visits to the operating room. He removes the enlarged kidneys laparoscopically, a minimally invasive approach that prevents a large incision. Then, in the same operation, using a kidney usually from a living donor, he gives the patient a new kidney.   

"In many cases of polycystic kidney disease, the kidneys are so big that it's very uncomfortable," Dr. Prieto says. "People cannot tie their shoes. They cannot bend over. They eat and feel full very quickly. Even breathing sometimes can be difficult. Also, their kidneys can bleed chronically, so patients are hospitalized with severe pain, bleeding or infection." 

He and his colleagues are now embarking on another new frontier: They seek to give patients kidneys that are such a perfect match that their bodies are much less likely to reject them, diminishing the need to take a high dose of immune system-suppressing drugs.  

"We want to give patients kidneys they will never reject," Dr. Prieto says. 

JOURNALISTS: Global, regional and national statistics on chronic kidney disease are available here (free log-in required). 

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About Mayo Clinic 
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news. 

Media contact:  

• Sharon Theimer, Mayo Clinic Communications, newsbureau@mayo.edu 

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Hailing from the historic town of Natchitoches, Louisiana, Roderick Baptiste has spent the last 17 years in Columbus, Georgia. His journey, marked by unexpected health challenges, began to unfold when he moved to Georgia in 2008. During a routine visit to his local primary care physician, an underlying heart issue and high blood pressure were discovered. This led to a diagnosis of congestive heart failure and stage 3 kidney failure.

The path to Mayo Clinic

For several years, Roderick made efforts to manage his condition. "I was treated and was being sustained with changes in medications and many prayers," says Roderick. "In August of 2014, my cardiologist referred me to Mayo Clinic in Florida, and this began my Mayo Clinic experience." At that time, his heart function had declined to a mere 10% ejection fraction, a measurement of the heart’s ability to pump oxygen-rich blood to the body.

The waiting game

Life took a slower pace in 2014 as daily activities became increasingly challenging. "Walking, talking, and normal, day-to-day routines slowly became more and more difficult to manage on my own," says Roderick. By August 2019, he had entered total kidney failure and required dialysis. Despite being listed for a heart and kidney transplant in December 2014, the wait extended for five long years, filled with monthly travels to Mayo Clinic for testing and assessments. Spring of 2019 brought multiple hospital admissions, and by December, his health had significantly deteriorated. In January 2020, Mayo Clinic admitted Roderick as an inpatient until a transplant could be performed. After a 23-day wait, he received a new heart and kidney on Feb. 22, 2020.

A connection beyond surgery

Six months after his transplant, Roderick reached out to his donor's family. His donor's mother responded, and since then, they have built a strong relationship, maintaining contact through visits, phone calls, texts and video conferencing.

Living his best life

Today, Roderick says he feels amazing, living his best life with no health issues to report. His story is a testament to the lifesaving effect of organ donation and transplantation. To those considering becoming organ donors, Roderick offers heartfelt encouragement: "If you check the box as a donor, you could help save so many lives."

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Imagine if your one life could help save the lives of many. Organ donation has the power to transform a single act into the gift of life for countless people in need.

"This tremendous gift of organ donation can make a new life possible for patients who are waiting for transplant, and there is a critical shortage of available donor organs," says Dr. Heimbach.

The need for living organ donors

As the need for kidneys and livers grows, living donation is becoming an increasingly important option for patients waiting for a transplant.

"The primary benefit of living donor transplant is to be able to go ahead to transplant sooner, so patients don't continue to wait on the list, become more sick, have a risk of dying on the list," she says.

Whether you consider being a living or a deceased donor, it's important to ask questions and plan ahead. 

"It's very important to make your wishes known, talk it through with your family and recognize that all of this is possible because of this remarkable altruism," Dr. Heimbach says.

If you want to be an organ donor, you can sign up for your state's donor registry, mark your choice on your driver's license when you get or renew it, and make sure your family knows you want to be an organ donor. 

Read more about living donor transplants.

Related posts:

• Mayo Clinic Minute: Liver transplant for patients with advanced colorectal cancer
• Mayo Clinic Minute: What to expect as a living kidney donor

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Dr. Maher Baz, a Mayo Clinic transplant pulmonologist, says a lung transplant is a complex and major surgery that can significantly improve a patient's survival and quality of life. 

Watch: Dr. Maher Baz discusses lung transplantation

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When it's time for a lung transplant

A lung transplant is typically considered when a patient's disease severely impacts day-to-day functioning and/or threatens survival. 

“About 30% to 40% of those who need a lung transplant have late-stage chronic obstructive pulmonary disease and need quality-of-life care,” Dr. Baz says.

Lung transplantation for patients with pulmonary fibrosis, emphysema or COPD can greatly improve overall health. For many, a transplant reduces dependence on oxygen, helping them live more active and independent lives.

"We feel that their quality of life will improve significantly after the transplant. Because they're no longer on oxygen, they can be out and about, walk farther, go on vacations and improve their survival," says Dr. Baz. "There's a subpopulation, especially for fibrosis; we think we can add several years to their survival.”

Advancements in lung transplantation

Medical innovation has dramatically evolved the lung transplant process, making transplants safer and more effective for patients. One of the most significant advances is a system that tests and preserves donated lungs.

"We have something called ex vivo lung perfusion, or EVLP. It's where we put the donated lungs on a breathing machine, circulate fluid in them, test them for about three to four hours and ensure they are good lungs," Dr. Baz explains.

This method ensures donated lungs are viable for transplantation, significantly boosting the availability of usable organs. It means shorter wait times and more opportunities to find suitable donors.

Improved care

Thanks to improved personalized patient care, rehabilitation, infection management and rejection treatment advancements, both short-term and long-term survival rates for lung transplants have improved significantly.

Transplant, says Dr. Baz, can be life-transforming. "It will take patients from being dependent on oxygen, dependent physically, to independent of oxygen and an independent lifestyle. And it can do that often within a few weeks after transplant surgery."

It's important to note that a lung transplant isn't right for everyone. Many factors determine eligibility, so working closely with your care team to evaluate the best treatment option is important.

Related posts:

• A journey of resilience and hope
• Mayo Clinic’s transplant center in Florida reaches 800th lung transplant milestone, on track for record-setting year

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In the U.S., it’s estimated that 4.5 million adults are diagnosed with chronic liver disease. It develops over time and may be caused by a number of conditions including, hepatitis, genetics, alcohol overuse or cancer. Chronic liver disease is different than acute liver disease, which can come on quickly and may be the result of an injury or a virus.

Regardless of the cause, Dr. Bashar Aqel, a Mayo Clinic transplant hepatologist, says when the liver can no longer function, a life-saving transplant may be needed.

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The liver is the largest internal organ of the body. It is essential for metabolism, digesting food and ridding the body of toxic substances. Liver failure can happen quickly, or over time.

"Once liver disease advances, the only way we can reverse the process and give the patient their life back is by replacing the liver, " says Dr. Aqel.

When patients become a candidate for a liver transplant, they are added to a waitlist. Unfortunately, there are more people waiting for a liver than there are available organs.

"As the patient is waiting on the list, they usually are anxiously waiting for that call when a donor becomes available. And that's what we call the deceased donor liver transplantation."

Another option is a living liver transplant. It's a major surgery where a person donates two-thirds of his or her liver. Donors needs to go through an extensive evaluation to make sure they can donate safely.

"A healthy liver is able to regenerate, and you will be surprised to know that with living donor liver transplantation, both segments of the liver will grow back to almost the normal size within 90 days after transplantation."

Being a living organ donor may not be an option for everyone, but there are ways to people can sign up to be an organ donor. It can be as easy as checking a box on your driver's license.

"Donating your organs is really donating the gift of life to people who are in urgent need for organ transplantation," Dr. Aqel says.

For the safety of its patients, staff and visitors, Mayo Clinic has strict masking policies in place. Anyone shown without a mask was either recorded prior to COVID-19 or recorded in a nonpatient care area where social distancing and other safety protocols were followed.

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April is National Donate Life Month. You may have seen or heard stories about transplant chains, also known as paired donations. This is when a living donor is not a match for a specific recipient but still agrees to donate, setting off a chain reaction of transplants. Most of these paired donations involve the kidney. Because most people have two kidneys and usually can get by with one just fine, donating the other is an option. Far less common is a paired liver transplant. 

But you might be asking yourself, if a person only has one liver, how can you be a living donor to start this chain?

The liver is the largest internal organ in the body. Among its jobs is helping to digest food and getting rid of waste. Unfortunately, disease and other factors can lead to liver failure.

Watch: Liver’s regenerative ability allows for living donors

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"At any given time, there's about 10,000 people waiting for a liver transplant in this country, and every year, we add another 10,000 to the waiting list," says Dr. Timucin Taner, a Mayo Clinic transplant surgeon. He adds that it can be a frustrating situation.

"The waiting list is not changing, because we're able to transplant only about 10,000 of them with deceased donor livers," he says.

What can make a difference is living donors. Even though you only have one liver, Dr. Taner says you can still be a living donor. "And this is all based on the liver's amazing ability to regenerate. Once you do this operation, you remove part of the liver. The remaining liver, as well as the part that goes to the recipient, starts growing right away, and it becomes a full-size liver within about three to four weeks. So it's an amazing capacity of the liver," he says.

Not every donor is going to be a compatible match for an intended recipient. That's where paired donation comes in, explains Dr. Taner. "So there are several situations where the donor may not be suitable or compatible with the intended recipient. In that situation, if they're clear to donate, then they can donate to somebody else who is compatible to them, and that recipient's donor can donate to the initial recipient. So we're just allowing these donors to give the gift that they're intended to give," he says.

Dr. Taner led the team that completed Mayo's first paired liver transplant in August. It was initiated by an altruistic donor. Dr. Taner says paired liver transplants are not as common as paired kidney transplants, in part because of the logistics involved. "You have to have a big team, and this big team includes nurse coordinators who work day in and day out with donors and recipients, the social work and independent liver donor advocate team, as well as the physicians, the surgeons," he says.

While the hope is to be able to do more of these procedures, Dr. Taner says the biggest hurdle is the number of donors. "So I would encourage people to look into the transplant programs to see if they can donate, and make a decision based on that information," he says.

Related Content:

• Mayo Clinic performs its first paired living liver donation

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