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.

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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.

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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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Dr. Denise Harnois, a Mayo Clinic transplant hepatologist, explains how this innovative strategy is expanding treatment options and improving outcomes.

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Learning you have advanced colorectal cancer that has spread to the liver can be scary. In some cases, a liver transplant may offer hope, providing better outcomes when other treatments aren't an option. 

"In those circumstances where patients have colon cancer that's gone to the liver that doesn't seem to be anyplace else within the body, but they're not eligible for consideration of doing a surgical resection — in those circumstances, we can consider replacing the entire liver, and that involves a liver transplant," explains Dr. Harnois.

It's a complex surgery requiring experts from multiple teams working together.

"We're working together as a team to make sure we are offering the best options for the potential for cure for these patients," she says.

Liver transplants have greatly improved survival rates. One-year survival is 80% to 100%, three-year survival is around 80%, and five-year survival is between 60% and 80%.

"Without consideration of liver transplant, their five-year survival rate would have been 15%. So we can offer a dramatic improvement in survival rates in patients that undergo liver transplant," says Dr. Harnois.

Related posts:

• Liver transplants offer new hope for colorectal cancer patients with liver metastasis
• Mayo Clinic Q and A:  Understanding colorectal cancer
• Mayo Clinic Minute: Warning signs of colorectal cancer in younger adults
• Innovative treatments for rectal cancer

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JACKSONVILLE, Fla. — Liver transplants are becoming a new treatment option for certain colorectal cancer patients whose cancer has spread to their liver and are ineligible for other surgical options. This innovative approach is providing hope to colorectal cancer patients who otherwise are often faced with a grim prognosis.

"Colorectal cancer is the fourth-most-common cancer in the United States, but it's also the second-deadliest cancer. At the time of diagnosis, about 1 in 5 patients will have metastatic disease, meaning the cancer has spread outside of the colon. The most common place we see metastasis is in the liver," says Denise Harnois, D.O., a Mayo Clinic transplant hepatologist.

In roughly a quarter of these cases, the cancer does not spread beyond the liver. Traditionally, surgeons first explore the option of cutting out the cancer in the liver. However, if the cancer has spread to more than one area of the liver, this approach may not be an option. That is when a liver transplant can be considered for patients who meet certain criteria, Dr. Harnois says.

The ideal candidate will have responded well to chemotherapy, and the colorectal cancer will not have spread beyond the liver. They are also not a candidate for surgical removal of the cancer in their liver. Patients also need to be healthy enough to undergo a liver transplant. This new approach is critical for these patients, whose five-year survival rate without a transplant is only about 15%.

"Mayo Clinic is one of very few transplant centers in the U.S. performing liver transplants on patients with colorectal cancer metastasis, in part because it's a relatively new treatment option. It also requires a multidisciplinary team of oncologists, surgeons and transplant experts who work closely together to help these patients," Dr. Harnois says.

Gary Gonzales is among those grateful this new option exists. The 59-year-old from Broomfield, Colorado, was diagnosed with colorectal cancer at age 52. The cancer soon spread to his liver. He was referred to Mayo Clinic after having undergone multiple rounds of chemotherapy and two liver resection surgeries at another institution. He had a liver transplant at Mayo Clinic in July of 2024, and says he finally feels like his old self. He is thankful for his care team and his liver donor.

"I am very grateful for that donor," Gary says. "I would definitely like to give the donor's family a hug. The donor is a part of me and my family and gave me a chance to live."

Journalists: Press kit, including b-roll, photos and interviews available here. Dr. Denise Harnois and Gary Gonzales are available for interviews. Please contact newsbureau@mayo.edu to schedule.

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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

Additional resources: Mayo Clinic Minute: Liver transplant for patients with advanced colorectal cancer

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ROCHESTER, Minn. — More than 90,000 people are on the waiting list for a kidney in the U.S. Unfortunately, less than a third of those waiting for a kidney transplant can expect to get one this year. This comes as rates of chronic kidney disease, which can lead to kidney failure, continue to climb across the globe. But there is a way to help. Healthy people can donate one of their kidneys, giving someone a much-needed second chance.

"For people with kidney failure, receiving a kidney from a living donor is the best possible option. When healthy people donate a kidney, they give someone a second chance. This helps kidney recipients get transplanted faster and enjoy a healthier life," says Carrie Jadlowiec, M.D., Mayo Clinic transplant surgeon.

There were more than 6,400 living kidney donations in 2024. And while the number has increased in recent years, it is still less than it was five years ago. Ahead of World Kidney Day on March 13, Mayo Clinic experts are helping dispel some of the most common myths surrounding living kidney donation.

Myth: Living kidney donors need to be in perfect health.

False. While it is important for kidney donors to generally be in good health, there is no expectation that donors be in perfect health. For example, some potential donors with controlled high blood pressure or type 2 diabetes are eligible to be donors. All potential donors need to be at least 18 and undergo a rigorous medical and psychological evaluation to make sure they are a good candidate to donate. At Mayo Clinic, those evaluations can be completed in a single day.

Myth: Anyone over age 50 can't be a living donor.

False. Plenty of people over 50 are living donors.

"We accept donors starting at age 18. There is no upper age limit for someone to be a kidney donor. We do a comprehensive assessment on all potential donors, regardless of their age, to make sure they are an appropriate candidate," says Ty Diwan, M.D., Mayo Clinic transplant surgeon.

Myth: You must be related to someone to be a match.

False. Anyone can be a living kidney donor. You can consider donating a kidney to a relative, friend, acquaintance or anonymously to someone on the waiting list. Sometimes a potential donor who wants to give to a family member or a friend isn't an optimal match for that recipient. In those situations, paired donation is considered. Donors and recipients are matched with other donors and recipients, creating what is known as a kidney chain. People without a specific recipient in mind can also choose to donate to a stranger via nondirected donation.

Myth: Kidney donors can't live an active lifestyle after donation.

False. In most cases, kidney donors can return to normal activities four to six weeks after surgery. Most donors undergo a laparoscopic procedure that involves making a few small incisions instead of a larger one. In some cases, minimally robotic surgery is also an option. Both types of surgery reduce recovery time. Many donors return to their pre-donation hobbies such as running, biking and swimming. As with any surgery, there are risks, and it is important for potential donors to discuss those with their healthcare team.

Myth: Donating a kidney shortens your lifespan.

False. Multiple studies have shown that donating a kidney does not shorten one's lifespan. In fact, kidney donors tend to live longer than the general population.

"Kidney donors undergo rigorous screening prior to donation, and those accepted as donors are often healthier than the general population at baseline. These individuals often continue to live healthy lifestyles post-donation, which can lead to a longer lifespan," says Shennen Mao, M.D., Mayo Clinic transplant surgeon.

Mayo Clinic has several transplant physicians who can talk about living kidney donation, including:

• Ty Diwan, M.D., a transplant surgeon at Mayo Clinic in Rochester
• Carrie Jadlowiec, M.D., a transplant surgeon at Mayo Clinic in Arizona
• Shennen Mao, M.D., a transplant surgeon at Mayo Clinic in Florida

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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

Additional resources:

• Mayo Clinic Minute: What to expect as a living kidney donor

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Dr. Carrie Jadlowiec, a Mayo Clinic transplant surgeon, says a living-donor kidney transplant has benefits for organ recipients, including better survival rates.

Who is eligible to become a donor and what can you expect? Learn more in this Mayo Clinic Minute.

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"As long as you're healthy and have good kidney function, then you could potentially qualify to be a kidney donor," says Dr. Jadlowiec.

It starts with a thorough medical evaluation.

"That gives us a good sense of where we're starting, and then it also allows us to better predict where will your kidney function be at in five years and 10 years after you donate," she says.

Risks

Both surgical and medical risks are low, thanks to advanced technology.

"For all kidney donors, that risk is less than 1%, which is what we see within the general population," says Dr. Jadlowiec.

It's a minimally invasive surgery. "Meaning that we do it through small incisions, which helps with faster recovery," she says.

Full recovery can take up to six weeks, but many people start feeling better around three weeks after surgery.

"The biggest benefit is the ability to help someone and to really change their life," Dr. Jadlowiec says.

Related posts:

• Mayo Clinic Q and A: Living kidney donation can start a chain reaction
• Mayo Clinic Minute: Why diverse organ donors are needed

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Researchers are pioneering innovative ways to restore voice to those who have lost it, leveraging advancements in transplant surgery and 3D printing. Discover these groundbreaking developments in the latest episode of Tomorrow's Cure.

Dr. David Lott, associate director of Mayo Clinic's Center for Regenerative Biotherapeutics and chair of the Department of Otolaryngology, joins his mentor, Dr. Marshall Strome, an otolaryngologist, professor, and chair emeritus of the Cleveland Clinic Head and Neck Institute, to share their insights as leaders at the forefront of this transformative research.

On Feb. 29, 2024, Dr. Lott, joined by Dr. Strome, led a multidisciplinary team in performing a groundbreaking larynx transplant for Marty Kedian, a Mayo Clinic patient. The procedure at Mayo Clinic in Arizona was the third known larynx transplant in the U.S. and first for a patient with active cancer as part of a clinical trial. The surgery offers new hope to individuals who have experienced severe laryngeal dysfunction or complete larynx loss.

Dr. Lott emphasizes the critical role of the larynx in daily life. "It allows us to swallow, eat, drink — all the things that we do on a day-to-day basis — breathe, get air into our lungs, and, perhaps most importantly, allows us to communicate and share a voice," he says.

The larynx transplant surgery is a pivotal advancement in making this rare procedure a scientifically validated, safe and effective option for patients.

Marty stresses the importance of the surgery, and he explains why he chose to undergo the procedure. "My reason of pushing this type of surgery, a total transplant, is because I know how it is not to have my voice and then to get it back. Not having a voice hurts. Having it back, life is beautiful," he says.

"The larynx has different meanings to different people," says Dr. Strome. "But it's clearly, very clearly, an organ that when you don't have it, alters your life in a way that most people would not choose."

Researchers are continually advancing innovative solutions to personalize transplants and implants, customizing them to meet the unique needs of each patient. The goal is to address the shortage of donor organs and reduce the reliance on lifelong anti-rejection medications. Among these advancements is the use of 3D bioprinting, which offers expanded options for both patients and surgeons, transforming the future of transplantation.

To learn more about these transformative advancements, listen to the latest episode of Tomorrow's Cure. The podcast is available on all audio platforms, including Apple Podcasts, Spotify and Amazon Music. Episodes also can be viewed on Mayo Clinic's YouTube channel.

Related Articles:

Breaking the silence: First known total larynx transplant on a patient with active cancer as part of landmark clinical trial

Mayo Clinic marks medical milestone with world's first known successful total larynx transplant performed in a patient with an active cancer as part of a clinical trial

Paving the way for future larynx transplants through regenerative science

Research prepares for Mayo's first larynx transplant

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Dr. Andrew Keaveny, a Mayo Clinic transplant hepatologist, says heavy drinking also can lead to alcoholic hepatitis, which is becoming more common in younger people.

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"Alcohol can cause liver damage. And in some individuals who drink excessively, it can result in significant complications," says Dr. Keaveny.

Sustained alcohol use can result in alcohol-related liver disease.

"There is a condition called acute alcoholic hepatitis, where the alcohol triggers an acute inflammatory process in the liver, and patients can become really quite sick, quite quickly," he says.

And it's rising among young people.

"Some of the more tragic cases of liver disease related to alcohol received now are due to young individuals who consume excessively, or binge alcohol," says Dr. Keaveny.

Alcoholic hepatitis can develop quickly. Symptoms can include jaundice, confusion, nausea and vomiting.

"They can present with multiple complications of their liver disease, which requires really a multidisciplinary approach to address and manage their issues," he says.

Treating alcoholic hepatitis requires an assessment of liver damage and complications, and addressing the patient's alcohol use disorder. Dr. Keaveny says corticosteroids may be used, but they have limited effectiveness and risks. The next step may be transplant.

"We consider patients for liver transplantation who have acute alcoholic hepatitis. This requires a very careful assessment of multiple factors, their medical, social and psychological factors, to determine whether they may be eligible for liver transplantation," Dr. Keaveny says.

Living with alcoholic hepatitis?

Connect with others like you for support and answers to your questions in the Transplants Support Group on Mayo Clinic Connect, an online patient community.

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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.

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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.

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DEAR MAYO CLINIC: I've signed up on my driver's license to be an organ donor if I die. It's important to me. I've also considered being a living kidney donor. I don't personally know someone who needs a kidney, but I've seen billboards and other advertisements from people seeking a kidney donor. Does that have something to do with a donor chain? I am not sure how it works. I'm a little scared and not quite ready to commit. 

ANSWER: First, thank you for considering making a difference in the lives of others with the gift of life through transplant. Participating in your state donor registry or the National Donate Life Registry helps people make their wishes about organ donation known in case of their death.

Living-donor transplantation is an option for some organs. For people over 18 born with two functioning kidneys, they can donate one and continue to live a healthy life. An altruistic living-donor kidney transplant chain begins when someone donates a kidney without a specific individual in mind. That can start a chain effect of donors. 

Another way to begin a chain is if a person intends to donate to a family member or friend, but they aren't a direct match. Instead, the person donates to someone else who is a match, and that individual's donor then donates either to the original intended recipient or starts a chain effect of individuals whose donors aren't necessarily a direct match to them, allowing many people to get transplanted.

There's no limit on the chain. It can occur within one transplant program or at multiple transplant programs. In fact, we've had chains that have involved the Mayo Clinic Transplant Center at our three campuses in Rochester, Minnesota; Jacksonville, Florida; and Phoenix; as well as at several institutions around the country.

Kidney function is necessary to live. These two bean-shaped organs remove waste from the blood by producing urine. They play a role in controlling blood pressure, fluid balance, red blood cell counts and more. Living with one healthy kidney is possible, making living kidney donation an option.

What I always tell potential donors is that coming forward as a potential donor is a commitment to find out information; it's not a commitment to donate. You can come forward, learn a little bit and decide it may not be for you.

Learning more about the living organ donor process often helps calm people's concerns. While any medical procedure has risks, you should know we expect living donors to live a completely normal life after donation with no restrictions in terms of activities or diet. Typically, donors have a short stay in the hospital, about a day or two. The recovery period is six to eight weeks, but donors often feel back to normal within one to two weeks after donation. 

Potential donors go through an evaluation online with a basic screening and health questionnaire. Then a donor coordinator contacts you to discuss. If you decide to pursue donation and are a potential candidate, further medical evaluation is done. 

The more people we bring into the donor candidate pool, the more benefit to everyone who is waiting for a kidney transplant. We encourage people to reach out among their community members to ensure we have equal opportunity and equal access of living donation to everyone who might need a donor.

The biggest thing I would say is thank you to all of our donor heroes — the deceased donors and their family members and our living-donor heroes who inspire us to do what we do every day. — Shennen Mao, M.D., Transplant Surgery, Mayo Clinic, Jacksonville, Florida

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