Liver transplant is of two types based on the source of the donor liver:

Cadaveric or Deceased Donor Liver Transplant ( DDLT)

The donor is a cadaveric or brain dead patient. It is an unrelated transplant and donation occurs if the brain dead patient’s family either wishes to or agrees to donate their patient’s organs solely for altruistic reasons.

Cadaveric Transplant can be further of two types depending upon whether the donation occurs before or after cardiac death:

A. Standard DDLT

In this the liver or organ retrieval happens while the heart is still beating. In fact, the anesthetists maintain the heat-beat with medical supports till the time of organ retrieval.

B. Donation after cardiac death (Abbreviated as DCD)

This is a relatively newer technique in which the organ retrieval happens after the cardiac death or after the heart beat stops. The liver retrieved after such procedures is kept on machine perfusion like Organox to look for their viability and quality.

Based on whether a complete or partial liver is given to the patient the cadaveric liver transplant can be of following types:

A. Whole organ Liver Transplant

When the complete liver is implanted in a recipient as it is, it is referred

to as a Whole- organ Cadaveric Liver Transplant. In fact, a whole organ transplant can only happen with a cadaveric or deceased donor Liver transplant.

B. Split Liver Transplant

Sometimes a cadaveric liver can be split into two and be given to two different recipients. Since liver is not a symmetrical organ but still is divided into a right and a left lobe which are asymmetrical and differ in size and shape. The right lobe is mostly larger than the left lobe. So after the split the larger right lobe is given to an adult patient and smaller left lobe is usually preferred for a pediatric group patient. Such type of liver transplant when done is referred to as split liver transplant.

Living Donor Liver Transplant (Abbreviated as LDLT)

Sometimes it is also referred to as Living Related Liver Transplant (LRLT). In contrast to a deceased donor living transplant when the donor is a living and healthy individual who wishes to donate a part of his liver out of affection and altruistic reasons, it is referred to as Living Donor or Living- related Liver Transplant. This arrangement by nature can be prone to organ trading and hence in most countries the liver donation is restricted by law to family members or relatives i.e. the donor has to be a family member or a close relative.

The organ retrieved from the live donor is obviously a partial liver. The right lobe is usually retrieved for use in an adult recipient and a left lobe is used for pediatric or smaller recipients.

Swap Liver Transplants

Liver transplant or any organ transplant can normally be done only within matching ABO blood groups and recipients can receive liver only from matching ABO group types like to A from A, B from B and O from O (exceptionally blood group AB can receive liver either from A, B, AB, or O and hence is called the universal recipient). Similarly donors can also donate to matching blood groups like A to A, B to B, AB to AB (exceptionally blood group O donor can donate to any group recipient A, B, AB or O and hence is called the universal donor.) (Rh does not pose any concern to liver donation and Rh positivity and negativity does not matter.)

So sometimes there can be situations when there are no matching donors in the family. In such conditions if there are pairs with opposite matching groups, say like one family has blood group A recipient and donors is B and the other family has blood group B recipient and donor is A, and if they agree for donation to each other’s recipient, then such transplants are referred to as Swap Liver Transplants.

ABO- Incompatible Liver Transplant

Normally liver transplants are done within the matching ABO group types. But with newer immunomodulatory processes it is now possible to do liver transplant even across blood group barriers. Transplants done across blood groups using these immunomodulatory techniques are referred to as ABO incompatible liver transplants. However, it should be noted that the general results of ABO incompatible liver transplants are slightly inferior to than conventional blood group compatible liver transplant. Secondly they are costlier that the normal transplant owing to the cost incurred by the immunomodulation process. Thirdly it is not suitable for severely sick patients or during emergency situations.