In its essentials, the operation involves removal of the unhealthy liver of the patient and replacing it with the healthy liver (or portion of liver in living donor liver transplantation). The operation to remove the liver of the patient (recipient hepatectomy) is difficult because the liver is firmly attached to surrounding organs with tissues containing many thin walled blood vessels (collaterals) with blood under a lot of pressure (portal hypertension). A lot of bleeding can happen during this stage of the operation and enough blood should be kept available to replace the losses. The liver must be removed in such a way that the blood vessels and bile duct of the patient are suitably prepared to be joined to those of the new liver.
The donor liver (in living donor liver transplants) must be divided into two parts, one of which is to be removed while the other will remain behind. Both parts of the liver must have a blood supply and a way for the blood to leave the liver and a way for bile to flow out of the liver. This is a much more difficult procedure than removal of a portion of the liver for disease or tumor.
The donor liver (or portion of liver) is removed and flushed with cold preservative solution and the blood vessels are prepared to be connected with those of the patient. This often involves extending the vessels of the donor liver with segments of vessels taken from the patients removed liver. The new liver is then implanted into the patient and all the blood vessels and the bile ducts joined to their counterparts in the patient.
These photographs have been taken from patients undergoing liver transplantation at Sir Ganga Ram Hospital. However, they are not from the same patient. They have been chosen for clarity in illustrating the steps of the operation.