Hepatology · UK
Private assessment for living donor liver transplant, alongside the NHS pathway.
A healthy relative donates part of their liver, and both livers regenerate. Common for children in the UK, rare and more demanding for adults - and always NHS-delivered under Human Tissue Authority approval.
Indicative pricing
What private assessment costs - and what it cannot buy.
The transplant operation is not on this list, because in the UK it cannot be bought at any price.
In short
A full private pre-referral work-up: £2,500–£5,000. The transplant itself: NHS only.
| Assessment step | Indicative range | Typical duration | Results |
|---|---|---|---|
| Consultant hepatologist opinion | £300–£500 | 45–60 min | Same visit |
| Full liver bloods + scoring | £250–£450 | 15 min | 2–5 days |
| Liver MRI with MRCP (donor mapping) | £800–£1,400 | 60 min | 48 hours |
| CT with liver volumetry | £700–£1,200 | 30 min | 48 hours |
| Cardiac and respiratory assessment | £700–£1,400 | 2 hours | 3–5 days |
| Transplant itself (NHS-designated centre) | NHS-funded | 6–12 hours | 2–4 weeks |
Under the Human Tissue Act 2004 it is a criminal offence to give or receive payment for an organ in the UK, and every living donation requires Human Tissue Authority approval following an Independent Assessor interview. Living donor liver transplantation is performed at a small number of NHS-designated centres, mainly for paediatric recipients. What private assessment buys is speed and completeness before referral.
The problem
A planned graft, at a known date - but only for the right patient.
Living donation removes the waiting list from the equation, which matters enormously for a child with biliary atresia or an adult whose disease is outpacing the list. What it introduces is risk to a healthy person, and that changes every calculation.
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A child needing a transplant?
Paediatric living donation is well established in the UK, usually a parent giving the left lateral segment, with excellent outcomes.
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Deteriorating faster than the list?
Where waiting-list mortality is high, a planned living-donor graft can be the difference. Few UK adults meet the criteria, but some do.
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Worried about the risk to your donor?
Donor mortality is roughly 1 in 200 to 1 in 500 for a right lobe, far higher than kidney donation. That figure deserves to be stated first, not buried.
When it helps
When living donor liver transplant is considered.
The situations where living donation genuinely changes the outcome, the ones better served by the deceased-donor list, and the emergency presentation.
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Biliary atresia in a child
The commonest paediatric indication in the UK, usually after a failed Kasai portoenterostomy. A parent typically donates the left lateral segment.
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Paediatric metabolic liver disease
Urea cycle disorders, Crigler-Najjar, tyrosinaemia and similar conditions where a normal liver corrects the metabolic defect.
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Adult decompensated cirrhosis
Selected adults with a high UKELD and a deteriorating trajectory, where a planned graft avoids the risk of dying on the waiting list.
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Hepatocellular carcinoma within criteria
Where tumour progression risks exceeding listing criteria before a deceased-donor organ becomes available, a planned living graft can preserve the chance of cure.
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Small recipients and size mismatch
Small adults and older children are disadvantaged on the deceased-donor list. A partial graft from a living donor sidesteps the size problem.
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A willing, fit and fully informed relative
The donor must be healthy, of compatible blood group, with suitable vascular and biliary anatomy, and free of any pressure to donate.
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Rare blood group or long predicted wait
Where the predicted wait for a deceased-donor organ is long enough to threaten survival, living donation becomes a serious consideration.
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Red flag: confusion, bleeding, rapid jaundice
New confusion, vomiting blood, or rapidly deepening jaundice signals decompensation or acute liver failure - A&E immediately, not a clinic appointment.
Graft types
Which part of the liver is donated.
The graft options - and the recipient each one is sized for.
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Left lateral segment graft
Segments II and III, around 20 to 25 per cent of the donor liver. The standard graft for infants and small children, and the safest donor operation by a clear margin.
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Left lobe graft
Segments II, III and IV, roughly 30 to 40 per cent. Used for larger children and small adults, with meaningfully lower donor risk than a right lobe.
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Right lobe graft
Segments V to VIII, 55 to 65 per cent of the donor liver. Usually necessary for an adult recipient, and the operation that carries the highest donor risk.
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Donor liver regeneration
Not a graft type but the reason this works: both the donor remnant and the implanted graft regenerate to near-normal volume within six to twelve weeks.
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ABO-incompatible living donation
Possible in young children, whose immune systems tolerate blood group mismatch, and in adults with antibody removal protocols at specialist centres.
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Auxiliary partial graft
Part of the native liver is retained and a partial graft implanted alongside - used where the native liver may recover, as in some acute and metabolic presentations.
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Deceased-donor whole or split graft
The alternative route, and the one most UK adults take. Split grafts already allow one deceased donor liver to serve a child and an adult.
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Assessment and second opinion only
An honest review of whether transplantation is indicated, and whether living donation is realistic in your case. Frequently the answer is the deceased-donor list.
Safety and recovery
What it asks of the donor, honestly.
This is the only common operation in which a completely healthy person undergoes major surgery for someone else’s benefit. The donor risk is real, materially higher than kidney donation, and it belongs at the front of the conversation.
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Donor mortality is roughly 1 in 200 to 1 in 500
For a right lobe donation. Left lateral segment donation for a child is substantially safer, at around 1 in 1,000. These figures are central to consent, not a footnote to it.
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Donor complications affect 20 to 40 per cent
Bile leak, wound infection, incisional hernia, pleural effusion and prolonged pain are the common ones. Most resolve, but the donor recovery is a genuine operation.
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Small-for-size syndrome in the recipient
If the graft is too small for the recipient’s body mass, it can fail to cope. Graft-to-recipient weight ratio is calculated precisely before anyone commits.
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Biliary complications are the commonest late problem
Strictures and leaks at the bile duct anastomosis affect 15 to 30 per cent of living-donor recipients - higher than with whole grafts, because the duct is smaller.
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Vascular complications
Hepatic artery thrombosis and portal vein problems are uncommon but serious, and are a major reason living donation stays within high-volume specialist centres.
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Rejection and lifelong immunosuppression
The recipient needs tacrolimus-based immunosuppression for life, with the attendant risks of infection, kidney impairment, diabetes and skin cancer.
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The psychological weight on the donor
Independent psychological assessment is mandatory, partly to detect pressure to donate and partly because a poor recipient outcome affects donors profoundly.
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Donor consent must be free of any pressure
The Independent Assessor interviews the donor alone specifically to test this. A donor may withdraw at any point, for any reason, without explanation.
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Red flags after surgery
For either party: fever, jaundice, pale stools, dark urine, spreading abdominal pain or breathlessness - contact the transplant centre immediately, at any hour.
Reading your assessment letter
Your assessment letter in four parts. Read the last one first.
Whether you are the recipient, a parent, or the potential donor, the letter written after assessment keeps to the same shape.
A quiet reminder
Transplant language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the letter before your next appointment, just ask.
- 01 Header
Indication and urgency
The underlying liver disease, the recipient’s current scores and trajectory, and why living donation is being considered rather than the deceased-donor list.
- 02 Technique
Volumetry and anatomy
Graft and remnant volumes, graft-to-recipient weight ratio, the biliary anatomy on MRCP, and the vascular anatomy that determines whether donation is technically feasible.
- 03 Findings
Donor suitability and compatibility
Blood group compatibility, donor liver health and fat content, cardiac and respiratory fitness, and the independent psychological assessment outcome.
- 04 Impression
Plan, HTA approval and timing
Read this first: whether the donation can proceed, when the Independent Assessor interview happens, and the realistic timeline.
Recognised by major UK insurers
Solid organ transplantation is not covered by UK private medical insurance and is not sold privately - it is delivered exclusively through NHS-designated transplant centres. What insurers do routinely fund is the work that surrounds it: specialist consultations, imaging, cardiac and respiratory assessment and second opinions.
Frequently asked
Everything we get asked about living donor liver transplant.
Quick answers on donor risk, liver regeneration, why adult LDLT is rare in the UK, and how outcomes compare.
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Is living donor liver transplant available for adults in the UK?
It is possible but uncommon. UK living donor liver transplantation is well established for children - usually a parent donating the left lateral segment - and only a small number of adult-to-adult transplants are performed each year, at a handful of centres. Most UK adults are transplanted from the deceased-donor list, which functions well here.
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How much of the liver is donated?
It depends on the recipient. An infant or small child needs the left lateral segment, about 20 to 25 per cent of the donor liver. A larger child or small adult may need the left lobe, 30 to 40 per cent. A full-sized adult generally needs a right lobe of 55 to 65 per cent, which is why adult donation carries much greater risk.
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What is the actual risk to the donor?
For right lobe donation, mortality is estimated at roughly 1 in 200 to 1 in 500, and 20 to 40 per cent of donors experience a complication, most commonly bile leak, wound problems or incisional hernia. Left lateral segment donation for a child is far safer, at around 1 in 1,000. These figures are stated explicitly during consent.
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Does the donor’s liver really grow back?
Yes. Both the donor remnant and the implanted graft regenerate to near-normal volume within six to twelve weeks, with most of the growth in the first fortnight. The liver regenerates as a larger version of what remains rather than regrowing the specific segments removed, and function returns to normal.
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Can I pay a donor, or find one abroad?
Paying for an organ is a criminal offence under the Human Tissue Act 2004, and every UK living donation requires Human Tissue Authority approval after an Independent Assessor interview. Transplant tourism carries serious clinical and ethical risks, and UK centres will say so plainly. Donors are lawfully reimbursed for expenses and lost earnings only.
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How do outcomes compare with a deceased-donor liver?
Recipient survival is broadly comparable, and in some series living-donor recipients do slightly better because the graft is healthy and the operation is planned rather than urgent. The trade-off is a higher rate of biliary complications, at 15 to 30 per cent, and the risk borne by the donor.
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How long does recovery take for the donor?
Five to ten nights in hospital, then six to twelve weeks before returning to work, longer for physical jobs. Fatigue during liver regeneration is significant and consistently underestimated. Donors are followed with liver function tests and imaging through the first year.
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Who can be a liver donor?
A healthy adult, usually between 18 and 55, with a compatible blood group, no significant liver fat, suitable vascular and biliary anatomy on imaging, good cardiac and respiratory fitness, and a clear independent psychological assessment. A close relationship with the recipient is usual but not strictly required.
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Can the donor change their mind?
At any point, for any reason, without giving an explanation. The Independent Assessor interview exists partly to ensure the donor knows this and is under no pressure. Transplant centres routinely provide a discreet route to withdraw that does not expose the donor to family fallout.
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When should I go to A&E rather than book a clinic?
For the recipient before transplant: new confusion or drowsiness, vomiting blood, black stools or rapidly deepening jaundice. After surgery, for either donor or recipient: fever, jaundice, pale stools, spreading abdominal pain or breathlessness. All are same-day emergencies.
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