WEDNESDAY, Nov. 9, 2011 — Joe Frazier, the former heavyweight champion perhaps best known for beating Muhammad Ali in 1971’s “Fight of the Century” and then battling him again in 1975’s epic “Thrilla in Manila,” died Monday after a short bout with liver cancer. He was 67.

Frazier, nicknamed “Smokin’ Joe,” was diagnosed with the disease just over a month ago and entered hospice care sometime last week. In the days after news broke of his condition, fans rallied to show their support for the ex-boxer, with some even offering to donate a portion of their livers to help, according to USA Today.

Living donor liver transplants (LDLT), in which a living person donates part of his liver to someone in need, were first performed in the 1980s on children as a way to bypass the long wait times for livers from deceased donors, which can be anywhere from a few weeks to a several years. Since then, the procedure has been carried out successfully in adults, too, though less frequently and with greater risk of complications. Still, it’s a lifesaving option for many patients. And unlike with kidney transplants, liver donors only have to give up a part of the organ, because the liver has the ability to regenerate itself over time. A halved liver, for example, can be back to full size and function within just eight weeks.

The Benefits of Living Donor Liver Transplants

There are currently more than 17,000 people in the United States who are waiting for a liver due to failure of the organ because of cancer, hepatitis, acetaminophen overdose, or another type of infection. Nearly 10 percent of those people will die waiting, according to the American Society of Transplantation (AST). Living donor liver transplants can shorten wait times and save lives by offering partial organs to eligible recipients who might otherwise have to spend years on the transplant list, hoping to receive a liver from someone who passes away.

Additionally, living donation makes it possible to schedule the procedure in advance and at a convenient time for both the recipient and the donor. Using cadaveric organs from deceased donors can be tricky in terms of timing, because transplant candidates must be ready at a moment’s notice to go into surgery. This means also that the liver is without blood for a longer period of time while the patient is being prepped — sometimes hours, as opposed to just minutes with living donors. During this time, the cadaveric organ is typically stored on ice, which both preserves the liver and damages some of the tissue.

Another advantage of live transplants is the rate of successful implantation. For one thing, living donors are often younger adults and have been thoroughly screened for any health problems that might complicate the transplant, so the quality of the liver may be better, according to the AST. Second, since living donors are often family members of the recipient, their organs are often a better genetic match, which helps lower the risk of rejection.

Who Can Become a Donor?

Many living donors, according to the United Network of Organ Sharing (UNOS), are directly related to the transplant candidate, but sharing DNA with the patient is not a requirement for donating a liver. Donors may be friends, spouses, even strangers — basically, anyone over 18 who passes the physical exam and is a match for the patient’s needs. In general, liver donors must be in good health, with no major medical or mental conditions; have a compatible blood type and similar body size to the patient; and be able and willing to follow instructions and undergo blood work, radiology studies, and biopsies.

Donors are required to submit to full medical evaluations both before and after transplant surgery. During the pre-operation workup, a transplant team would test liver and kidney function, measure blood and platelet counts, and screen for viruses and signs of liver disease. Donors would also have an ultrasound, MRI, or CT scan to check for tumors and make sure their liver was a good fit for the recipient, followed by a chest X-ray and EKG to rule out heart or lung problems that could pose problems in the operating room. In some cases, a liver biopsy might also be warranted.

After the physical exam, a social worker or psychiatrist would discuss the donor’s reasons for sharing their liver. Liver transplants, though generally safe, do carry some risk of complications, so it’s important that donors know and feel comfortable with what they’re getting into. A strong support system to help through the recovery is essential. And ideally, you would also have an emotional tie to the recipient to motivate you throughout the process.

What Happens During and After Donor Surgery?

Once someone has been approved as a donor, they would work with the transplant team and recipient to schedule a time for the surgery. Keep in mind that donors would be unable to work for at least a month after the procedure.

On the day of the transplant, separate teams would operate simultaneously on both the donor and the recipient: As the recipient’s liver gets removed, the donor’s would be split approximately in half. One part would be taken out to be given to the recipient; the other left to heal and grow new tissue, which typically takes six to eight weeks. The operation to remove the liver from the donor takes around five hours, about half as long as the actual transplant operation.

After surgery, the donor would be kept in the hospital for anywhere from four to seven days — or longer, if there are complications. Doctors and nurses monitor vitals and help patients get back on their feet as soon as they’re able, which, for most patients, is on the second or third day after the procedure, according to the University of Southern California Department of Surgery. Even after the donor is released, however, it may take as long as eight weeks to fully recover, during which time they would be required to take off work and return to the doctor’s office or hospital for frequent checkups.

Risks of live liver transplantation in donors are considered low, but in rare cases, complications may occur during or even years after surgery. They include wound infections, adverse reactions to anesthesia, hernia, abdominal bleeding, bile leakage, intestinal problems, organ impairment or failure, and even death. These problems are rare, however, and may be linked to other underlying health conditions. According to the AST, a donor’s risk of dying from transplant surgery is about 1 in 500 — whereas a recipient’s risk of dying while waiting for transplant surgery may be as high as 1 in 10.

Could a Transplant Have Saved Joe Frazier?

Judging by how quickly Joe Frazier’s cancer metastasized, or spread to other parts of his body, it’s not likely he would have been a good candidate for live donor liver transplantation. Still, the gesture from his fans is a generous one and sheds light on an aspect of organ donation that isn’t widely known, but could have profound effects for future liver disease patients.