mris are done to image the liver. in most cases, the work up is done in 2–3 weeks. complications living donor surgery is done at a major center. very few individuals require any blood transfusions during or after surgery. all potential donors should know there is a 0.5 to 1.0 percent chance of death. other risks of donating a liver include bleeding, infection, painful incision, possibility of blood clots and a prolonged recovery. the vast majority of donors enjoy complete and full recovery within 2–3 months. pediatric transplantation in children, due to their smaller abdominal cavity, there is only space for a partial segment of liver, usually the left lobe of the donor's liver. this is also known as a "split" liver transplant. there are four anastomoses required for a "split" liver transplant: hepaticojejunostomy (biliary drainage connecting to a roux limb of jejunum), portal venous anatomosis, hepatic arterial anastomosis, and inferior vena cava anastomosis. in children, living liver donor transplantation has become very accepted. the accessibility of adult parents who want to donate a piece of the liver for their children/infants has reduced the number of children who would have otherwise died waiting for a transplant. having a parent as a donor also has made it a lot easier for children – because both patients are in the same hospital and can help boost each other's morale. benefits there are several advantages of living liver donor transplantation over cadaveric donor transplantation, including: transplant can be done on an elective basis because the donor is readily available there are fewer possibilities for complications and death than there would be while waiting for a cadaveric organ donor because of donor shortages, unos has placed limits on cadaveric organ allocation to foreigners who seek medical help in the usa. with the availability of living donor transplantation, this will now allow foreigners a new opportunity to seek medical care in the usa. screening for donors living donor transplantation is a multidisciplinary approach. all living liver donors undergo medical evaluation. every hospital which performs transplants has dedicated nurses that provide specific information about the procedure and answer questions that families may have. during the evaluation process, confidentiality is assured on the potential donor. every effort is made to ensure that organ donation is not made by coercion from other family members. the transplant team provides both the donor and family thorough counseling and support which continues until full recovery is made. all donors are assessed medically to ensure that they can undergo the surgery. blood type of the donor and recipient must be compatible but not always identical. other things assessed prior to surgery include the anatomy of the donor liver. however, even with mild variations in blood vessels and bile duct, surgeons today are able to perform transplantation without problems. the most important criterion for a living liver donor is to be in excellent health. post-transplant immunosuppression like most other allografts, a liver transplant will be rejected by the recipient unless immunosuppressive drugs are used. the immunosuppressive regimens for all solid organ transplants are fairly similar, and a variety of agents are now available. most liver transplant recipients receive corticosteroids plus a calcineurin inhibitor such as tacrolimus or ciclosporin, (also spelled cyclosporine and cyclosporin) plus a purine antagonist such as mycophenolate mofetil. clinical outcome is better with tacrolimus than with ciclosporin during the first year of liver transplantation. if the patient has a co-morbidity such as active hepatitis b, high doses of hepatitis b immunoglubins are administrated in liver transplant patients. due to both the pharmacological immunosuppression and the immunosuppression of underlying liver disease, vaccinations against vaccination-preventable diseases are highly recommended before and after liver transplantation. vaccine hesitancy in transplant recipients is less than in the general population. liver transplantation is unique in that the risk of chronic rejection also decreases over time, although the great majority of recipients need to take immunosuppressive medication for the rest of their lives. it is possible to be slowly taken off anti rejection medication but only in certain cases. it is theorized that the liver may play a yet-unknown role in the maturation of certain cells pertaining to the immune system. there is at least one study by thomas e. starzl's team at the university of pittsburgh which consisted of bone marrow biopsies taken from such patients which demonstrate genotypic chimerism in the bone marrow of liver transplant recipients. recovery and outcomes the prognosis following liver transplant is variable, depending on overall health, technical success of the surgery, and the underlying disease process affecting the liver. there is no exact model to predict survival rates; those with transplant have a 58% chance of surviving 15 years. failure of the new liver (primary nonfunction in liver transplantation or pnf) occurs in 10% to 15% of all cases. these percentages are contributed to by many complications. early graft failure is probably due to preexisting disease of the donated organ. others include technical flaws during surgery such as revascularization that may lead to a nonfunctioning graft. history as with many experimental models used in early surgical research, the first attempts at liver transplantation were performed on dogs. the earliest published reports of canine liver transplantations were performed in 1954 by vittorio staudacher at opedale maggiore policlinico in milan, italy. this initial attempt varied significantly from contemporary techniques; for example, staudacher reported "arterialization" of the donor portal vein via the recipient hepatic artery, and use of cholecystostomy for biliary drainage. the first attempted human liver transplant was performed in 1963 by thomas starzl, although the pediatric patient died intraoperatively due to uncontrolled bleeding. multiple subsequent attempts by various surgeons remained unsuccessful until 1967, when starzl transplanted a 19-month-old girl with hepatoblastoma who was able to survive for over one year before dying of metastatic disease. despite the development of viable surgical techniques, liver transplantation remained experimental through the 1970s, with one year patient survival in the vicinity of 25%. the introduction of ciclosporin by sir roy calne, professor of surgery cambridge, markedly improved patient outcomes, and the 1980s saw recognition of liver transplantation as a standard clinical treatment for both adult and pediatric patients with appropriate indications. liver transplantation is now performed at over one hundred centers in the us, as well as numerous centres in europe and elsewhere. the limited supply of liver allografts from non-living donors relative to the number of potential recipients spurred the development of living donor liver transplantation. the first altruistic living liver donation in britain was performed in december 2012 in st james university hospital leeds. society and culture famous liver transplant recipients