Mr Charles Imber provides an insight into his work with the liver transplant team at the Royal Free Hospital…

It’s 45 years since the first liver transplant was done in the UK and, today, around 650 such operations are carried out in British liver transplant centres each year. Mr Charles Imber, one of the lead surgeons in the liver implant team at the Royal Free Hospital in London, describes what it’s like to be responsible for regular liver transplants.

“I am part of a large team of other surgeons and health professionals who work together to implant a suitable liver into a patient on the recipient waiting list. We are on call one week in four and can perform a transplant for several different patients during that time.”

CT imaging of the liver of a potential donor

Planning and preparation

The on-call liver transplant team receives several offers of potentially suitable livers each day. These are organs from people who have been declared either brain stem dead or whose heart has stopped beating. The donor liver is transplanted into the recipient ideally within 12 hours for the operation to have the best chance of success, so liver transplant operations are always emergencies.

“The situation is very difficult for the relatives and family of the donor, who need to give their consent to the liver being used in this way. Even if someone carries a donor card and is on the organ donor register in the UK, we still need to obtain permission from the next-of-kin, at a very emotional time. It is also a highly stressful time for the recipient. After months of waiting, sometimes while they are very ill in intensive care, the good news that a liver may be available is tempered by the possibility that the liver will not turn out to be suitable.”

To be approved for use in a transplant, the liver from the donor must be in good condition and the donor must not have any underlying health conditions that affect their liver. The organ must also be a good match in terms of blood group and other factors, to reduce the risk of organ rejection.

“We end up being able to use only a proportion of the livers offered, and, very sadly, patients do end up dying while waiting for a suitable liver. It is good that the incidence of fatal strokes is decreasing and that fewer people are dying in car accidents – but we need to do more to encourage more people to think about organ donation and to discuss their wishes with their families so that organs can be used if the worst happens.”

Implantation of the liver

The actual surgery to implant a liver takes place at the liver centre where the recipient has been cared for. The liver is transported and as it is moving across the country, the patient is prepared for their operation.

“The implant surgery is usually complex and can take between 5 and 15 hours. The patient then needs to be in intensive care but survival times are increasing all the time. Around four in five people having a liver transplant in 2013 will live for five years.”

Living liver donors

Although most liver transplants involve using the liver from someone who has recently died, there is an alternative. It is possible to transplant part of the liver from a health donor, usually a relative of the patient needing the liver.

“Although this type of liver transplant is still urgent, it is not done as an emergency. The donor and the recipient need to think through the idea carefully and to be sure that this is what they want to do. Removing part of a healthy liver carries a risk to an otherwise healthy donor. There is some debate in the UK about whether it is ethical to expose a healthy person to this risk, even if they agree and want to do it. We certainly only carry out this type of liver transplant after potential donors have been evaluated in detail, both physically and psychologically.”

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