HN Summary

• A UHN feasibility study (PROPELLER) found that prehabilitation (prehab)—exercise, nutrition, and mental health support before surgery—can safely improve recovery for living liver donors. 

• Donors who participated felt better prepared and recovered faster, addressing both physical and psychological challenges commonly experienced after donation. 

• The program also encouraged lasting lifestyle changes and peer support, showing promise for broader adoption as standard donor care pending further research.

Matt Delorme never thought donating a piece of his liver would give him the tools to live a healthier life.

Through UHN’s prehabilitation (prehab) program — a service designed to optimize a patient’s health before surgery — Matt quit smoking, took up running and came out of the experience feeling stronger than ever.

He went back to daily activities in weeks. Within months, he was running 10 kilometres regularly.

“I didn’t even think it was possible,” says Matt, 52, who made the donation when he was 49. “I hadn’t exercised like that since I was a teenager. But there I was doing it.

“I don’t think I would have done it if it weren’t for prehab. That experience is really what triggered my mindset.”

Prehab helps patients recover after surgery by preparing them mentally and physically before their procedure. Clinicians work with patients to create a personalized plan that includes daily monitoring, physical conditioning, nutrition guidance and psychosocial support.

While UHN has offered prehab to organ recipients for years, it has never been researched in donors before.

In a recently published feasibility study, PRehab tO PreparE Living Liver Donors for Enhanced Recovery (PROPELLER): A Feasibility Randomized Controlled Trial, Drs. Daniel Sibley and Daniel Santa Mina set out to understand how prehab could benefit living liver donors, such as Matt, a participant in the research. 

Participants reported prehab physically and mentally prepared them for surgery and expedited their recovery. The study demonstrated prehab is a safe and potentially effective approach to reduce commonly experienced adverse outcomes in living liver donors.

“Some [earlier] studies have shown participants up to two years after their donation have not fully recovered physically to their pre donation abilities,” says Dr. Sibley, a kinesiologist and post-doctoral researcher at UHN.

Donors can also experience psychological disturbances such as anxiety, depression and sleep problems, he adds.

“Organ donation is such a selfless act. It does compel us to do as much as we can to preserve a donor’s well being,” says Dr. Santa Mina, co-director of the prehabilitation program.

“If prehab can, in even a small way, help them manage the stress of surgery — we should try to do that.”

Lifestyle changes for stronger liver donor recovery

Drs. Sibley and Santa Mina began their feasibility study, an early clinical trial to assess if prehab could be implemented in a donor’s care and how well they engaged with it, in 2023.

Through the study, Matt learned practical ways to exercise, underwent fitness testing, nutrition counselling and connected with a peer support advocate ahead of the procedure.

As someone who had been smoking for years, it motivated him to change his lifestyle.

“I had just assumed because I had smoked a bunch in my life and was in my late 40s that it was too late to do anything about it,” Matt explains.

“It was really reassuring to see that I was actually quite healthy and there was still time to carry on … because I was sort of giving up.”

Matt worked up to running three times a week only months after recovering. He also found the means to exercise in smaller, but still impactful ways.

“It opened up my mind to the concept that opportunities for exercise are everywhere,” he says.

“I can exercise anywhere, anyhow, anytime — I don’t have to go to a gym.”

Guidance for donors, from donors

Another key element of the study was the peer support advocate, Sonia Munoz, who used her lived experience as a donor to help others going through the same.

“I basically gave [participants] an idea of what happened to me, what I felt I lacked and what was helpful in going through the transplant process,” Sonia says.

Sonia spoke with Matt before his surgery, shared her story and answered the questions she remembers having on everything from recovery timelines to managing fear.

“When some of these things were happening afterwards, I thought, ‘Oh yeah, that’s normal,’ because I’ve talked to someone who went through it,” says Matt.

For example, one of the biggest barriers patients face in their recovery is difficulty using their abdominal muscles.

Sonia recommended that Matt strengthen his back in advance of surgery to offset that effect, enabling him to get up and move around properly on his own.

“I wish someone had told me that if I put more effort into strengthening my back, my recovery could have been easier,” says Sonia, who was a donor for her father in 2018.

“My dad was healthy … then he was sick. Then he had three months left to live,” she recalls. “It all happened so quickly.”

She says being a donor for a critically ill parent was a whirlwind. At the time, UHN didn’t offer a prehab program and Sonia navigated much of the process on her own.

“It’s a really great program, and I’m just grateful that people can now talk to someone whose been through it, because I definitely would have benefitted from that.”

Sonia has supported six donors to date and hopes to keep doing so.

The next phase of the study will assess how effective prehab is for a larger pool of donors before it can be implemented routinely at UHN.

“Living liver donors perform an incredible act of altruism,” says Dr. Sibley.

“They undergo a major surgery with no benefit to themselves, and they deserve to be protected.”

Shauna Mazenes works in communications at University Health Network.