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A woman in her late 40s who donated part of her liver to her daughter last year has suffered liver failure and was receiving a transplant from another donor in an operation that started Monday, doctors at Kyoto University Hospital said.

The woman received the liver from a patient at Nagoya University Hospital, who is undergoing a transplant of part of a liver from another living donor, in a so-called domino organ transplant, the doctors said.

The operation was expected to end early Tuesday.

At the Kyoto hospital in August, the woman donated about 70 percent of her liver to her teenage daughter, who was critically ill with biliary atresia. While the daughter recovered, the woman’s liver functions deteriorated and she is now in critical condition, suffering from respiratory failure and infectious illnesses, they said.

Doctors had warned her of the difficulties of a donation, as she was suffering from a fatty liver as well as high blood pressure. However, she chose to go ahead with the procedure to save her daughter, they said.

The woman lost consciousness in December after contracting pneumonia, according to the doctors.

More than 2,000 liver donations from live donors have been carried out in Japan since the first in 1989, with some 900 taking place at Kyoto University Hospital. Although there have been cases where the recipient died or the donor suffered complications, this is the first report of a donor becoming ill to the point of requiring a transplant, experts said.

The hospital has been instrumental in spreading understanding about live donor transplants, which were initially met with skepticism because the process involved an operation on a healthy person. But experts said that the latest case may rekindle such concerns and prompt medical experts and health officials to review the practices and standards in carrying out these transplants.

The woman’s daughter first received a part of her father’s liver in an operation at the Kyoto hospital in 1994, but her condition worsened. She then received part of her mother’s liver in a second operation. Although surgeons planned to leave 37 percent of the mother’s liver intact, they ended up leaving only 30 percent.

Hospital director Koichi Tanaka explained that the complications were mainly due to the woman suffering from a fatty liver, as well as the small amount of liver she was left with.

The hospital’s ethics committee decided Monday to give the green light for the surgery as an emergency case, based on the principle of giving priority to a donor’s life.

The Nagoya University Hospital patient suffers from a liver metabolism disorder and will receive part of the liver of a healthy donor, the doctors said. The patient’s entire liver, which still functions, will be transplanted into the comatose woman.

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