Amateur Vigilante - Ch. 65 - Keeping In Mind

[MangaDex]

 

[Drakun_Auger]

The dumbass thug got an assassin to respect him.

 

[yuriloveisthebestlove]

i dont think you can survive without a liver in IRL.

 

[HelioCesar]

Damn, this series gives some pretty good points that i never thought about when dealing with the implications that some things that are common in most action series wouldn't really fly normally, of course it has some pretty whacky moments, like the Oshiro and Diddy fight.

 

[BalrogDeMorgoth]

Thanks for the chapter

 

[Kendama]

i dont think you can survive without a liver in IRL.

He hasn't donated the entire liver, just a chunk of it. The liver has some reserve function to spare even if part of it is lost.

Also, not sure whether the author doesn't know, or whether the assassin is deliberately making it sound worse than it is to rattle Anzai, but livers regrow: https://en.wikipedia.org/wiki/Liver_regeneration

 

[rckvnka]

He is going to die

Thanks a lot for the update

 

[sssr]

He hasn't donated the entire liver, just a chunk of it. The liver has some reserve function to spare even if part of it is lost.

Also, not sure whether the author doesn't know, or whether the assassin is deliberately making it sound worse than it is to rattle Anzai, but livers regrow: https://en.wikipedia.org/wiki/Liver_regeneration

No, the medical diagnosis is correct. The liver regrows but it needs time. Judging from the flashback Anzai probably sold his liver in the same year, and he should really be keeping up with the drainage regime for about two years before the gap is refilled. It's actually possible to fix the issue during the original donation process with simple surgery that's usually done two days after the removal (and first drainage), but that's probably off the table for him. The problem isn't the removal of the liver but the way they did it and the lack of medical care afterwards.

 

[Kendama]

No, the medical diagnosis is correct. The liver regrows but it needs time. Judging from the flashback Anzai probably sold his liver in the same year, and he should really be keeping up with the drainage regime for about two years before the gap is refilled. It's actually possible to fix the issue during the original donation process with simple surgery that's usually done two days after the removal (and first drainage), but that's probably off the table for him. The problem isn't the removal of the liver but the way they did it and the lack of medical care afterwards.

Oh, I didn't mean that the diagnosis is incorrect. What I mean is that it's probably not true that he only has two years left to live even if the cavity is drained.

And well, here's your friendly LLM to the rescue (since I'm not a specialist in liver surgery):


Short version: that manga scenario is very over-dramatic and medically inaccurate, mostly because the premise about “periodic drainage so the liver can regrow” is wrong.


Let me unpack this cleanly.

---

What actually happens after living liver donation​

1. There is no permanent “dead space” that needs routine drainage​

After a partial hepatectomy (donor surgery):

• The liver regenerates rapidly (hypertrophy of remaining hepatocytes, not stem-cell regrowth).
• This starts within days and reaches ~70–90% of original volume in 6–8 weeks.
• The abdominal cavity re-equilibrates naturally as organs shift and the liver expands.

So:

• There is no cavity that must be periodically drained
• Drainage is not a maintenance procedure

That idea alone makes the manga medically incorrect.

2. Drains, if placed, are temporary​

Surgical drains (e.g., Jackson-Pratt):

• Are usually placed prophylactically
• Stay in for a few days, sometimes up to 1–2 weeks
• Are removed once output decreases and is non-pathologic

They are never something a patient must keep draining weekly for months.

---

What can go wrong after donation?​

There are real complications — just not like that.

Possible post-op complications:​

• Biloma (bile leak)
• Seroma (sterile fluid)
• Hematoma
• Abscess (rare, usually early)
• Pleural effusion (right-sided)

Key point:

These usually declare themselves within days to a couple of weeks, not silently over a month.

And importantly:

• If discovered late, they are still treatable in most cases
• Percutaneous drainage + antibiotics works very well

---

“He didn’t drain it for a month and now it’s irreversible”​

This is where the manga really goes off the rails.

In reality:​

• A month without drainage would not doom someone
• Even a sizable abscess discovered late can often be:
  • Drained
  • Treated with antibiotics
  • Fully resolved

To get irreversible, fatal damage:

• You’d need untreated sepsis, massive bile peritonitis, or vascular injury
• The patient would be acutely ill, not just “showing symptoms” casually
• Survival would be measured in days to weeks, not “you’ll die in two years”

The “two-year death sentence” is pure fiction.

---

What about liver regeneration being blocked?​

Also wrong.

• Liver regeneration is not dependent on drainage
• It is driven by:
  • Portal flow
  • Hepatocyte growth factors
  • Cytokine signaling
• Even with complications, regeneration usually proceeds unless:
  • There is massive necrosis
  • Or liver failure (which would be immediately life-threatening)

---

How this could be made realistic (for fiction)​

If the author wanted realism, better options would be:

• Undetected bile duct injury → chronic cholangitis → secondary biliary cirrhosis (years-long decline)
• Severe post-op sepsis causing multi-organ damage
• Portal vein thrombosis leading to progressive liver failure
• Immunosuppression + abscess → delayed diagnosis → systemic complications

But not “you forgot to drain the cavity once a week.”

---

Bottom line​

• ❌ Routine post-donation drainage is not a real thing
• ❌ Missing drainage for a month would not make damage irreversible
• ❌ A delayed complication would not lead to a neat “two-year prognosis”
• ✅ The scenario is dramatically exaggerated and medically implausible

If you want, tell me the manga title — I’m happy to sanity-check other medical bits too.

 

[sssr]

Oh, I didn't mean that the diagnosis is incorrect. What I mean is that it's probably not true that he only has two years left to live even if the cavity is drained.

And well, here's your friendly LLM to the rescue (since I'm not a specialist in liver surgery):


Short version: that manga scenario is very over-dramatic and medically inaccurate, mostly because the premise about “periodic drainage so the liver can regrow” is wrong.


Let me unpack this cleanly.

---

What actually happens after living liver donation​

1. There is no permanent “dead space” that needs routine drainage​

After a partial hepatectomy (donor surgery):

• The liver regenerates rapidly (hypertrophy of remaining hepatocytes, not stem-cell regrowth).
• This starts within days and reaches ~70–90% of original volume in 6–8 weeks.
• The abdominal cavity re-equilibrates naturally as organs shift and the liver expands.

So:

• There is no cavity that must be periodically drained
• Drainage is not a maintenance procedure

That idea alone makes the manga medically incorrect.

2. Drains, if placed, are temporary​

Surgical drains (e.g., Jackson-Pratt):

• Are usually placed prophylactically
• Stay in for a few days, sometimes up to 1–2 weeks
• Are removed once output decreases and is non-pathologic

They are never something a patient must keep draining weekly for months.

---

What can go wrong after donation?​

There are real complications — just not like that.

Possible post-op complications:​

• Biloma (bile leak)
• Seroma (sterile fluid)
• Hematoma
• Abscess (rare, usually early)
• Pleural effusion (right-sided)

Key point:


And importantly:

• If discovered late, they are still treatable in most cases
• Percutaneous drainage + antibiotics works very well

---

“He didn’t drain it for a month and now it’s irreversible”​

This is where the manga really goes off the rails.

In reality:​

• A month without drainage would not doom someone
• Even a sizable abscess discovered late can often be:
  • Drained
  • Treated with antibiotics
  • Fully resolved

To get irreversible, fatal damage:

• You’d need untreated sepsis, massive bile peritonitis, or vascular injury
• The patient would be acutely ill, not just “showing symptoms” casually
• Survival would be measured in days to weeks, not “you’ll die in two years”

The “two-year death sentence” is pure fiction.

---

What about liver regeneration being blocked?​

Also wrong.

• Liver regeneration is not dependent on drainage
• It is driven by:
  • Portal flow
  • Hepatocyte growth factors
  • Cytokine signaling
• Even with complications, regeneration usually proceeds unless:
  • There is massive necrosis
  • Or liver failure (which would be immediately life-threatening)

---

How this could be made realistic (for fiction)​

If the author wanted realism, better options would be:

• Undetected bile duct injury → chronic cholangitis → secondary biliary cirrhosis (years-long decline)
• Severe post-op sepsis causing multi-organ damage
• Portal vein thrombosis leading to progressive liver failure
• Immunosuppression + abscess → delayed diagnosis → systemic complications

But not “you forgot to drain the cavity once a week.”

---

Bottom line​

• ❌ Routine post-donation drainage is not a real thing
• ❌ Missing drainage for a month would not make damage irreversible
• ❌ A delayed complication would not lead to a neat “two-year prognosis”
• ✅ The scenario is dramatically exaggerated and medically implausible

If you want, tell me the manga title — I’m happy to sanity-check other medical bits too.

No, the LLM is incorrect. It's talking about the situation of a normal liver donation that's done in a proper hospital. This isn't what usually happens in illegal liver "donation". I live in Indonesia where this kind of illegal organ trafficking is common, and both my parents are doctors who used to see the aftereffect of this procedure (and my mom's a pediatrician, so kids also become victims regularly).

In this case, what usually happens is that the liver is literally just hacked off on one end and no immunosuppressant is provided to the victim. The reason for this is complicated, but it's generally because in these cases there is no prepared recipient for the organ before surgery, so instead of removing one lobe cleanly, the hack-doctor just cuts off half the liver including BOTH lobes (so the removed liver can be transplanted twice). This causes immediate injury in the cut-off area and partial scarring (cirrhosis) at the surface. Bile leak and abscess can also happen depending on how hacky the hack-doctor is. The regrowth of the liver takes more than a year instead of the 6-8 weeks in a normal donation because the cirrhosis at the cut-off surface prevents direct outwards regrowth and forces the liver to regrow from the inside. There is a gap that is immediately filled with pus because the body is trying to repair the damage, and this is usually drained in about two days after the procedure (Jackson-Pratt). However, what needs to be drained regularly isn't this gap. That's where the manga makes a mistake.

What actually happens is that you end up with a guy with half (or less) of a liver, and that with cirrhosis, who needs more time than normal to regrow the liver, so it's the exact same condition as someone with partial liver failure. Therefore, peritoneal dialysis is usually prescribed for the victim. That's the regular drainage that they need to go through, not draining the gap caused by removal of the liver. Unlike in the case of kidney failure where PD is done several times a day, in this case PD can be done every few weeks. The symptoms described are "correct" in that they're some of the symptoms of someone who'd missed several PD sessions. The dramatization is in the claim that Anzai might drop dead in two years if he misses the next PD session. That isn't true. He will either drop dead right away or get a late PD session and get better.

Also, for PD usually there would be a drainage tube implanted in the abdomen to make things easier for everyone. Instead of having to cut a hole every time, you just connect the saline solution to one end of a T-junction and the drainage hose to the other. So Anzai would in reality be walking around with a tube sticking out of his belly.

The recipient of the liver transplant will probably have the exact same problem depending on how bad their liver failure is, especially since they'll receive only one lobe and it'll be a partial lobe instead of a full one, but if they can buy liver in the black market, they can probably afford proper dialysis for two years.

RANT:
I usually don't comment like this for a manga, but for some reason this subject matter is triggering an emotional reaction because I'm making this after watching a YT video about the organ trafficking in the Epstein files. See, you people in the West don't understand just how common the kind of shit described in the Epstein leaks actually is and what I find sickening is the supposed outrage at "finding out" about them "just now". NO! That shit has been going on for years, and look at me! I'm just a family member of doctors who isn't in the medical industry at all, and I KNOW ABOUT IT. I even know how this shit works from people who see it happen regularly enough to be able to joke about it in front of their kids at the dinner table. That's how desensitized people have become where I'm at. I'm over 40. That dinner table conversation was when I was in junior high. I found out about the PD treatment when I was in fucking high school. That's how long and how common this kind of shit has been going on, and Westerners have been the buyers for countless millions of these organs for all that long. NOW you think the Epstein files are exposing something special? REALLY? FUCK YOU!!! You fuckers only claim that to score political points.

My sister works in the US as a nurse and she used to work in an elderly care home for rich retirees in Cali. In a weird twist she found out that some of the people in the home were recipients of trafficked organs. She found this really funny and told us about it when she came back to visit. We agreed and thought about how some rich Jewess in Cali might have the organs of that kid mom treated back in '99. LOL.

 

[Kendama]

@sssr

I did consider the possibility that this was a quack transplant. I still think that Japan would have "better quack doctors", since the clients are probably even higher-profile than the examples you gave seeing as they can get a donor of a top advanced country. Then again, I didn't consider the possibility that Anzai travelled to an undeveloped country under the auspices of the yakuza to get his liver removed in the way you describe.

Your reply explained a lot of things to me, and I can't even imagine having this conversation at dinner table in high school. I do know liver physiology (I teach Biochemistry), so indeed the jaundice is correct. Blood thinning isn't by anaemia, it's from loss of albumin production. And dialysis becomes necessary as you said, to clear bilirubin and ammonia from the body.

By the way, I'm also from an undeveloped country, though in LatAm I think organ trafficking isn't as prevalent as in SEA/Oceania. So yeah, Epstein is no news to me. It's only a shock in the developed countries because it has hit too close to home, which does compound on the hypocrisy of it all.

 

[n3na3]

this is a really informative forum