Nineteen donor deaths following living donor liver transplantation: review of the worldwide experience

Abstract

Background: The risk of death after donor hepatectomy for living donor liver transplantation (LDLT) is unknown, because of the lack of a sufficient database to accurately determine the rate of this infrequent, but devastating outcome. In the absence of an accurate estimate of donor death, the medical literature contains anecdotal reports of donor deaths which in some cases are based on verbal reports, circularly references or unsubstantiated data. Because donor death is one of the most important outcomes of LDLT, we performed a comprehensive survey of the medical and lay literature to provide a better estimate of the total number of worldwide donor deaths. Methods: We reviewed all published articles from PubMed which reported donor outcomes from 1989 to February 2006 and the lay literature (using Google.com and www.refdesk.com/paper.html). We classified each death as “definitely,” “possible” or “unlikely” related to donor surgery. Results: There were 19 documented donor deaths and 1 donor in a chronic vegetative state (2 years after surgery), as shown in the Table. Thirteen and one additional vegetative donor were “definitely”, 2 were “possibly” and 4 were “unlikely” related to donor surgery. The estimated total number of LDLT’s performed worldwide is 7087. The estimated rate of donor death “definitely” related to donor surgery is 13/7087 or 0.18 % and the rate of donor death which is “definitely” (13 patients) or “possibly” (2 patients) related to the donor surgery is 15/7087or 0.21%. The most common cause of “definite” deaths was sepsis (5), liver failure (2), unknown (2), MI, CVA, pulmonary embolus and peptic ulcer (1 each) which occured at a (median/mean) 11/38 days after surgery. Conclusions: This analysis provides: 1) a source document of all identifiable living liver donor deaths, 2) a better estimate of donor death rate and 3) an impetus for centers with unreported deaths to submit these outcomes to the liver transplantation community.