Living donor liver transplantation: Donor selection, evaluation, and surgical complications

Abstract

The technique and practice of living donor liver transplantation have undergone major changes recently as a result of the extension of its application to adult recipients. The issues of defining the optimum graft size for donor and recipient safety; the technical details of a more extensive donor operation with the associated risks; and the ethics of nonparental, or even unrelated, donors for adult recipients; have added to the controversies of selection, evaluation, and protection of the living liver donor. Donor safety must always be the primary consideration, and the evaluation of the living donor should continue to be refined. With a wider practice of this operation from a few experienced centers to more programs with less experience in hepatic resection, a wave of dreaded complications may ensue. There is good reason to be concerned with the underreporting of donor morbidity and mortality. Until mutual sharing of positive and negative results can be ensured, the information as reported in the literature should be analyzed with caution.