Donor Selection and Examination

LDLT poses many questions regarding the ethical justification to place a healthy donor at risk. The complexity of these operations in the donor can lead to potential complications, such as bile leaks, bleeding, need for reexploration, pulmonary embolus, and death. The risk of death is estimated to be approximately 0.4 to 0.6%. In the United States, there have been 3 reported donor deaths (0.26%). Of these, 2 were early in the postoperative period and one at 2 years postdonation secondary to suicide. In addition, two donors were placed on the liver transplantation waiting list after undergoing a donor hepatectomy. Of these, one underwent a liver transplantation and the other improved while waiting for a liver and did not require a liver transplantation.

The true incidence of complications after undergoing a living donor hepatectomy is unclear because, until recently, there was no uniform and compulsory submission of complications to a registry. In November 2003, UNOS, which holds the contract from the federal government to administer the Organ Procurement and Transplant Network, established a live donor registry, which will be operational by March 2004. It is estimated that donor complications can range between 10 to 20%. A right hepatectomy for living donation has a higher rate of complications compared to a left lateral segmentec-tomy. The potential donors are thoroughly examined by a multidisciplinary team consisting of liver transplantation surgeons, hepatologists, social workers, psychologists, and hepatobiliary radiologists. In our institution, the living donor liver evaluation is carried out in the following three stages:

1. Preliminary screening

2. Medical and psychosocial evaluation

3. Graft evaluation

In the evaluation of the graft, before entering into the anatomical details of the liver, it is of paramount importance to determine the adequacy of the hepatic volume to be transplanted. This volume is estimated by computed tomography scan or magnetic resonance imaging using the following two formulae:

1. The graft-to-recipient body weight ratio (GRBW)

2. Graft weight as a percentage of the standard liver volume. It is considered acceptable for transplantation GRBW > 0.8% and > 40% of standard liver volume. However, in recipients with significant medical decompensation, the minimal calculated donor volume may not be sufficient.

The hepatic vasculature (hepatic artery, portal vein, and hepatic veins) and the biliary system should be evaluated in detail. The need for a liver biopsy on donor tissue is controversial.

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