Adult-to-adult living donor liver transplantation: history, current practice, and implications for the future

More than 1600 Americans have received adult-to-adult living donor liver transplants. As the number of patients with end-stage liver disease is expected to grow significantly in the next 20 years due to hepatitis C infection, living donor liver transplantation has become a promising solution to the shortage of donor organs. The use of living donors provides organs in an environment of scarcity, allows patients to receive transplants when medically optimized, and produces liver segments with minimal ischemic damage. The donor complications most frequently cited in the medical literature include bile leaks and strictures, biloma, hepatic encephalopathy, wound infection, and pressure sores. In the wake of 2 donor deaths in the United States and subsequent media publicity, there have been new efforts by the transplant community to describe the risks and outcomes for donors, and establish safeguards to protect them from excessive pressure to donate.