Practical considerations of right lobe living donor liver transplantation in adults

The practice of living donor liver transplantation in adults has developed rapidly over the past five years and brings with it a set of unique technical and ethical challenges. The evaluation of potential donors focuses on their health and motives, and the results of noninvasive imaging, with the objective of ensuring the best outcomes for both donors and recipients. Graft volume is critical to success, and venous outflow reconstruction is paramount, although there is no consensus on the preferred method. Biliary tract complications occur in 30% of recipients. Complications that may interfere with recovery or delay the return to well-being occur in one of every four or five donors. The precise risk of donor death cannot be stated with certainty because comprehensive data on all cases are not available. It is clear, however, that donation of the right lobe of the liver carries with it a much greater risk of mortality than kidney donation. The paucity of details reported on donors who have died make it impossible to determine to what extent the deaths were preventable. The option of living donation is an invitation to expand the criteria for recipient selection to include, for example, patients with tumours that exceed traditional transplant guidelines. The risk-benefit ratios for donors become especially problematic when post-transplant recipient survival is below current standards.