Donor evaluation and hepatectomy for living-donor liver transplantation

In the past decade, considerable technical advances have been accomplished in living-donor liver transplantation (LDLT). The procedure has become accepted globally as a standard modality for the treatment of end-stage liver disease and hepatocellular carcinoma in both pediatric and adult populations. During the period of this procedure's development, however, tragedy has occurred. Serious morbidity and even mortality have been experienced and reported in live donors. The transplant community has been very much aware of its responsibilities toward live donor care, and much effort has been made to improve and secure the overall outcomes of donors. Unlike in deceased-donor liver transplantation (DDLT), opportunity or chance plays a lesser role in the availability of an organ for LDLT. Judgment calls are often made by individuals; therefore, the evaluation process includes social and ethical aspects not encountered among the usual indications for hepatobiliary surgical disease. Thus, the selection of live donors should be made from a wider perspective compared with that for conventional patient care. The approach to selecting live donors may vary slightly between the West, where a large number of DDLTs are performed daily, and the Far East, where they are much less frequent. However, the recognition that the transplant community has a responsibility to provide care to living donors is common. This review provides an overview of the current donor evaluation and surgical procedures involved in LDLT, with the recognition that an open and educated debate is key to ensuring public confidence and maintaining ethical standards in the field.