Anesthetic management of living transplantation

Living donor transplantation has helped to partially relieve the refractory shortage of deceased donor grafts. However, living related donation exposes healthy donors to a certain risk of morbidity and even mortality. Anesthetic management of elective live donation surgery with a relatively young and healthy patient is apparently simple; nonetheless, it requires both knowledge and diligence from the anesthesiologist. Some concerns persist regarding the appropriate intraoperative organ protection strategy and potential negative effects of certain surgical maneuvers on graft function. Even when careful attention is paid to maintaining intraoperative cardiorespiratory and metabolic homeostasis, preventing blood loss, preserving renal function, and assuring adequate postoperative analgesia, among other things, these procedures are not completely devoid of some major risks related to anesthesia and surgery. Maximal effort should be applied to minimize the perioperative risks for the donor, every minimal impending complication should be promptly recognized, and a timely treatment implemented. Some anesthetic considerations regarding the most frequently performed living organ transplantations are briefly reported in this article.