Progression of living liver donation worldwide

Living donor liver transplantation (LDLT) has developed into a well tolerated and viable option when deceased donor transplantation is not available. Transplant and advanced hepatobiliary surgeons from around the world have performed living donor hepatectomies consistently for decades with acceptable donor outcomes. However, optimizing the preoperative workup, donor selection, operative technique, and perioperative care will improve these outcomes. This manuscript reviews recent worldwide literature for the living liver donor.

Overall, younger living donors produce better recipient outcomes but with careful selection donor over 55 years old may be used safely. Magnetic resonance is becoming the imaging of choice for living donor preoperative planning and its ability to predict steatosis may make predonation liver biopsy unnecessary. Programs with experience in LDLT and laparoscopic liver resection are making significant progress toward consistent use of the laparoscopic approach to living donor hepatectomy. Biliary, pulmonary, and infectious complications are the predictable complications with more serious complications and donor death being very rare. In a majority of cases, the donor's health-related quality of life and psychological well being are preserved.

These recent findings will allow us to better care for the living liver donor and enable LDLT continued progress.