Standardized evaluation protocols for deceased and living liver donors: a practical framework for emerging liver...

Area of Science:

• Hepatology and Transplant Surgery
• Organ Donation and Transplantation Science

Background:

• Liver transplantation (LT) is crucial for end-stage liver disease, but practices for deceased donor LT (DDLT) and living donor LT (LDLT) vary globally.
• Infrastructure, policy, and clinical practice disparities impact DDLT and LDLT implementation, especially in developing programs.

Purpose of the Study:

• To synthesize current guidelines and expert consensus on donor evaluation for LT.
• To present a standardized, evidence-based framework for both DDLT and LDLT donor assessment.
• To promote reproducible protocols aligned with international standards for improved consistency and quality assurance.

Main Methods:

• A narrative review approach was employed.
• Contemporary guidelines, expert consensus documents, and high-impact clinical studies on donor evaluation were synthesized.
• A framework integrating medical, radiologic, ethical, and psychosocial domains was developed.

Main Results:

• Optimal DDLT requires effective donor management, accurate death determination, and thorough infectious disease screening.
• LDLT necessitates rigorous psychosocial and anatomical assessments for donor safety.
• Innovations like machine perfusion and expanded donor criteria enhance outcomes and transplant accessibility.

Conclusions:

• This review proposes a practical, harmonized approach to LT donor evaluation across diverse healthcare systems.
• Adoption of this framework can improve donor safety and optimize graft utilization.
• The framework supports the sustainable growth of DDLT and LDLT programs globally.