In the vein of silent stasis: Weighing thrombotic risk in living liver donors

Thrombophilic states in the setting of living donor liver transplantation raise concerns regarding perioperative thromboembolism in the donor, as well as the potential transfer of inherited prothrombotic tendencies through mutated, hepatically synthesized coagulation factors. Screening practices for thrombophilia remain heterogeneous across centers and may result in donor exclusion based on local policies. However, accumulating evidence over the past decade suggests that most prospective donors are asymptomatic, and those with heterozygous inherited thrombophilias-such as Factor V Leiden or Prothrombin G20210A mutation-can safely undergo donation with standard perioperative thromboprophylaxis for the recipient and donors. These states are unlikely to be transmitted to the recipient, as extrahepatic synthesis of coagulation proteins contributes to maintaining hemostatic balance. In contrast, donors with a prior history of thromboembolism, high-risk genotypes (eg, homozygous or compound heterozygous states), or high-risk acquired thrombophilias should generally be excluded owing to an increased risk of thrombotic complications.