Are transplant surgeons currently performing living donor liver transplantation using partial livers donated from family members?

Living Donor Liver Transplantation: Current Practice and Outcomes

Yes, transplant surgeons are currently performing living donor liver transplantation (LDLT) using partial livers donated from family members, with this practice being well-established worldwide but varying significantly by region. 1

Current Status of Living Donor Liver Transplantation

Living donor liver transplantation has evolved as a critical solution to organ shortage, with different adoption rates globally:

• Asian countries: LDLT is the primary transplant option due to limited deceased donor availability 1, 2
• Western countries: Practice is more limited, representing less than 5% of liver transplants in the US and Western Europe 1
• Technical approach: Uses either the right lobe (segments V-VIII) for adult recipients or left lateral segments (II-III) for pediatric recipients 1

Surgical Techniques and Considerations

The surgical approach depends on recipient age and size:

• For pediatric recipients:

  • Typically uses segments II and III from an adult donor 1
  • Has successfully reduced waiting list mortality for children 1

• For adult recipients:

  • Generally uses the donor's right liver lobe (segments V-VIII) 1
  • Requires meticulous surgical dissection of vascular and biliary structures 1
  • Minimum graft size must be at least 0.8% of recipient body weight to prevent graft failure 1, 2

Safety Considerations and Outcomes

LDLT carries important risks that must be carefully weighed:

• Donor safety concerns:

  • Donor morbidity affects approximately 38% of donors 1
  • Mortality risk is estimated at 0.18%, though this may be under-reported 1
  • Right lobe donation carries higher morbidity than left lobe donation 1

• Recipient outcomes:

  • Similar long-term outcomes to deceased donor transplantation when performed at experienced centers 1
  • Some studies suggest potentially higher recurrence rates in rapidly performed LDLT for malignancies like hepatocellular carcinoma 1

Ethical Considerations

The procedure raises important ethical considerations:

• Double equipoise principle: Balancing recipient survival benefit against donor risk 1
• Restriction to centers of excellence to minimize donor risk and maximize recipient outcomes 1
• Observation period of approximately 3 months may be beneficial before LDLT to assess tumor biology in malignancy cases 1

Regional Variations in Practice

The adoption of LDLT varies significantly by region due to cultural and systemic factors:

• Japan and other Asian countries: LDLT became the primary transplant option due to limited deceased donation programs 3
• Western countries: More reliance on deceased donation with LDLT as an adjunct option 1, 2

Conclusion

Living donor liver transplantation using partial livers from family members is an established practice worldwide, though with varying adoption rates. The procedure requires specialized expertise and careful consideration of both donor safety and recipient outcomes. When performed at experienced centers, outcomes are comparable to deceased donor transplantation.