Incidence of Death in Living Liver Donors
The incidence of death in living liver donors is approximately 0.18% according to the European Liver Transplant Registry, though this figure may be under-reported 1.
Mortality Risk Data
The mortality risk for living liver donors varies slightly across different studies:
- The European Liver Transplant Registry (ELTR) data indicates a donor mortality rate of 0.18% based on analysis of 3,622 living donor liver transplantations performed between 1991-2009 1
- A worldwide survey of 71 transplant programs representing 11,553 donor hepatectomies found a donor mortality rate of 0.2%, with most deaths occurring within 60 days of donation 2
- A recent meta-analysis of 60,829 living liver donors reported a lower overall incidence of donor mortality at 0.06% 3
Morbidity Associated with Living Liver Donation
Beyond mortality, living liver donors face significant morbidity risks:
- Approximately 38% of donors experience some form of complication 1
- The overall pooled incidence of complications is 24.7%, with 17.3% being minor and 5.5% being major complications 3
- Biliary complications are the most common surgical complication, occurring in approximately 9% of donors 4
- Right lobe donors have significantly higher complication rates compared to left lobe donors 1
Types of Complications
The most common complications by category include:
- Psychological complications: 7.6% 3
- Wound-related complications: 5.2% 3
- Respiratory complications: 4.9% 3
- Cardiovascular complications: 0.8% 3
Long-term Outcomes
Recent research suggests potential long-term consequences for living liver donors:
- A Korean study found that living liver donors had worse outcomes compared to matched healthy controls, with a mortality rate ratio of 2.03 and higher incidences of liver failure, depression, cancer, diabetes, hypertension, and other conditions 5
- Some donors experience persistent laboratory abnormalities, such as suppressed platelet counts that can last for years after donation 4
Risk Factors and Considerations
Several factors influence donor risk:
- Program experience affects the incidence of near-miss events and aborted hepatectomies, with these being more common in low-volume centers (≤50 LDLT procedures) 2
- The type of liver segment donated impacts risk, with right lobe donation carrying higher morbidity than left lobe donation 1, 6
Clinical Implications
When considering living liver donation:
- Donor safety must be carefully weighed against recipient benefit, following the double equipoise principle 6
- Comprehensive donor evaluation and selection processes are essential to improve donor safety 5
- Transplant centers should have protocols in place for managing potential donor deaths, as studies in crisis management indicate this is crucial for both responding to and preventing catastrophic events 7
Living donor liver transplantation remains an important option to address organ shortage, particularly in regions with limited deceased donor programs. However, the mortality risk, though relatively low, is real and must be thoroughly discussed during the informed consent process with any potential living liver donor.