Patient and donor selection in living donor liver transplantation
Mohamed Rela, Ashwin Rammohan
Abstract
The impetus for the development of living donor liver transplantation (LDLT) has been the gross mismatch in the number of recipients to available deceased donor organs. Its complex ethical issues notwithstanding, LDLT remains a technically demanding procedure. However, since the turn of the millennium the operation has dramatically improved, rendering results on par with those of deceased donor liver transplantation (DDLT). In these surgeries, donor safety is of paramount importance as are recipient outcomes with preservation of liver graft function. The ultimate goals of LDLT are to achieve very low morbidity and near-zero mortality to the live donor, while providing a survival benefit to those who need it most. LDLT is comparable to other demanding procedures, where the commitment and experience of a team is intimately entwined with the development and results of the operation. Apart from technical excellence, selecting the best possible ‘transplant pair’ remains the sine-qua-non for good outcomes in LDLT. An “ideal LT survivor” is one with a stable first allograft function, normal growth, and absence of immunosuppression related complications, a goal which every clinician works towards. An algorithmic protocol-based multidisciplinary approach to donor and recipient selection is the first step in achieving this not-so-utopian goal. This review provides an overview of the donor and recipient selection criteria in LDLT.