Who will benefit from living donor liver transplantation?
Over 12,000 patients are currently awaiting liver transplantation. Of these, approximately 10% will die while waiting for a cadaveric organ. Obviously, all patients who have fulfilled the selection criteria for liver transplantation will benefit from the procedure at an earlier stage in their disease. Those patients with hepatocellular carcinoma, sclerosing cholangitis or fulminant hepatic failure may derive additional benefits from early transplantation.

Is living donor liver transplantation better then receiving an organ from a recently deceased donor?
Although not enough adult living donor liver transplants have been performed to answer this question, it is believed that the living donor organ may be a better option for some patients for the following reasons.

• Patients receive their transplant on an elective basis when they are not hospitalized for hepatic decompensation. The elective nature of these procedures should lead to a reduction in morbidity and mortality.
• The cold ischemic time (time between taking the organ out and placing it into a recipient) is minimal.
• The liver is procured from a young healthy hemodynamically stable donor. The reduced cold ischemic time and the quality of the donor organ contribute to the success of the transplantation.
• A living organ donated from a family member theoretically provides an immunological advantage.

Am I a candidate for living donor liver transplantation?
Not all patients awaiting liver transplantation will be candidates for living donor liver transplantation. Below are some guidelines. These criteria are not absolute and each patient will be evaluated on an individual basis.

Recipient Inclusion Criteria

• Patients with stable end-stage liver disease eligible for transplantation by standard criteria for cadaveric donors. This includes all patients with a Child's-Pugh score of greater than 7. Patients with a Child's-Pugh score of less than 7 may be candidates if there is another reason for liver transplantation such as hepatocellular carcinoma.
• Age 18-60
• Recipient dry weight of less than 200 pounds
  * Negative T-cell crossmatch with the donor

Recipient Exclusion Criteria

• Recipients with a positive T-cell cross-match with the donor
• Pregnant or nursing females
• Patients with significant infections
• Significant pulmonary disease
• Re-transplants

Who can be a donor for a living liver transplant?
The donor has to be a family member or emotionally related friend of the family. Only healthy adults will be considered. The selection criteria are very strict and the potential donors will undergo an extensive series of tests to determine suitability for the procedure.

Donor Inclusion Criteria

• Age 18-55
• No current or prior history of heart, lung, or other medical problems
• No history of liver disease
• No history of malignancy
• ABO compatibility with the recipient
• If female and pre-menopausal, a negative pregnancy test
• Stable relationship with recipient

What are the risks of the procedure?
The most serious risk to the donor is death. The risk of death has been estimated from numerous studies involving over 2,000 living donor liver transplants in children and from studies on liver resection in adults. It is estimated that the risk of dying is 1 in 1,000. Other complications such as bile leaks or postoperative infections are usually minor and can be treated without further surgery. These complications occur in approximately 10-15% of donors.

The risks to the recipient are centered mainly around the adequacy of the liver tissue transplanted. Studies have shown that for a successful transplant, the recipient needs to receive at least 30% of their estimated liver volume. The Transplant Institute attempts to transplant at least 40% of the estimated liver volume of any given recipient.