Over Thirty Years of Living Liver Donation in North America

Objective: The objective of this study is to determine the incidence of death following living donor hepatectomy. Summary Background Data: Greater than 11,000 living donor hepatectomies have been performed in the United States (US) and Canada over the last three decades. Risk of donor death is unknown. Methods: All living liver donors in the US from 1989–2023 were identified within the Organ Procurement Transplantation Network (OPTN) database. Donor death was ascertained. Summary data for number of donors and deaths was collected directly from Canadian centers. US Centers with a death within 5-years of donation were surveyed to determine cause of death. Results: In the US, 9,400 donor hepatectomies were performed with 79 deaths (0.8%). In Canada 1,550 were performed with 4 deaths (0.3%). Median time from donation to death was 8.8 years (0 days to 24.5 years). Six deaths occurred perioperatively (<30 days), 2 postoperatively (30–90 days), 17 between 90 days to 5-years, and 53 beyond 5-years. Risk of perioperative/postoperative death decreased over time (0.19% to 0.02%) with no deaths since 2016. Causes of perioperative/postoperative death included cardiovascular arrest, liver failure, respiratory arrest, and infection. Causes of death between 90 days and 5-years included trauma, suicide, drug overdose, and cancer. Conclusion: Perioperative/postoperative death following living donor hepatectomy is rare in North America, with ~1 death per 5000 donors. Causes of death within 90 days were associated with hepatectomy but deaths beyond 90-days were not attributable to hepatectomy. Defining outcomes after living liver donation is vital for donor selection and counseling.