Living donor liver transplantation in adults

The scarcity of cadaveric organs has promoted the introduction of liver transplantation from living donors initially in paediatric patients and consecutively in adults. Living donor liver transplantation enables the surgery to be scheduled when medically indicated, provides an optimal liver graft with short ischaemia, and lowers the waiting list mortality. The procedure opens a new donor pool not only for patients with ‘standard’ end-stage liver disease but also for those with borderline indications for transplantation. Selection of appropriate donors and recipients is the key to a positive outcome of the operation. The success and acceptance of live organ donation depend upon the ability to keep donor morbidity and mortality at minimal levels. Adult-to-adult living donor liver transplantation (LDLT) using right hemi-liver has become a promising treatment modality for patients with end-stage liver disease. The rapid adoption of the procedure has been triggered mainly by the significant gap between available cadaver grafts and the number of patients on the waiting list for liver transplant. Since the arguments against LDLT focus only on the safety of the donor, the demonstration that the donor operation can be performed with minimal morbidity will make it more ethically acceptable. The advantages of LDLT are the possibility of performing an elective operation, access to a graft in best condition, and the possibility of lowering the likelihood of death while waiting for a suitable organ. As well as the standard indications for liver transplantation, LDLT opens up the possibility of treatment of patients with borderline indications. Further improvement of surgical and medical technology, careful long-term follow-up of donors and recipients, and profound analysis of socioeconomic aspects are essential issues for the transplantation community.