When an individual is considering donating a part of their liver, it is no exaggeration to say this may be lifesaving.  In pediatric hepatology, live donor liver transplantation (LDLT) is frequently considered by desperate parents. The risk of this gift has been poorly understood due to a lack of a LDLT registry.

This month (Gastroenterology 2012; 142: 273-80) better data has emerged.  By combining information from UNOS and the Social Security Death Master File, the authors were able to follow 4111 LDLTs (donors) in the U.S. between 1994 and 2011. Key findings:

• Seven early deaths (1.7 per 1000)
• Death rate was not affected by portion of liver donated
• 11 early catastrophic events: early deaths or acute liver failure (2.9 per 1000)
• Long term mortality was similar to that for live kidney donors and NHANES III healthy participants over 11 year followup (1.2%, 1.2%, and 1.4% respectively)

Although these data are somewhat reassuring, there is a definite increase in mortality and morbidity among LDLT donors.  An editorial in the same issue (pg 207-09) states that LDLT donors are probably healthier than the general population; up to 65% of donor candidates are rejected during the evaluation process.  As such, when survival at 11 years is similar to NHANES III participants, this indicates the likelihood of a detrimental effect on long-term health. Besides early perioperative deaths, suicide and drug overdoses among donors was significant (n=4) and 4% of donors may develop psychiatric problems.  Specific complications include biliary leaks (9%), bacterial infections (12%), and incisional hernias (6%).

At the same time, the direct benefit of this gift including the potential of saving a loved one cannot be measured.  In addition to avoid a protracted uncertain period on the waiting list for a recipient, a donated liver may help another unidentified individual obtain a deceased donated liver.

Additional references:

-Gastroenterology 2008; 135: 468. Donor morbidity/mortality. n=393. 62% without complications. 3 deaths and significant morbidity.
-Liver Transplantation 2006; 12: 499. Review.
-DDW 2003, T Tran, n=56. only 27% of prospective donors c nl histology.
-NEJM 2003; 348: 818-25. (L & R-Lobe) complications from donating in 449. 6% biliary complications, reop in 4.5%, death 0.2%
-NEJM 2002; 346: 1074-1082. & 1038. R lobe Tx.
-J Pediatr 1999; 134: 280.  Results of LDLT: 92% 1 yr survival; higher biliary complications 19-34%.