Donor hepatectomy

BackgroundLiving donor liver transplantation (LDLT) is performed all over the world today. The shortage of cadaveric grafts makes it the only option for many end stage cirrhotics in many countries. Donor hepatectomy is a complicated operations and this has raised concerns about the safety of this operation. However, today donor hepatectomy is a safe operation with a low incidence of complications.HistoryFrom the first living donor transplant performed in Brazil it has grown into a highly successful operation performed in many centers. The amazing regenerative capacity of the liver allows us to perform this operation with a good degree of safety. While increasing the donor pool the quality of the graft is also better.Donor SelectionSelecting a donor for LDLT is a complex process with the aim of providing a graft that will benefit the recipient and at the same time not put the donor at risk. To be eligible the donor has to satisfy the donor criteria. Following this a potential donor has to undergo biochemical and radiological investigations that will assess the functional capacity of the liver and ensure a suitable anatomy.The OperationToday donor hepatectomy is a standardized operation performed with finesse is LDLT units. The complication rates are low and the success rates are high. The operation starts with a suitable incision and good exposure. The first step is a good cholangiogram. The liver is mobilized and the outflow is looped. The inflow vessels and isolated followed by parechymal transection.ComplicationsThough, there are reports of a high incidence of complications in the initial years of LDLT the incidence has decreased. The morbidity and mortality of this operations in high volume LDLT units is extremely low. The most common complication are bile leaks (−8%) with overall morbidity of 12–16%.Ethical DilemmaAs this is complex operation performed on a normal healthy adult there will always be questions about the ethics of this operation. However, the benefits to an end stage cirrhotic who has no chance of getting a cadaveric graft is unquestionable. The surgeon however has the responsibility to inform all donors and recipients of the potential risks of this operation.ConclusionDonor hepatectomy is a safe operations in high volume centers. It is a good option for end stage cirrhotics who find it difficult to get a cadaveric graft.