Problem of living liver donation in the absence of deceased liver transplantation program: Mansoura experience

Table 1 Living donor evaluation protocol

Potential donor: Is any living donor at our center after the recipient is informed of the accepted donor criteria. The criteria for living liver donors include an apparently healthy relative of the recipient aged between 21 and 45 years. Recipient, donor and their families are informed regarding the risks and benefits of right lobe hepatectomy for LDLT and both the donor and the recipient must sign an informed written consent to proceed to the evaluation process

Phase I: Confirmation of the relation between the living donor and the candidate recipient by the independent legal and ethical committee, confirmation of being within the accepted age limits, assessment of BMI, initial anesthetic and surgical evaluation, confirmation of ABO compatibility, complete blood count (CBC) and biochemistry assays, pregnancy test, abdominal Doppler ultrasound, serological tests for hepatitis C and B viruses (serum HCV RNA qualitative and quantitative assay using PCR, HBV surface antigen, HB core antibody, HB e antigen, HB e antibody, HB surface antibody), serological assessment for different viruses (human immunodeficiency virus (HIV), Epstein-Barr virus (EBV), Herpes virus I and II, Cytomegalovirus (CMV), Chagas disease and syphilis), electrocardiography (ECG), echocardiography, plain X-ray of the chest, exclusion of specific liver diseases (ferritin, transferrin, and serum iron), and reassessment after previous investigations

Phase II: Liver biopsy for assessment of degree of steatosis and detection of any pathological conditions

Phase III: Hepatic angiography to delineate the anatomy of the portal vein, hepatic artery and hepatic veins. Magnetic resonance cholangiopancreatography (MRCP) is performed to assess the anatomy of the biliary system. Liver volumetry to assess the right lobe graft size, residual donor liver volume and graft-recipient weight ratio (GRWR). The donor is accepted if GRWR > 0.8 and the residual donor liver volume ≥ 30%

Phase IV: All donors must sign a written informed consent including agreement to participate in LDLT

LDLT: Living donor liver transplantation.